health & science

Interim DHB boss’s uphill battle

The fill-in chief executive for Canterbury’s health board has a tough job ahead. David Williams explains why

Unprecedented blood-letting from the senior leadership team isn’t the only indicator all’s not well at the Canterbury District Health Board. It’s worth stepping back and letting circumstances tell part of the story.

With a showdown between the board and management leading to the resignation of long-time chief executive David Meates, as well as three others from the 11-strong executive team, recently, the place looked a shambles.

The board needed to right the ship – to send a signal to staff, the Ministry of Health and the public that it could recover, despite being dealt such a blow.

On Tuesday last week, board chair Sir John Hansen signalled to Newsroom an announcement about its interim management was likely before the end of the week. By Thursday, however, nothing had materialised.

That presented a slight problem, because on Friday, Association of Salaried Medical Specialists (ASMS) union members – senior doctors and dentists – were scheduled to meet. (About 30 people gathered at Manawa, a health research and education facility near Christchurch Hospital, while about 70 people joining the meeting via video link.)

It was the kind of meeting at which unsettled staffers would want to send a message to their bosses – and Crown monitor Lester Levy – that they disagreed with their approach of focusing so intently on the DHB’s financial deficit.

Surely, Hansen and the board would want a “clean” announcement – one that sent a stablising message about temporary management and would dominate the news cycle without being muddied by yet more bad news.

Early afternoon last Friday, Hansen told staff, and, soon after, media, it was appointing Dr Andrew Brant, the acting chief executive at Waitematā DHB, as acting boss of the Canterbury and West Coast DHBs. Brant isn’t available till early October, so Nelson Marlborough Health’s chief Dr Peter Bramley will sub in until he can get there. A global search is underway to find a replacement for Meates.

There are two things to note, here. The first is the acting chief executive doesn’t come from within Canterbury DHB’s existing leadership team. Newsroom understands it was offered to someone from the team but they turned it down – a slap in the face for the board, and its message of stability.

The other thing to note is the appointment comes from Waitematā, a health board that, until two years ago, was chaired by Crown monitor Levy. (Levy was also, for a time, chair of the Auckland and Counties Manukau DHBs.)

Brant was chief medical officer at Waitematā during the Levy years so it’s fair to assume the pair have a close working relationship. That will give some staff pause, considering it’s Levy who has been pushing Canterbury hardest to turn around its finances. (The projected deficit for the 2019-20 financial year is $170 million – the biggest of any DHB.)

There’s no questioning Brant’s professional credentials. He’s a respiratory physician who is a fellow of the Royal Australasian College of Physicians, and has been involved in management at Wellington Regional Hospital. He’s seen as a nice guy.

But Brant has his own baggage with Canterbury. He’s been appointed as an independent clinical adviser to the health board, and has attended some board meetings. That would have ruffled the feathers of some senior Canterbury staff, as he’s basically there to fact-check what they’re telling board members.

Newsroom asked Hansen how many people were offered the interim CEO position, including existing members of the executive leadership team. We also asked how long Brant has been an independent adviser to his board, why that role was established, and whether Brant has a strong relationship with the Canterbury’s leadership team. Hansen didn’t answer.

(Hansen must have wondered what he’d walked into when he was appointed Canterbury’s chair last December. On his second day, he was told the Health Ministry’s capital investment committee had rejected a $438 million application for a hospital rebuild, settling instead for a five-storey, $150 million tower, panned by doctors as inadequate.)  

Flurry over Nightingale

The muddying of the board’s message of stability came just after 3pm on Friday.

ASMS put out a statement calling on the board to be transparent and accountable, which also delivered the bombshell the DHB’s chief medical officer Sue Nightingale had resigned.

The union’s executive director Sarah Dalton says she was told about Nightingale’s intentions on Friday morning. When its meeting started many of its members were already aware of it. So it’s fair to assume it had been announced around the hospital by late morning, meaning the board would have known – but failed to mention it – when it sent its statement a few hours earlier.

That’s the fifth senior Canterbury DHB manager to resign in a matter of weeks. There was Meates, obviously, but also chief financial officer Justine White, chief people office Michael Frampton, and Carolyn Gullery, the planning, funding and decision support executive director.

Putting a positive spin on losing your DHB’s leading medical voice, amidst other top executives, proved impossible. A front page story in Christchurch’s The Press newspaper the next day led with news of Nightingale’s departure, only getting to the Brant/Bramley appointments in the 10th paragraph.

Nightingale, a trained psychiatrist, was one of the most prominent Canterbury health voices during the emergence of Covid-19 as one of the DHB’s emergency coordination centre incident controllers.

Of the leadership crisis at Canterbury, Dalton says: “I think it’s unprecedented, certainly in the modern era, or the modern structure of DHBs.”

On Friday evening, Hansen confirmed Nightingale’s resignation in an emailed statement. “I would like to acknowledge her significant contribution to the Canterbury health system over many years,” he said. “I am pleased that she will be staying on in the role until the end of December which will allow time for the organisation to recruit a replacement.”

It lacked the warmth of a note from CEO Meates – whose notice period is only a month – who announced Nightingale’s resignation to staff “with regret” earlier that day.

Contained in Meates’ missive is a sense of the values within Canterbury’s leadership team – ethics, patient-centric decisions, and being a voice for medical staff.

Under Nightingale’s watch, the clinical leaders group “found its voice”, Meates wrote, and provided invaluable input into its facilities development programme.

“In her time as chief medical officer Sue has championed clinical ethics, equity, clinical governance, quality improvement and putting people receiving treatment and care at the heart of all we do. Ensuring the consumer voice is heard and improving the consumer experience of health care are behind Sue’s passion to continue to do the right thing and make it better for patients.”

There was even room for Meates to mention how careful the DHB is with the public’s money. He said Nightingale’s responsibilities included “ensuring decisions on medical supply purchasing are clinically-led and represent value for money”.

Perhaps unusually for DHBs, Canterbury is seen as a place where senior leaders and medical staff agree – which, right now, makes their relationship with the board more fraught.

Might there be more resignations? Dalton: “It just wouldn’t surprise me now. I did call it an implosion, recently. What do you do to stop it?”

Dalton intends to raise Canterbury’s ructions in a face-to-face meeting scheduled with director-general of health Ashley Bloomfield in Wellington today.

“It wouldn’t be something I’d expect to make a fuss about usually, and certainly the situation in Canterbury wouldn’t be the only thing I’d be raising with him, but that is on my list and it’s pretty near the top,” she says.

“I’d like to understand the ministry perspective about all of this, and where it’s sitting in terms of their risk management.”

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