DHB overhaul latest salvo in control war

The Government’s plan to scrap all 20 district health boards in favour of one mega health authority could make or break this Government when it faces reelection in 2023.

It also opens a battlefield in a political war between the forces of centralisation and those of localism.

The new mega agency, New Zealand Health, will split the country into four regions, but the Government is also proposing a new Ma¯ ori health authority. It will not only be a policy workshop but will also have the power to commission healthcare services. That is, it will have money to buy health services for Ma¯ ori.

For the National Party this potentially presents a longrunning political opportunity.

Up until the last election, National had the best grounding in communities around the country. It had the ability to mount a campaign based on the Government taking away your health board and relocating it into an ugly building filled with faceless bureaucrats – and Ashley Bloomfield – in Wellington.

Whether it has the resources or wherewithal in its numerically diminished state to do that now is an open question.

Nevertheless, National Party leader Judith Collins and her deputy and health spokesman Shane Reti have lined up against the changes. They acknowledge the health board system has some problems, but say localism is important.

Their problem is the current system is widely considered broken. And, damning for the localists is that very few people know who the hell they are voting for to sit on these boards. It’s a tough proposition to defend. Few outside the system think the status quo is working.

Even within the troubled Canterbury District Health Board, the chairman, Sir John Hansen, welcomed the changes as good for equity and to reduce duplication, while another board member slammed the changes as ‘‘terrifying’’ and ‘‘undemocratic’’. But outside the local government set, it is unclear how far that latter sentiment spreads.

Contrast that with Labour’s big new health plan, which Health Minister Andrew Little was keen to describe yesterday as a ‘‘a truly national health service’’ that would deliver the goods more equitably around the country.

The question now for the Government will be whether Little has the political skill to drive this reform through.

The exact shape of the new system is so far basically unknown save the high-level structure. There is a good chance it will be a make-work bonanza for management consultants and organisational change specialists. Not to mention the massive IT, payroll, and employment changes that will need to go alongside this.

In its first term Labour was rightly castigated for its inability to deliver on its promises. Delivering this change, before the end of the term, will require Little to confound those expectations.

To be fair, the Government has done this, on a much smaller scale, with the amalgamation of the nation’s polytechnics. There have been resignations and certainly some unhappiness in the sector – it is too early to tell whether it has been a success.

With health, it will be easier to know, and quickly. Basically every New Zealander is a customer of the health system. And the Government has said it will find a design that includes lots of local feedback on how the system should work in different areas. Easier said than done.

The other big play for National is over the proposed Ma¯ ori health authority. Collins calls it a ‘‘separatist route’’ that will end up ‘‘giving people operations based on race, not on need’’, and which National has vowed to repeal.

Again, managing the politics of this is a fine line for Collins. No doubt many Kiwis will agree with this sentiment, and Collins is a genuine one-law-for-all person.

Equally, lots of New Zealanders look at the terrible health outcomes for Ma¯ ori and will figure if it takes elements of a separate Ma¯ ori system, why not? Even within Labour, what precise shape the authority should take, and what powers it should have, have been and will continue to be a cause of heated debate.