Serious Health Sector Questions Raised By CDHB Funding Debacle

In the news for the last few weeks has been the debacle over CDHB’s deficit. The issue is driven by underfunding of CDHB in recent years, and questions are due as to why the present Government has failed to address this matter, despite expectations. In fact, there is a much greater picture brewing over government policy and direction in general, because Dr Ian Powell, the former head of the senior doctors’ union (Association of Salaried Medical Specialists, or ASMS) has asked some very pertinent questions over Labour’s silence to date and hiding behind the Board when it suits them, which lately has been a lot.

Ian Powell characterises the CDHB’s recent series of issues as being caused by a shift in hospital sector management towards a “centralist authoritarian path”. And if we look in more detail, well that’s particularly been an overall policy focus of the Labour government to date. Examples include:

  • Proposals to roll back “Tomorrow’s Schools” in favour of centralised government management of the schools sector. So far, these proposals have not been implemented.
  • Centralising the Polytech sector with one single polytech for all of NZ being created. Legislation has been passed for this.
  • Health sector reforms proposed to drastically reduce the number of DHBs and create a new super-ministry usurping the role of the existing Ministry of Health.

The question therefore is obvious, and that is whether this Government is much more intentional about going down Powell’s “centralist authoritarian path” in as many of its policies as possible, not just the health sector. Leaving that to one side for now, the lack of Government action on fixing the CDHB’s problems, or even acknowledging them, is very concerning for Canterbury residents. A second issue is the loss of localisation in the provision of health services by the 20 DHBs currently existing around the country. Doubtless there are tensions over the appropriate form of governance of the health sector, or in fact anything that involves a local political system. Here we see the benefit in local governance terms of the current structure of regional and territorial Councils. There is however a balance to be found in respect of the size of elected authorities and of the territories they administer. We have long thought that our local government reforms of 1989 struck a reasonable balance, but did leave too many very small territorial councils around parts of the country struggling to run their services, when these councils should have been amalgamated into bigger ones whilst creating local boards for specific smaller areas within the large councils.

The biggest problem with the health reforms being proposed by Heather Simpson is twofold: the 20 DHBs are to be amalgamated into a smaller number, and the elected membership is to be replaced by appointees. The problem has always been that the Government set out by design to undermine the elected membership from the start. The Government has always appointed DHB chairs and a large percentage of the members as well. Chairs are also able to ban elected members from speaking out independently. But there is at least some semblance of local political input into the DHB and it is very hard to understand the rationale for the Government’s thinking, but the most obvious outcome is that what DHBs do and how they achieve their objectives will become much less visible to the public. It is very easy to see the Government wanting to control the key areas of Government spending (such as Health and Education) even more than they do now. This impression is exacerbated to a large degree by the Government’s obvious silence and acquiescence on a considerable number of issues to the extent that it has been remarked upon considerably by Labour activists and members.

Dr Powell has done a great job in his article of alerting us to the poisonous culture that has been created by Government buck passing on the problems at CDHB, and the conspicuous lack of commitment to sensible resolution by the current administration. We have felt that David Clark was clearly out of his depth or unwilling to make the effort needed to understand the issues in the sector. But his successor has had a great opportunity to set matters right, and so far his performance has been unimpressive. Nor should it be overlooked that the much-lauded in Covid-19 health management Director General, Dr Bloomfield, has done very little to address the existing problems within the sector in the last 2 1/2 years since he was appointed. It thus becomes a question of the justification that the Government has for its lack of action in resolving longstanding problems in the health sector. It should not be overlooked in general that Labour has chosen not to issue a policy manifesto for the forthcoming election. Whilst this may be somewhat appropriate from the viewpoint that the landscape has changed substantially because of Covid-19, the overriding concern is that Labour has become arrogant and regards itself as entitled to govern without much feedback to the electorate. The election has become dominated by Labour’s management of the Covid crisis and very little else. In essence this has unfortunate overtones of the Fourth Labour Government in its mid-term elections (1987). Labour at that period of its history had bridged the divide between its traditional support base and the centre-right element of the electorate and gained an increased majority to return to the Treasury benches that year. This time around, a lot of policy for the last three years has been dictated by the Coalition partnerships between Labour and its support parties, and Labour itself has become more focused on controversial issues like the abortion laws, and endless reviews and inquiries. It got the welfare reform proposals but has failed to act on most of the recommended outcomes. We rapidly get the impression that the Government is just feeling its way through its term without a strong sense of direction, since the reviews and enquiries could be charitably seen as just another way of pretending to be committed to an issue without actually following through with any action.

As the campaigning is ongoing, with senior doctors and clinicians continuing to campaign publicly about the troubled approach the Government has been making to CDHB’s funding woes, we fail to see how it is possible for the Government to continue on their current course, lest they get their fingers badly burned over the issue. It only takes one astute politician to make a promise to properly fund the DHB and it could end up being a considerable embarassment for Labour. To date they are showing themselves either quite inept at addressing the issues, or deliberately scheming to shut down debate and further centralise control. We think the overall approach is a combination of these, in that the Government has made use of the convenience of Covid-19 upstaging all other news reports and crowing about their skills in managing the pandemic to date. However every time there is some sort of stuff up in quarantine as has happened each time there has been an unexpected outbreak, a buck passing exercise has ensued, and whilst Dr Bloomfield hasn’t got to deal with the embarassment of being thrown under the bus by David Clark yet, the ongoing failures have the potential to cost the Government dearly in election support. In other words, it is hard to understand Labour’s results to date; either the Minister of Health is remarkably uncommitted and unable to rise to the task, or the Government is really engaging in a ruthless political whitewashing strategy of attempting to avoid accountability. This is of course what we saw in the 2017 elections; the damaging speculation on capital gains tax was not effectively managed by the senior Labour candidates and cost votes in the end. This in turn puts Ian Powell’s references to “centralised authoritarianism” all the more relevant; if the Government can control the news coming out of the health sector even more, it can limit the spread of bad news in the form of how it is coming out now, but consumers will be the losers.