Social Housing Works Best Under Local Authority Control

In New Zealand we have a perennial debate about the interaction and service distribution between central government and local authority control. This happens because the country does not have any form of state government. Instead, there is one central (federal) government based in Wellington, and two tiers of local government with far less powers and limited delegation from Wellington. As such, Wellington tends to focus on national programmes and policies, with less accountability at a local level for the people who benefit from these programmes and the communities they live in. The value of local authority control is most evident in our public health system where our DHBs have elected membership, and to a lesser extent in the various services provided by territorial and regional authorities. However, in places like the UK where there is no state governance either, the State compulsory education system has long been placed under local authority control in spite of efforts to undermine it or give control back to the central government departments.

Whilst the blog authorship aren’t always big fans of local government administration, and see the need for Wellington to become involved where central governance is clearly in the national interest, such as situations where local governance is clearly incompetent, or where there is significant conflict or turf wars between different local government authorities, local management can often result in more cohesive and inclusive communities that are of greater benefit to all of their residents. This is quite evident in the operation of the social housing network in Christchurch City, although somewhat clouded by a poorly considered amendment to the District Plan severely restricting the requirement for public notification or consultation in any social housing development in the city. Furthermore the new local council social housing system introduced in Christchurch recently with the creation of Otautahi Community Housing Trust means that Wellington funds the construction and maintenance costs of the housing through its Income Related Rents tenancy policies, which for a number of years have been extended to community social housing when they were formerly only available to tenants of Housing New Zealand (Kainga Ora).

In Christchurch, to qualify for Income Related Rent subsidies, the City Council has retained ownership of the properties and leased them to OCHT (subsequently, some ownership of existing and all new properties has been transferred to OCHT). CCC has a minority shareholding in OCHT (49%) to qualify for IRRs. It lends capital to OCHT for the construction of new units. This cost is recovered by setting an appropriate rate of market rental for the properties, which is then received either from the Government through Kainga Ora for tenants who qualify for Income Related Rent, less the amount of rental paid by the tenant, or as the actual rental charged for tenants who are not eligible for Income Related Rent. Hence, OCHT is effectively self funding through the rental subsidies. The debacle currently in Wellington City Council and Nelson City Council over the future funding of their social housing, resulting in the NCC selling to Kainga Ora, shows that other local authorities have not bothered to fully investigate the option taken up by CCC, although there is a caveat in that only new tenancies can access the IRR subsidy. In other words, a transition to IRR funded tenancies could only occur over time as tenancies turn over, and long term social housing tenants could miss out or only be able to access more expensive Accommodation Supplement subsidised tenancies in council funded accommodation.

Local control of major social service schemes such as social housing or health are very important for ensuring these services are as well tailored to local needs and integrated into local communities as they possibly can be. Our experience with our local DHBs has proven the worth of this, albeit there is too much variance of service quality, particularly in smaller rural DHBs because of inadequate central government funding provision. In the case of social housing in particular, CCC has shown itself to have a significantly better community focus than Kainga Ora, due to local political accountability, with more community social service input into the services provided to their tenants. The real issue is that Kainga Ora is a government department run by bureaucrats in Wellington which is a key component of the overall thrust of 20 years or more of Government service level cuts agenda to reduce provision of social services overall. Kainga Ora has the essential task as part of this agenda of providing accommodation for high needs tenants who are transferred into the community from other government agencies (such as mental health or corrections) without sufficient support to integrate them, with the clear intention of reducing the cost to government and transferring the costs and impacts onto residential communities. This is why these communities have mounted and continue to mount strident opposition to Kainga Ora housing developments such as the recent Flagstaff proposal in Hamilton which often involve development of dozens of residential units in medium to high density on single sites. This represents a regressive return to the previous development of large Housing New Zealand estates in parts of urban New Zealand cities which subsequently have become notorious ghettos. What is needed apart from keeping social housing as much as possible in local government control is the Government itself being willing to address widespread concerns over the impacts of its social policies that are not actually making meaningful efforts to address issues such as these, as they have become “too hard” for Ministers.

Quick Reflection

Why does this blog exist? What is it for?

When this blog was set up it was suggested the blog wouldn’t write about many things. Having launched it, that has been the case. Only a few posts have been made to date.

Author/s behind this blog are deeply compassionate and deeply moved by social injustice in society. However, Author/s have launched other similar blogs in the past that quickly became all consuming and dealt with a lot more politics than was desirable. Author/s find that it is difficult to blog a lot and stay out of becoming too focused on politics. Politics is a divisive force, and Author/s circles of friends have few that are interested in political discussion hence Author/s prefer to focus on interests that engage more people and are less divisive, therefore personally more rewarding.

The main reason more posts aren’t appearing on this blog is the dilemma of attempting to find subjects that are important enough to meet a necessarily high bar and also don’t descend too much to a personal level. It’s much easier to write about the government or some other institution than flag the policies of one particular cabinet minister or MP.

Given the current situation therefore, where there is a constant tension between trying to find worthwhile topics to blog about, and refraining from making posts that are overly critical at a personal level, it’s unclear at this stage if the blog will even be able to meet a suggestion of one topic a month. The CDHB topic has been a good example. It is a topic that has is able to engage a lot of people in the community. Other topics that Author/s post about that have a political component may appear on some of the other blogs that Author/s own, if there is an overlap, and be reposted or adapted here. This is more likely to be the type of content that appears on this blog in the future rather than content being created from scratch only for this blog.

6th Labour Government led by another “smile and wave” politician of no substance.

This blog has previously focused on concerns about Labour’s health policy with particular relevance to the Canterbury District Health Board leadership crisis. This was the subject of a series of blog posts in the last few weeks.

The hallmark of the John Key led National government was that Key was perceived to be a “front person” for the hard right political agenda of his party, in that his personal charisma and appeal could help to deflect any negative publicity and shut down or deflect serious attention to the policies his government was implementing. As a result, Key could command widespread political support over 2 1/2 terms of government (he stepped down before the third term was completed) whilst behind the scenes, National was true to form in its typically neoliberal focus, targeting public spending cuts in order to deliver tax reductions. This meant behind the scenes cost cutting and other measures in the public health system including the DHBs.

Labour was not able to make much headway against the Key Government over the three terms until its newest leader Andrew Little resigned just months before the 2017 election and handed over power to Jacinda Ardern, who has in office to date, as the 2020 election looms, largely succeeded with the public by being a good communicator with personal charisma. After many broken promises and policy failures, Labour earlier in this year looked like their re-election prospects were slim. National was polling strongly and it appeared the Government’s lead was very marginal. That is, until suddenly Covid-19 came out of nowhere and Labour pulled ahead due to strong communication and leadership from the Prime Minister. However, cracks have appeared most notably in border control which has failed on several occasions, revealing what every political junkie knew already, that whilst the PM was clearly able to articulate the big picture of our “elimination” strategy well, the detail, as has always been the case in the 6th Labour Government, was found to be significantly wanting. At this time however, it still appears Labour has a chance of doing very well in the election, but purely on the basis of the Covid-19 policy which is the only real substance they have been able to articulate to date.

The rest of Labour’s achievements in the 2017-2020 term have been unremarkable and in fact reflect the capture of the Government by the Wellington bureaucracy, enabling effective continuation of National’s policies by default. In what universe can it be expected that DHBs have unlimited reserves of money to meet extra out of pocket costs, like the extra work needed to respond to Covid-19, and in Christchurch, the Canterbury earthquakes, the 2019 mosque massacres, and a two year delay in the completion of a major building project at the Hagley site? But this policy has been continued by Labour, as nonsensical as it is. Furthermore, the Ministry of Health has been clearly exposed as having conducted a vendetta against the CDHB management over a long period of time, and abandoned its so called “truth and reconciliation” process when it spotted an opportunity to appoint a new compliant chairperson to the CDHB board after the 2019 elections. The hugely shameful rollover by two successive Labour health ministers to the Ministry of Health bureaucracy means they are bound to be relegated to the same level of incompetence as the previous health minister of the National government. This is a typical outcome of the 6th Labour Government which has yet to implement any substantial policy in reversing the damage done by its predecessor to the fabric of society. That is the key reason why Labour hasn’t created policies for the 2020 election campaign – because they do not have any ability to do so. They have done nearly nothing in the past term of office in many areas in which reviews were sought, and then shelved, and key policies campaigned upon in the 2017 election campaign have been abandoned.

Unless this Government changes direction radically after the 2020 election, they will be regarded as no more than a minor blip on the political history of New Zealand. The failure to make significant change in areas according to their core supporters’ expectations would have severely dented their prospects at the election apart from Covid and the same factors will come back to haunt them at the 2023 election campaign. When it comes to health, Labour’s purported solution of centralising control by reducing the size of DHBs and eliminating elected members plays straight into the hands of neoliberal Wellington bureaucratic interests, in the interests of shutting down democratic input into the health system. This blog welcomes and supports the ongoing debate in Canterbury, especially from regional leaders who have knowledge and experience of health, and the staff and activists who continue to expose the madness and inequity of Labour’s failure in governance. There has recently been a key resignation in the Ministry of a bureaucrat who was a key enforcer of the massive financial and structural inequity of Government policies within recent years. If Labour does not address the whitewash in Health it will cost them dearly in 2023, and this blog looks forward to continuing debate and campaigning on the subject.

Canon David Morrell: “The Government must move decisively, and not by handing the problem to the Ministry of Health – it would appear far too likely to have created it.”

Canon David Morrell is a former Christchurch City Missioner and a Canon of the Anglican Diocese of Christchurch. He was an elected member of the Canterbury District Health Board from its inception in 2001 until last year’s CDHB elections – sitting for a total of 18 years. His commentary on the Health Board issues appears in The Press website today. The summary of his commentary is that the Ministry of Health was compelled to negotiate with CDHB to resolve differences – until someone saw an opportunity in the Health Board elections to exploit a power vacuum and, essentially, revert to the previous adversarial position. Evidently, bureaucratic empire building is dominating.

This means that deputy National Party leader Gerry Brownlee and clinicians Dr Phil Bagshaw, Gary Nicholls and Stuart Gowland are correct in calling for an inquiry into the historically adverse relationship between the Ministry and CDHB. Until the Government is willing to address that, and back off its current process of backing the Ministry, we are not going to see an improvement in this situation. The Ministry has become too bureaucratic and too powerful and the politicians in Wellington are too willing to pass the buck onto officials as a convenient way of keeping a lid on politically heated issues. We reiterate our concerns about the inability of the Government to formulate and promulgate substantive policy in health or a number of policy areas.

Waiting On The NZ Government In CDHB Debacle

In the last few days the NZ Government has taken steps to meet with the CDHB Board and protesting health staff to discuss their concerns, alongside the first steps to implement staff and resourcing cuts in the Board’s operations following Board approval of a $56.5 million cut in expenditure this week. Some Board members and CDHB staff are extremely concerned about the expenditure reductions especially against the backdrop of the current Covid-19 pandemic and ongoing challenges in resourcing public health in Canterbury and the rest of NZ.

We feel we cannot add any further comment to our previous articles on this subject recently and until there is further commentary from the parties to these discussions we do not see a need to continue posting on the issues. However we do not believe that the issue fundamentally can be resolved without the Government being prepared to change the policy settings it has articulated to date and have yet to see any admission from the Government that there is anything wrong with their overall policy on health or admission that any particular failure at Government level exists.

Does The Government Have Any Major Health Policy At All?

Labour is campaigning to be re-elected in a few weeks, and has ruffled a lot of feathers by declining to issue any policy manifestos, saying they are “too busy” with the Covid-19 crisis. The real question, however, is whether Labour has any major policy in a number of areas, including health. During the 2017 election, Labour’s policy manifesto for health included a number of promises, but the only policies significant to the hospitals and DHBs were to improve cancer care through a National Cancer Agency, rebuild Dunedin Hospital, and increase overall health expenditure by $8 billion. The latter amounts to allocated funding increases of $21 million in the 2017/18 year, $846 million in 2018/19, $1.535 billion in 2019/20, $2.361 billion in 2020/21 and $3.157 billion in 2021/22. It could therefore be said that the current funding crisis at CDHB is not breaking any election promises, because Labour didn’t actually commit to making any major changes to the public health system. However, it could also be the case that Labour did not product any significant policies because they did not wish to make any real change to the way that the Government interacted with the public health system or DHBs, including any commitment to addressing growing public concerns over waiting lists and diminishing availability and provision of services.

In a post at his blog Otaihanga Second Opinion, Dr Ian Powell, who recently retired from the directorship of the Senior Doctor’s union, the Association of Salaried Medical Specialists (ASMS), which he had served for 30 years, questioned the funding commitments the Labour-led government had made, particularly in relevance to the 2020/21 financial year. To quote, “total funding for the 20 DHBs for community and hospital care increased to $15.274 billion from $13.980 billion in the 2019/20 financial year. In other words, a 9.2% increase. This is massive by any stretch of the imagination”. He points out that a real increase of these terms would wipe out DHB operating cost deficits by the end of that financial year. However, this optimistic note is soon dashed by noting that the actual operating costs in 2019/20 amounted to $14.359 billion owing to deficits incurred, and this made the real increase in funding only 5.1%.

The question that we feel is important, regardless, is whether this funding increase would have been sufficient to allow Canterbury DHB to proceed with its original proposals to shrink its deficit over several years rather than halving it within a year as the Ministry is said to have demanded recently. We feel there is nothing further we can add to the debate over the DHB’s funding issues without repeating what we have written in previous posts. We don’t have a specific knowledge of or insight into the DHB system, we just have a significant level of concern over the way the issue has been handled by the Labour-led government to date that is similar to that held by clinicians and other professionals employed in the public health system in Canterbury.

The issue of Labour’s policy is quite significant because the current administration has gained, with some justification, a reputation for being extremely slow to develop or implement major policy, even some campaign promises, since being elected in 2017. Take as an example social welfare. The Government commissioned a major review of the welfare system on election and the panel which was convened and received public submissions, and then produced a report with about 55 recommendations for change. In 2020, very few of its proposed actions have been implemented and there has been very little public comment about the report from the Ministers concerned. This pattern is similar to growing concerns from agencies involved in public health. The obvious conclusion is that the Government has either made very little effort to upskill its own limited knowledge of the best way to implement a public health system, or has deliberately concealed from the public its preference for almost no significant changes in the way the public health system is run. Either way, it seems to be willing in this and other major policy areas to concede significant power to existing bureaucracies, which provide a convenient smokescreen for its lack of action. As we mentioned previously, the Government during its first term has commissioned what has become known as the Simpson Report. One of the key premises of this document is an expectation that significantly greater funding will be needed in coming years. Former minister Dr David Clark committed in principle to the implementation of the report in a press release on 16 June 2020, but his statement carefully omitted the report’s fiscal conclusions or any reference to funding whatsoever.

We have said previously that the major issue we wish to have addressed is the Government’s obvious wish to avoid having public conversations about the kind of health system it is shaping for New Zealanders, specifically how it will be influenced by funding decisions. Whilst the public at large has become increasingly concerned by shrinking service provision over many years, the system now lacks the capacity to be able to deal with major emergencies such as the present Covid-19 pandemic. Despite this being flagged on numerous occasions this year, the Government is yet to produce any meaningful response to the capacity concerns apart from its existing nationwide capital works programme. But increasing the size of hospital facilities is irrelevant if the operational funding to provision them is insufficient. It has been highlighted in CDHB’s case that even if they get another new building that they have sought in their current investment case, it will not be able to be used to capacity in the shorter term because of operational fiscal constraints.

In effect, the lack of commitment by Labour to produce policy manifestos for the imminent election, and their unwillingness to have a public debate on the type of public health system that will be provided by Government in future, are clearly two sides of the same coin. The Government, having fudged its way through its first term with relative silence within many major policy areas of which health is just one, is hoping that its recent performance in the Covid-19 crisis will get it over the electoral success line. It may well succeed due to poor performance by ineffective Opposition parties and the personal charisma of the Prime Minister, but there are alarming echos of the Fourth Labour Government of the 1980s, whose electoral platform was similarly funded on popular appeal rather than substantive policy considerations. Unless by some extraordinary circumstances Labour is in a similar position in 2023 to capitalise on exceptional handing of a national crisis, the electorate is likely to be far more critical of Ardern’s administration, just as it appeared to be earlier in 2020 when some opinion polls suggest National had a much greater prospect of bringing the Government down. Ultimately, whilst the Government may be willing to sweep these issues under the carpet and hope that sufficient of its MPs and key supporters will look the other way, the very independence of DHBs from the Crown provides them with important leverage with the public at large that can easily blow up in the Government’s face, as is happening now.

On Tuesday 25 August 2020, the following articles were published in the news media in relation to the Canterbury DHB crisis:

Crown monitor claims CDHB was financially mismanaged

So the war of words over Canterbury DHB continues, this time with an interview in The Press today with Lester Levy, claiming Canterbury DHB’s deficit “has grown out of control”. Levy was appointed Crown Monitor to the CDHB board last year and is a former chairman of all three Auckland DHBs. However, the counter claim made by senior clinicians and others working at CDHB is that the organisation has been significantly underfunded over a period of many years since the earthquakes. Obviously CDHB say they have a special case due to the quakes, and we think they do. We feel however there is little more we can add at this stage to what we have posted over the past few days.

The problem is that if the issue is reduced to mere dollars and cents then people have become unimportant. That is the key viewpoint that ASMS has identified in previous experience of working with Lester Levy in Auckland. The government is using this issue as a very heavy lever to, basically, shift the blame from its failure to address its failure to properly fund the CDHB over many years since the earthquakes. One very visible example of this is the failure to replace the public carparking building opposite the hospital which is still an ongoing issue.

The key issue remains whether the Government actually does have a commitment or plan to address the funding problems because that is the key issue that has been identified with Covid-19. It is actually mentioned in the Simpson Report and whilst Government has proposed adopting the report they haven’t specifically referred to the funding issues. As we iterated previously the Government appears to be avoiding having public conversations about important issues to do with the public health system. One clear example from when David Clark was the Minister came up when the Government was considering the need to improve cancer treatment through the provision of linear accelerators (LINACs) around the country that needed to be purchased. Simon Bridges issued a press release saying National would fund the installation of these machines if elected, which prompted a hurried announcement from Clark and Ardern that the coalition government had approved the installation of new LINACs around the country. It should also be remembered that until the Covid-19 issue came up, the coalition government was facing a realistic prospect of being a one term administration, having done poorly in the polls up to that point. People have every reason to question Labour’s performance not just in health but in other key portfolios as well. This is amplified by Labour’s announcement that no policy manifesto will be issued before the election. It’s becoming abundantly clear that this government has made very little effort to even maintain faith with its own supporters, let alone with voters.

Does the NZ Government have any comprehensive policy on fixing the public health system?

It seems appropriate at the moment for us to continue documenting the unfolding CDHB crisis and asking some hard questions relating to this. In our last post yesterday, the key question asked related to this actual issue. Simply put, the Government has to date failed to take any sort of lead and front up to the issues raised both by the CDHB saga and the Covid-19 pandemic policy failures. The key issue identified in the case of Covid-19 is that the public health system lacks the capacity to be able to implement the Government’s wishes. In the CDHB saga, the key problem is the Government failing to articulate policy. Instead, it has chosen to pass the buck to the board. Whilst the Government has produced the review by Heather Simpson (the Simpson Report), it contains a number of questionable elements that have been challenged by clinicians. Chief among these is the underfunding of Health over many years; Simpson claims that DHBs are still inefficent despite this.

It appears that the Government is following this line in refusing to address the concerns of clinicians in the current CDHB saga. The problem is that CDHB has been at the forefront of developing new innovations and cost savings. The conflict between the CDHB board and clinicians very much looks like the Government seeking to undermine the CDHB executive management using the board as its proxy. This makes the government look every bit as ruthless as its predecessor, and not really committed to improving the public health system at all except by taking total control of all operations currently being run by health boards. This same approach underlines the expectation of the Simpson Report that elected boards will be replaced by appointed boards. We found an interesting interview in the NZ Herald with Lester Levy outlining the process that he had gone through to attempt to get building issues at Middlemore Hospital in Auckland resolved. This time around it looks like Levy and Hansen have been put into the CDHB board as the government’s hatchet men. There is some evidence to suggest that the Government has developed an adversarial relationship with clinicians and/or has been holding back on funding on the basis of what appears to be a flawed assumption that all DHBs must be inefficient and unproductive.

Another problem with Government policy is that boards are not open now. This serves government interests to keep the board process under the radar. When Sir John Hansen was interviewed by Garry Moore last week, he claimed to be speaking in a personal capacity, not as a representative of the Board. No other board member would be allowed to speak or give an interview. We also know that two key National Party people and an Act supporter sit on CDHB as elected members. We do not know where they stand on these issues. They could well be advocating that the National/Act perspective of the public health system prevails. There is no opportunity for public debate or input into these issues. We suspect that the election of these members along with the appointment of the new chairman and the Crown Monitor has driven a significant part of the breakdown between the executive leadership and the board.

Yesterday the key developments were:

  • The Press published an opinion piece by Kamala Hayman (Editor) stating the leadership of the CDHB was clearly in meltdown and calling for urgent intervention by the government.
  • Departing Chief Medical Officer Sue Nightingale gave an interview listing her reasons for leaving, in which she cited the adversarial relationship between the Board and executive management as the key issue. This was specifically referring to the new Board that has been elected since the 2019 elections.
  • CDHB elected member Jo Kane and former CDHB elected member / Christchurch Hospital clinician / Otago Medical School professor / Charity Hospital founder Phil Bagshaw called for government intervention in the CDHB crisis.
  • Deputy National leader Gerry Brownlee called for an independent advisory board to “look at every aspect of the long history of difficulty between the CDHB and the Ministry of Health”.
  • The Prime Minister finally gave a public acknowledgement of the issue at a press conference on Friday afternoon.

In brief, we are concluding this post with a quick look at New Conservatives’ election manifesto. An in depth treatment of the particular issues referred to may be considered as a future key issue for this blog, or another related blog site.

New Conservatives have a Treaty of Waitangi policy published on their web site. Most of the policy focuses on minimising and denying Maori from their rightful place as the indigenous people of New Zealand prior to European colonisation. It includes the following statement as a general attack on the welfare system:

Thirty years of expanding welfare delivery by successive governments has undermined our families/whānau and has created an underclass which has marginalised some of our most in need.

When we have challenged New Conservatives on the basis of their belief in making this statement we were unable to get a response from them. The facts, however, is that the expansion of welfare provision has not been an explicit Government policy. Instead, the welfare state has expanded as a result of fiscal policies virtually identical to those advocated by New Conservatives. It is those policies, not the welfare system, that have been responsible for a very substantial role in the development of an underclass in NZ. However, the creation of a specifically Maori underclass is itself a product of the colonisation history in NZ. Either way we look at it, New Conservatives do not have policies that would produce an equitable and socially just resolution to the elimination of this underclass.

NZ Pandemic Response Raises Questions Over Future Structure of Health System

We’re still evolving what this site is about and how we will use it, but we are sticking for now with our plans that it won’t be a general political site, but that we will continue to use it to address a small selected range of issues that we feel are of key importance. The public health system of NZ and its structure is the issue we have been focusing on most recently.

The emergence of the Covid-19 pandemic and the resulting failures within our health system have naturally resulted in a focus on how to best address the incapacity within public health to gear up a rapid and effective response to events such as pandemics. The key suggestion is that the Government will have to find some way to increase capacity within the system. However, there does not appear to be any indication at present of any Government policy that would enable this to occur, especially compared with the ongoing debacle over CDHB. The Simpson Report does not propose to abolish the DHB system and we have not seen anything within it that suggests the focus be changed to predominant centralisation of health provision in the way that some political commentators are advocating for a Government response specifically to pandemic preparedness.

The real question now in light of the CDHB funding conflict is that the Government is actually prepared to produce an appropriate response to health system capacity issues and so far the evidence is not encouraging. Even if we take into account that this pandemic will eventually fizzle out, undercapacity in health is and has been a long term issue in NZ. So far the Government does not appear to have been able to address this, and it is questionable that the restructuring of public health proposed in the Simpson Report should become more important. At the end of the day, the work proposed by Simpson is very unlikely to change the nature of public health facilities as they currently exist within the community, because these facilities are the bare minimum of what is necessary to ensure the provision of services at just the current level.

The key credibility issue that it is necessary for the Government to address is, therefore, the failure of either the Prime Minister or the Health Minister to date to engage with the CDHB staff campaign, since the issues raised there are key to engaging with the undercapacity issue throughout the public health system as a whole. It is just possible that the Government is proposing that Simpson’s reforms will produce such massive efficiency improvements that the capacity issue can be addressed without major funding increases, but we believe this to be highly unlikely. It must therefore be asked whether the Government does, in fact, have any coherent policy on doing on what is actually needed to fix the health system, or whether the deeper issue is a lack of competence in this portfolio as in others.

Canterbury District Health Board campaign increasing in public prominence

This post is a followup to the last two posts we wrote which were also relevant to this subject. Our post of 18th August referred specifically to the relevance of proposed health sector reforms to the overall direction of government policy, and yesterday’s one was about the need to ensure that elected representation is maintained on District Health Boards because the government has proposed removing it. This is a brief note to record that ASMS and health board staff have undertaken additional public campaigning this week and it is becoming increasingly more difficult for the Government to keep sweeping the issues under the carpet.

We’ll note here in passing that the purpose of this blog is to focus on a small number of issues rather than everything that comes along. We will pick about one issue a month and examine that in depth. This issue is one of the very important ones we feel passionate about. We have been posting a bit more lately than in the past but there won’t be lots more posts coming on the blog because we don’t have the time or inclination to write them, and neither are we inclined to seek public prominence.