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.