A scathing report on the state of the health ministry calling its leadership "invisible" has been released two days after Director General Chai Chuah resigned.

The Performance Improvement Framework Review for the Ministry of Health, prepared by the State Services Commission, outlines a lack of sound management and accuses leadership of being inwardly focused.

"Leadership is invisible in the Ministry and across the system, as the ELT (Executive Leadership Team) has spent considerable time working on itself."

The report also recognises that the health system cannot survive financially if the current trend of health spending continues.

"The Ministry has identified that the current model for delivery of health services is not fiscally sustainable."

"DHBs have increasingly struggled to deliver contracted services within budget with a number of DHBs reporting operating deficits reflecting ongoing financial pressures within the health system."

The Ministry received a fail mark for several key areas - which the report labelled as areas where there is critical weakness or concern in terms of delivery and/or capability, a lack of plan to respond to any weakness and areas where management focuses on tasks and actions rather than results and impacts.

All eight of the below areas fit into that category:

Fiscally sustainable Health System

Implementing the New Zealand Health Strategy

Leadership and Governance

Values, Behaviour and Culture

Management of People Performance

Engagement with Staff

Operating Model

Collaboration and Partnerships

Health Minister Dr David Clark has labelled the report an "indictment on the previous Government’s nine years of neglect and under-resourcing".

Newshub.