A bold health package

Published in Insights, The New Zealand Initiative’s newsletter, 23 April 2021

Is it okay not to have an instant opinion on the Government’s proposed health shake-up?

There is no doubt the package, announced by Health Minister Andrew Little on Wednesday, is bold.

Abolishing all existing District Health Boards (DHBs), creating a single national health service, establishing a Māori Health Authority, curtailing the Ministry of Health, and forming a Public Health Agency: each one of these measures is significant. Taken together, it means no stone in health will be left unturned.

Hardly anyone would disagree with the Government’s analysis that the current health setup is broken. It is wasteful, inefficient, and does not deliver the outcomes the public expects.

Not even convinced localists like myself will miss the DHBs. Lacking in accountability and transparency, they were devolution in name only – and there were too many of them in any case.

The Government also deserves praise for introducing their health reforms while allowing for consultation, debate, and scrutiny. This should be standard practice, of course. Except more recently, it has not been.

The idea of a Māori Health Authority has turned out to be the most controversial part of the package. The opposition is portraying the move as institutionalised racism.

However, there is a different way of looking at it. It is also possible that the Māori Health Authority would inject a form of competition into the health system. Providing a Māori alternative could be a benchmark on which the rest of the health system could be measured – and vice versa.

So there are some positives about the package, and indeed the overall public response has been welcoming.

That said, a few aspects are worrying. Why, for example, would the Māori Health Authority have a veto on Health New Zealand’s operations? Both organisations are separate, why not independent?

You may also wonder whether the solution to the sham devolution of DHBs should be the complete centralisation of everything. If 20 DHBs did not work, why abolish them all? Why not group them into larger and fewer organisations, just as Heather Simpson proposed?

The Government likened their proposed model to Britain’s NHS. But the point of the NHS is not primarily that it is centrally administered but that health services are free at the point of delivery.

Finally, it is already clear that the new Public Health Agency could have a remit well beyond genuine public health concerns such as pandemic preparedness. From a policy perspective, this could be highly problematic.

It is early in the discussions, and much will depend on details not yet available. The Government’s package is intriguing and courageous. Whether it will work remains to be seen.