Health Minister Andrew Little says the reforms the government has announced this week will mean for the first time New Zealand will have “a truly national health system”.
The new system will consist of a national health organisation, a Maori health authority, and a new public health authority to centralise public health work. The Ministry of Health will remain in over-arching control.
It is a major structural reform, going even further than the raft of initiatives proposed in the Heather Simpson report.
So will Andrew Little be top of the pops, the only minister (so far) in the Ardern government to deliver a radical new policy to reform a key government service?
Initial reactions seemed highly in favour. The Dominion-Post’s headline ran “Overhaul of DHBs Welcomed”. The NZ Herald was even more vivid in its imagery: “The faces of failure”, it shouted, “Health overhaul to end ‘postcode lottery’ comes too late for these loved ones”.
The message was clear: good riddance to the district health boards (generally known as DHBs).
But will a centralised direction provide the vastly better health service New Zealanders now expect?
In the new system, under Health NZ, there will be four regional organisations.
Guess who will be staffing them? None other than the people now working for DHBs. As part of the transition they will transfer to the new Crown entity, probably working in the same offices as they do now.
Possibly – and hopefully – there will be some efficiency gains, but the critical issue is whether that means more surgeons, oncologists and so on will be on the job.
Beyond that, critics point to how dismally centralised bureaucracies have performed – for example – in transport or education. Only this week ministers were stigmatising their predecessors for the huge cost over-runs in the Tranmission Gully highway project while others were flinching at the Ministry of Education’s failure to do anything about conditions that rendered half of Hutt Valley High School uninhabitable.
This scarcely suggests a centralised health system will do much better providing more beds in more salubrious hospitals.
Virtually every health lobby has cited under-funding as a fundamental cause of problems in staffing, particularly identifying shortages of midwives, nurses, and medics. The expectation is the new system will provide an enormous leap in funding, and much higher salaries.
Yes, there may be more cash in the pipeline. But don’t forget that most DHBs have been running very substantial deficits.
Maybe the government will just write off those deficits—but it still has to fund the health service (as the jargon puts it) ”going forward”.
As they deliberated in Cabinet – and with their teams of media advisors supporting them – did the ministers appreciate that every case of medical misadventure or failure to apply appropriate treatment will be feasted on by the media, and the blame laid at their door?. There won’t be any buck-passing to a DHB.
One informed critic of Little’s reforms points to a fundamental issue: the emphasis is on structure rather than output for dollars spent. Measurement of productivity in the health system has never been attempted.
Perhaps this should be (belatedly) sent across to the Finance Minister’s ally at the Productivity Commission, Ganesh Nana, to carry out. Then the taxpayer might get some idea if whether he, she or whatever is getting value for money in the health service.
The “us” and “them” concept of a separate Maori Health Authority raises its own set of issues. It will have the power to commission new services, monitor the state of Maori health, and “develop new policy”.
It is intended to overcome “inequities” in the system which are said to be at the root of poorer health outcomes for Maori. Already its advocates are insisting it should get special funding to be spent as it chooses on “new policy”.
It seems those advocates believe this racially based authority can ignore the responsibility of Health NZ as a Crown entity to account for every dollar spent to Parliament.