So TIC embarked on a series of articles in this subject the most recent of which was written some 12 months ago. And now 1 July 2022 has rolled around, the 20 DHBs have been abolished and the new central bureaucracy has taken over. This week in the media there have been a flurry of articles questioning the basis of the reforms and whether they are actually going to make a difference at a time when the health system is under increasing strain. There is certainly a large amount of scepticism from the health sector as a whole about the Government’s policy and its ability to make meaningful changes in the sector. Many issues are highlighted, but a key one is that there has been next to no resourcing improvements, instead the restructuring has been held up as being the solution to all of the problems. This is a fallacy: it will take years to make that meaningful improvement in outcomes from restructuring, but there are matters that can’t wait for that. Or to put it another way, the reform has been excessively ideological. It also has been driven from the start by a vision held exclusively by the Government and deviating sharply from that which its own consulation panel delivered to it, which advocated keeping a form of the DHB system with a smaller number of DHBs.
This is largely symptomatic of a re-emergence of ideological ambit from the Labour Government as the giddy heights of absolute one-party-majority support obtained in the 2020 election rapidly become a distant memory. One of the most obvious examples in policy outside health is in the unpopular co-governance provisions of the 3 Waters restructuring currently before Parliament; and whilst TIC supports this idea and the whole 3W policy, Labour has failed to carry a significant percentage of its own supporters who believe in the fable of local government “democracy”, the most strident opposition coming from its politically connected members in territorial councils. The result is that, just as was the case before the emergence of Covid and the fluke opportunity that the government gained to increase its popularity through pandemic management policies, it is falling behind in the polls and is unlikely to recover. The ideological bias is particularly relevant as the last two-term Labour government was in power from 1984-1990 and displayed a similar level of disconnect from its heart and soul core membership and electors in general.
As previously noted in this article series and other posts of this blog the essential issue is the Government being captured by bureaucrats, the reason being a marked lack of experience and knowledge in portfolio areas for many Cabinet ministers, including of course the PM who was parachuted into the party leadership only months out from an election. Consequently the development of the health saga has been long in the tooth, yet it has played out extensively in Canterbury in particular with the so called “truth and reconciliation” process that was completely turned on its head by order of the health minister leading to the gutting of senior leadership at the DHB. As Dr Ian Powell notes in his blog, the Ministry of Health was increasingly in conflict with CDHB management, as seen in their demands during the John Key-led government for the CEO and other managers to be sacked by the DHB chairs. CDHB was seen as too independent, amongst other things having turned down the National government’s contracting out of certain core services such as hospital food and laundry services, which was more a classical case of National privatising a government service provision in favour of its business community membership; and CDHB was also apparently too strident in campaigning behind the scenes, particularly in the difficult period post the 2020-11 Canterbury earthquakes when it had to repair and rebuild many of its facilities with very little Government help. This Ministry conflict was re-enabled in the first term of Ardern’s administration as part of the decision to abolish the DHBs and hand all the power to Wellington. The problem is that there are very few ministers in Cabinet and almost none in the health portfolio in the past two terms that have sufficient political experience to stand up the bureaucracy. This is seen very clearly in a succession of centralisation policies of the government, from education to health to infrastructure.
Lack of political experience is unfortunately likely to figure in the next National government as well given the likely elevation of their leader to office after the 2023 election so it remains to be seen where the health sector or public sector in general will go after this.