Labour Health Sector Restructuring Credulity [3]

OK. So waiting to write this last part has been good. Sitting back, gathering more information and watching the government make itself look weak and incompetent hasn’t been such a bad idea at all. Whilst we aren’t affiliated with any particular political cause, we draw strength from the knowledge that the Government has become disconnected from many of its core supporters and members – the health system, especially public hospitals, is highly unionised and many people who work there are passionate supporters of left wing political causes. Their problem is that the Government is unwilling to listen even to them and has sided with Wellington bureaucracy in the Ministry of Health. In respect of public health, we all want to see a better health system and less Government buck passing and vacillation, one way of this would be to stop pretending restructuring will make the public health system better and admit it is not being funded well.

Last December when Parliament rose for the Christmas break, the Government had received a report on the testing and surveillance system for Covid-19, which they chose to release it to the public on the last sitting day of Parliament, ensuring that none of the Opposition MPs would have a chance to read it and ask questions in Parliament about it until next year, when hopefully everyone would have forgotten about it. The report roasted the Ministry of Health, and its myriad failings have continued this year as the vaccine rollout stumbles and falters, along with the rest of the Covid-19 response. Looking at where things have gone with this as close as Australia, New Zealand has been pretty lucky that we haven’t had more virulent outbreaks of some of the more contagious strains here, and the government is sure to find all the goodwill it lapped up at the last election will evaporate pretty quickly in 2023. After all, since the government has just won an election, just why would it choose to suppress a report so early in its new term?

In part 2 we took a look at the Government’s “truth and reconciliation” process followed with Canterbury DHB and how quickly this was suddenly abandoned in 2020. The reason for this is obscure, but it smells strongly of a buck passing exercise from the Ministry of Health in Wellington, who were only really willing to undertake the process at the behest of a new government, and then only for a limited period. It went a certain distance and then collapsed because the contracting process over new buildings in Canterbury, which was under the control of the Ministry in Wellington, blew out its deadlines multiple times resulting in substantial extra cost to the Canterbury DHB. When this produced a ballooning deficit, the Ministry’s response was to pass the blame to the DHB and invent various reasons to “prove” the DHB was mismanaged, simply because the alternative would be politically embarrassing to the government. As we have seen in a number of different spheres, the natural instinct of the present Labour administration is to take greater centralised control of just about everything, and in this particular context, the health system. This means a pretence has to be made that they can do a better job at it than other administrations in the past have. The real truth, however, is that the health system has been restructured multiple times, and each restructuring is a face saving exercise from Government to obscure the real issue, which is lack of sufficient funding. There are really no new ideas to be tried in health administration and the Government’s claims about the purported benefits of the change are mostly focused on managing political outcomes.

The problem for Labour is that they have a strong activist base, one which expects them to do better than the previous National government, and health is one of the key areas where this is important to their supporters. Unions are particularly strong in public health, especially the hospital system, and they are not afraid to protest against the actions of “their” government. We owe a lot to activists in the health system like Dr Phillip Bagshaw and many of his senior doctor colleagues in Christchurch in exposing glaring failings in Government policy resulting in suboptimal outcomes in the health system. This of course is a key part of what has driven Labour to another health restructure and one that is designed to give the Ministry greater control, which is to silence those opposing voices, not to necessarily improve the health system and outcomes for patients. The problem is that they risk alienating key supporters, some of whom will then choose to stay at home on election day. Until Covid came around, Labour was performing poorly in the polls in 2020, an understandable outcome for a party that has largely won political support on the basis of a leader’s personal popularity, rather than in competency of governance. But there is only so much that can be achieved by Jacindamania after all. When it turns out that key political promises aren’t able to be kept and excuses are wearing thin, popularity plummets as has been evident. And the Government has hardly done itself a favour by commissioning reports and then ignoring or burying them – the one mentioned above being an example, but also the report from Heather Simpson and co that didn’t call for the abolition of the DHBs.

Because, in fact, Heather Simpson’s report was a whole lot more closer to what we actually need in the health system than what Andrew Little is proposing. And what experience does Andrew Little have? He is a former union lawyer, and before that a student activist – not someone with experience actually working in the health system. So that means he has to get all his advice from bureaucrats, who have their own vested interests. Whereas, Simpson is a former health economist and her fellow expert review panel members drew on extensive knowledge of the sector. But the bigger picture is simply this: If the government cannot be trusted with the task of managing an effective response to Covid-19, how can people trust that it will be able to restructure the health system effectively, or be able to guarantee all the rest of the public health system will function effectively under a more centralised model?

At the end of the day, Simpson recommended relatively modest changes, and that’s because anyone can see where the failings of the current system are, and that most of them fall with the Government, which has been content for decades to pass the buck on health care, making DHBs a convenient scapegoat for what really comes down to lack of funding. DHBs may not be a perfect solution, but there are many ways in which the government could improve and integrate service delivery in areas like IT without a draconian takeover such as it is proposing. National tried this in their last term, but they were mostly ideologically driven into forcing services to be contracted out to the private sector, rather than in improving outcomes. There’s a whole lot of the proposals about restructuring that look like Ministers living in ideological fairyland, or captured by bureaucratic and consultants’ interests more than by actually making things better.