Rob Campbell: Caution needed on Government’s plans to devolve health back to community, iwi

Health Minister Shane Reti's health dream for Māori might be a nightmare for whānau. Photo / Mark Mitchell

OPINION

The parties which comprise the Coalition successfully sold to the electorate a view that the previous Government had centralised too much and that the costs of centralisation far outweighed the benefits. This has created a support base for some cutting back on reforms and promises of further decentralisation and returning influence and funding to local communities.

This whole process of setting the scene and feeding the perception has been effective to date. Many local community and iwi-based organisations, even if they retain some scepticism about their new “friend”, are drawn towards this option given previous years of central government confusion and under-funding.

Health Minister Dr Shane Reti had a Martin Luther King moment for Māori health, and he has plans to make that dream a reality. Photo / Supplied

Shane Reti’s dream for Māori health is admirable but comes with warnings.

I have been an advocate for moving control and funding in social services closer to local communities but even so, I urge great caution on the direction of change we now have.

There is a number of reasons for caution. I outline some of them here but emphasise that this is not an argument against localisation itself for many services. The fact that some centralisation has been poorly defined, funded, and managed by a previous government/s does not make national standards, policies and funding wrong in themselves in a country with a population less than many cities.

Caution 1. It’s all very well to devolve funding and control but this can only work if there is capability at local level to handle whatever process is involved. In most cases this will not exist if it has never been needed in the past. In some cases it will be there and in most if not all out can be developed but no devolution will work without it.

Caution 2. Funding does not increase by devolution. Often it can be associated with some sleight of hand or “balance sheet” shifting which means that local funding costs or direct user charges will come with it. A big reason central government devolves is to shift risk of failure and funding costs. If you did not trust them to deliver themselves then hard to see why you would trust the devolution proposal without great care.

Caution 3. Devolution does not avoid inherent inequities on its own. Local or regional controls may be just as, or even more subject to power imbalances between classes and cultures to the detriment of those in greatest need. The influence of the white, wealthy and well-educated does not end at the borders of Parliament.

Caution 4. For many services there are economies of scale and scope. From technology to financial management to fundraising . Any planned devolution must include a clear and committed plan to national delivery of such services on equitable terms in regard to their structure, access and cost.

Caution 5. There are significant inequities between any selected local, regional or other communities. While community control can drive and energise the best services, there remains a need to have funding collected centrally and disbursed by defined needs unless such inequity is to be entrenched.

All of these cautions can be met and increasing controls and funding devolved safely, sensibly and socially equitably. But its not just a matter of stopping old practices. Far from it. To succeed there is an even greater need for design to be detailed and appropriate from market structures to management and regulation of activities. There may also be a need for much higher degrees of inter-community trust than currently exists. From health to water services to education and elsewhere you have to doubt whether this can be created quickly or effectively.

Rob Campbell. Photo / Michael Craig

Some iwi are well advanced in this. Capabilities at local authority level vary widely (and this may be an an area in which prior reform is required for substantive devolution to succeed). In other communities new structures will need to be created. This will cost and take time.

My view is that both the cost and the time and the care needed are very worthwhile for Aotearoa. But the present process where the old is liable to be stopped before the new is able or properly funded to work is fraught with danger and mostly for those in most need of social services.

Rob Campbell is a professional director and investor. He is chancellor at AUT, chairman of Ara Ake, chairman of NZ Rural Land, and an adviser for Dave Letele’s BBM charity. He is also the former chairman of Te Whatu Ora Health New Zealand.