Health Boss Recruitment Process a Very Worrying Sign

by Kevin Hague

I didn’t wade into the debate a few weeks back about the reasons for Stephen McKernan not seeking reappointment as Director-General of Health when his contract reaches the end of its term. I didn’t think I had anything to add the comments already being made. But I am grateful to the Association of Salaried Medical Specialists (essentially the union for senior doctors) for bringing to my attention the lamentable process for appointing Stephen’s replacement. This from their newsletter to members this week:

“4. Director-general position – a sad, sorry tale

There has been much media comment on the decision of the Director-General of Health, Stephen McKernan, not to seek a renewal of his contract which expires in July.  The general consensus is that this decision was in response to the lack of encouragement from the Minister of Health to him renewing his contract.  This would have made Mr McKernan’s decision inevitable.  The response of a wide range of sector groups (including the ASMS, NZNO, PSA and NZMA as well as the Health & Disability Commissioner) is, despite criticisms from time to time of the Ministry of Health, that Mr McKernan has been an outstanding Director-General.  With the Ministry of Health going through a period of radical restructuring his experience and understanding of systems issues (second to none) will be a big loss.  It seems inevitable that whatever frustrations there may be with the Health Ministry, these are likely to increase in the absence of Mr McKernan’s experience and abilities.  It does have the feel of a ‘political own goal’ about it.

Compounding the sad sorry state is that it now appears that in effect the decision over his replacement has already been made with an appointment process set up simply to go through the motions.  Whereas one might have thought that the government would use the advertising process to enable the greatest number of quality experienced applicants (including international) to apply, a mere three weeks have been allowed with applications due by 6 April.  Further, it is difficult to imagine a smaller advertisement for one of a small number of state sector chief executive positions.  It contains no information about the position aside from a website link and email address.  This sad little advertisement was overshadowed in the Dominion Post (27 March) by a much larger and encouraging advertisement on the same page for the position of general manager of the MidCentral Primary Care Organisation! ”

ASMS is completely correct. The world’s smallest Situations Vacant ad is code for “dont bother applying; we’ve already got the person we want”. This very unfortunate: closed minds in employment decisions lead to the best candidates not even being considered, to the detriment of all. But what disturbs me most of all, and which should send a shudder down the collective spine of the health sector, is that a closed mind at this stage probably indicates that the Minister has made up his mind about who he wants. While some may not see what is so objectionable about this, in fact it cuts to the heart of how we want our public service to operate. Of course it’s important for the Minister to be able to work with the chief executive of his or her Ministry, but that chief executive nonetheless works for the public of New Zealand, not the Minister. The public deserves the highest standards of professionalism and independence. This appointment will not deliver this.

What is particularly worrying about this is that the Minister has taken an unprecedentedly political perspective to the Health portfolio. He has focused on the flashy and the headline-grabbing (hence the extreme focus on elective surgery) at the expense of the highest (but lower profile) priorities, like reducing health inequalities, trying to get ahead of the wave of chronic disease threatening to engulf the health system, and keeping people well in the first place. When I say expense, I don’t just mean attention, but actual cost. This Minister has shifted resources from what is genuinely important into those areas that he thinks will be politically advantageous to him.

One of the safeguards of an independent public service is that it can ensure that what is genuinely important still gets done despite the politics. If chief executives are now to be effectively political appointees this is put at risk.