Ousted Te Whatu Ora chair Rob Campbell has publicly slammed New Zealand's health reforms just a month after getting dropped from the top job.
Campbell hit out at the system in a Monday night speech to the Fabian Society in Wellington.
He likened the new health system to a half-baked cake that hasn't made enough change.
Campbell told AM Te Whatu Ora is staffed with too many managers who are indecisive or inadequate.
"In the discussions that I've had and the time I've been involved with health; with staff, with patients, with people in the community about the health system… there's nothing extraordinary about what I was saying - it's a widespread appreciation of the issues," he said on Tuesday.
"You've got to look back to the way the system was set up - it was very much a top-down restructuring. There wasn't sufficient account taken of the views of staff, unions, professional organisations [and] deliverers of primary care - that whole range of people that make up our health system were excluded from it."
The reforms revolved around bureaucracy and not what those working on the frontline wanted, he alleged.
Because of that, it wasn't a surprise the reforms were flopping, Campbell said.
"There was always going to be a struggle," he told AM host Ryan Bridge.
"I don't know anyone in the in the public health system who would not say that we are in crisis situation. Some politicians might not like that but it is a crisis."
Meanwhile, he accused senior managers of hindering progress.
Despite managers and Te Whatu Ora's board wanting to make a difference to meet the needs of New Zealanders, some were "not just no help - they were actively blocking change".
Campbell said more needed to be done.
"The people who need efficiency and effectiveness in the health system most are those that love the public health system - those that want a strong public health system… the people who want a public health system are the ones who have got the responsibility to stand up and say, 'This has to work better - we have to run this differently.'"
Responding to Campbell's claims, Prime Minister Chris Hipkins agreed there was still a long way to go in the public health reforms.
"The old system wasn't sustainable either and reform was required," Hipkins told AM.
"We're still relatively early on in the piece of a major reform program for the health system and there's still a lot of work to be done. The health system isn't where we need it to be and so we are uptaking reform because the old system wasn't working - the new system's got a lot of work to do make sure it does actually deliver on the improvements that New Zealanders deserve to see.
"If you take 20 district health boards, each with their own management teams - each with their own systems and processes in place, you put them together and you try streamline that - that is going to be a very big undertaking and it's going to take some time to work through that. Has that work been completed? No, not even close to being completed."
