It might sound like a prank, but the entire accounting for the public healthcare system of a country has been managed on a single Microsoft Excel spreadsheet. Yes, you read that right. As a report published by Deloitte at the end of last year revealed, Health New Zealand (HNZ), the nation’s agency responsible for a US$28 billion budget, covering hospitals, staff salaries, medical supplies, and infrastructure almost collapsed because of its poor management processes.
The study conducted by the consulting firm showed that the financial data did not follow standard rules and simple errors, like missing zeros or a misplaced comma, went unnoticed by management for months, and some of the expenses were not registered at all. Being tracked on such an informal platform also left room for number manipulation, and even internal staff could struggle to find important information such as budget allocation.
It is not hard to imagine the damage. In a single year, between July 2023 and July 2024, HNZ registered more than US$722 million in deficit, still according to Deloitte’s numbers. The audit process also found that the budget projections didn’t align with the country’s needs or reality, and there were no savings or investment plans. Decisions were made with little to no visibility on the spending or capital intensity of projects.
“Decline in financial performance was caused by HNZ losing control of the critical levers that drive financial outcomes,” said Deloitte analysts in the report. “There were many factors that gave rise to the growth in expenditure beyond HNZ’s revenue, but the key factor was the inability to identify and respond to the disconnect between expenditure and revenue.”
To put things into perspective, HNZ was created in 2022 to streamline New Zealand’s public healthcare system by merging 20 district health boards. The idea was that one national body would cut waste, centralize operations, and improve efficiency. Instead, it lost control over basic financial processes. The agency also conducts other areas of the operation with 6,000 different applications and 100 separate digital networks, according to the review—many of them outdated and incompatible.
But the government doesn’t seem in a rush to fix it. Despite the bombshell report, Health Minister Simeon Brown has not announced any immediate plans to replace Excel. Instead, the politician and his team are considering a new “Health Infrastructure Entity” that might take over financial and digital systems, but without further details.
This dramatic story shows how much public policies need to improve in terms of transparency, compliance, and processes. It highlights the critical importance of implementing modern, integrated systems and the potential risks of neglecting financial control in public institutions.
