Fixing the Health System?

Really interesting to read various summations of the report delivered by the veritable Helen Simpson containing recommendations for the future management of Health Boards.  She recommends “culling” the number of Health Boards to eight.  There are currently twenty.

Further – she recommends a new Crown Entity to oversee services and finances to which members would be appointed rather than elected.

Finally, she recommends a new Maori Health Authority that reports to the Health Minister.

Notwithstanding that the process of electing SOME members of DHBs was a dodgy dupe by a previous Labour led government successfully hoodwinking us into thinking we would have a say in how local health should be managed; I think the idea of reducing the number of decision-makers is sound.  However, the “appointments process” needs to be about skill rather than  reward; and it needs to focus on governors who have the intestinal fortitude to hold their teams to account.  If that happens Helen Simpson’s recommendation just might work.

I’m less excited with the notion that a separate Maori Authority reporting to the Health Minister is a good thing.  So far, the current Minister has transgressed the Covid 19 restrictions twice and been noticeably absent from most media coverage during that period at least until he reappeared to toss Ashley Bloomfield under a bus.  What guarantees do we have that future Health Ministers will be any more savvy?  Especially with regard to Maori Health? 

Look no further than the Auditor General’s 2015 damning investigation into Whanau Ora. I wrote then in a blog to myself: “There is nothing wrong with the concept of Whanau Ora.  There is however something seriously wrong with a civil service who by their complacency would allow such a simple concept to founder on the basis of a wide and varying range of “initiatives” to implement (complicate) it. 

Across the health, education and social service sectors commonplace tactics include:

• unavailability and/or failure to return phone calls

• ‘need for  further  research to inform their actions’

• participation in cross agency ‘project teams’ with no delivery date

• focus on the process rather  than the problem

• departmental restructures which put everything else on hold

• ‘need to investigate alternatives’

• ‘need to  see how other ‘initiatives’ or ‘pilots’ have panned out’

• one size suits all solutions  designed by policy analysts with little knowledge of what goes on              outside of Wellington”

These tactics are still commonplace.  What we need is not more bureaucracy, but a process to ensure that those implementing it have the humility and the ability to communicate; and the imagination to get off their butts and work towards a common goal rather than their own generously funded retirements from a system  seemingly disinterested in holding anyone accountable. Both the damning statistics of Maori health and the dodgy statistics of the health and well-being of New Zealanders generally, confirm this.  Had Whanau Ora been implemented according to its original intent ALL new Zealanders would have benefitted.

I salute Dame Tariana Turia for her vision and I mourn with her its delayed implementation.