Last time we talked about the Government’s “centralist authoritarian path” as described by Dr Ian Powell, former head of the senior doctors’ union ASMS, in the context of funding challenges at Canterbury District Health Board. As we know, in the year 2000, the Government set up the 20 District Health Boards to run local health services in their regions, and gave them a partially elected membership, the Government appointing some members of the Boards themselves and also appointing the chairperson. This system has therefore been in operation for about 20 years, and it replaced the unelected Regional Health Authorities and their predecessors, Crown Health Enterprises (CHEs). So it seems strange that after one Labour government introduced the elected Health Boards, another Labour government has suggested dismantling them. The Government commissioned a review of the public health system which has recently published its final report, and one key recommendation will be for the appointment of all board members rather than having elections as is the case now.
This is a very important issue of public accountability and it matters a great deal because the public health system needs to be open and accountable to its customers, the people of New Zealand. When the DHB system was introduced, a key driver for the Government of the time was to create that culture within the public health service as a reversal of the commercialisation policies of the 1990s. But there was a clear suggestion that the Government also had an incentive to suppress public debate over the form and function of health, and political commentators of the time lauded the ability of the Health Minister of the time, Annette King, to keep a lid very effectively on public debate in the sector. The health system is one of the few segments of the public services in NZ to have elected local oversight, another key example being the education sector, where schools and tertiary institutions have had varying degrees of self-governance, still somewhat different from the system of the UK where traditionally, schools have been administered by local government. There is, in our view, a fairly strong case for governance of other key public services to be opened to an elective process as well, but this has not happened beyond health and education, and the roles delegated to local government.
The president of Local Government New Zealand has noted the inexorable drive by government to centralise the provision of services, to the extent that local governance influence is steadily diminishing. Examples include the Government’s heretofore referred to proposals for DHB membership, its takeover of regional polytechs into a single national body, and the intention of its 3 waters reforms to nationalise local government reticulation infrastructure. Many councils around the country have in particular cited the last example as being of great concern to them, but it must be noted at the same time that few of them have made much effort to properly maintain and repair their freshwater supply or wastewater treatment networks; South Wairarapa District Council is an extreme example with a freshwater supply network that loses over half of its volume through leaks, but Wellington City Council is not much better with a string of recent major failures in its wastewater pipes. However, it can be said in general that central government seems to find itself unable to avoid meddling in local government with key examples being the 1989 and 2009 reorganisations nationwide and in Auckland respectively, and the penchant especially of the National Party for direct intervention in the provision of highways and housing, for example. There are cases for centralising, regionalising and localising different functions, but not to the extent sought by some politicians especially those at the lowest local level who are constantly campaigning for abolition of regionalised governance in favour of local control.
As noted in our previous post, local representation is important as long as it is implemented in a way that is effective in the purpose which it is intended to achieve. The reorganisation of local governance in 1989 around NZ merged many smaller local authorities into larger ones, and many of those lesser ones vehemently argued against losing their existence. This even was the case in the city of Christchurch where Riccarton and Waimairi, and historically Sydenham, were separate from the central city and was really way too parochial. The same arguments were of course advanced in Auckland in 2009, and in fact are heard all over NZ every time someone calls for improved local governance. However it is hard to argue that Auckland is worse off for being amalgamated and their Local Board structure is another way of representing communities of interest which is similar to Community Boards in the rest of NZ. There are still a number of small councils around NZ resisting suggestions they would be better off merging with their neighbours. However if a large authority is constituted then it must have some means of representing specific communities and their interests effectively, which is generally achieved by a ward system with each having its own board (sometimes several wards have a combined board).
In our view, the much preferred system for representation is to have a larger rather than a smaller authority with specific wards to represent communities on the ground. However, we also feel that members should be elected at large and assigned to specific wards after an election, so that we do not end up with members who are only interesting in capturing the votes of their choice of ward and not in the issues across the rest of the authority as a whole. Dunedin City Council is an example of a local authority where the Councillors are all elected at large, although we do not know the mechanism by which they are assigned to wards, since the city has community boards like all others. There are numerous examples of where regionalisation of some local authority services has proved highly beneficial, for example in Auckland in the provision of public transport; their current transport authority system is keenly cited as a model that should be implemented around the country, with Wellington and Christchurch cited as particular examples.
Returning to the health reorganisation proposals, as noted, the government has proposed abolishing local board elections for the new, larger DHBs. This is of great concern, since the possibility of the government stacking boards with cronies to rubberstamp their policy directions is all too real as seen many times with the boards of SOEs and other Crown agencies. Dr Ian Powell, the director for 30 years of the ASMS, who has now retired and continues to blog from Otaihanga about health system issues, has particularly cited the loss of local influence, in that he referred to the previous regional health authority structure created by National as having the tendency to prioritise services in main centres over all others. From our perspective, the government’s argument that all health board members should be qualified for their duties is weak, since the government exerts sufficient control over the whole system by appointing a number of the Board members and the chair. If the government chose to appoint half the total board and the chair, that would give them effective voting control whilst still ensuring local elected representation. The Simpson report argues that elected boards are not more effective than appointed boards, but there is no way that an appointed board can safeguard against the possibility of stacking referred to previously. The appropriate type of representation desired such as representing different ethnic communities can still be achieved within an elected system very easily. It is important that the election of a percentage of each district health board remains elected for the key reason that equitable constituency representation is maintained throughout the DHB area and reflected in the provision of services and this will become much more important with a smaller number of larger DHBs. It is of great concern that the Simpson report seeks to significantly marginalise representation relating to local services and issues. Claims are also made that declining voter turnout is relevant even though this argument could equally be applied to all systems of elections in NZ.
The most significant concern that would accrue from the abolition of local health board elected membership is that the prospect of membership being stacked by a particular government (already the norm with other public sector entities, and virtually impossible to guard against) would serve to shut down the current degree of openness and accountability that exists in the system. The ongoing debacles and public debate in Canterbury over funding woes of late are issues that the Government has shown itself to be unwilling to address without passing the buck back to the DHB. It is very evident in these matters that the Government is extremely reluctant to encourage any sort of widespread conversation about the bigger challenges of service provision against a capped and in many respects insufficient level of funding, regardless of circumstances. It must therefore be extremely obvious that a fully appointed district health board system would create the problems that it would be impossible to guarantee equitable representation, and that it would also give the Government a much stronger platform to control and limit the extent of public conversation on the policy directions of both the Government and the DHB itself.