John Roughan: Change is an illusion with health restructure

OPINION

Today, if you can believe it, our public health system has been reformed. Don't believe it. District health boards disappeared yesterday and the Ministry of Health was divided, its policy advisers remaining the ministry while its administrative apparatus is now called Health NZ.

This is merely a restructure, not a reform. There is a big difference. As the chairman of Southern Cross Health, Greg Gent, put it this week, "Structure follows strategy and I can't clearly see yet what the strategy is."

Nor can professionals in the public sector, from what I hear. They are going to work for a nominally different organisation on Monday but they don't know the point of it all. They don't know what, if anything, they are supposed to do differently.

Restructuring without a clearly stated practical purpose causes only uncertainty, confusion and needless stress. Staff in the health services will have been attending meetings and seminars about this "reform" since it was proposed two years ago.

They will have been assured in general terms that nothing will change, which is probably right but when they sought that assurance for their specific role or task, the sooth-talkers will have hedged. Not even the change-agents know whether anything will change in practice.

We have had an Interim Health NZ for nine months and its website is full of worthy intentions. however, not a word about what it will actually do. The same is true of the new addition to the health structure, a dedicated Māori Health Authority.

District health boards are out - but how will a single health authority operate? Photo / Sylvie Whinray

An Interim MHA has had a great deal to say about "reflecting Māori perspectives" and "ensuring services are designed and delivered to meet Māori needs" but it is hard to find anything in its output so far to suggest it knows precisely what might be done differently.

Who would want to be a health professional at a time like this? It is bad enough that restructuring should be started in a pandemic, doubly odd that it was timed to take effect in mid-winter, when, predictably, hospitals are dealing with seasonal illnesses plus Covid.

But to indulge in a restructuring without strategy is just cruel. Staff emerging from their briefings will have naturally wondered why the Government was going to all this trouble if nothing was going to happen that could threaten their jobs or at least change what they do.

They might well ask. My theory is that Labour people go into politics to change the world but usually lack the courage or practical application to do it properly. So they create illusions of change.

They've done it with tertiary education – what exactly was the point of centralising polytechs? We're seeing it in public broadcasting – tell me again why they are combining RNZ and TVNZ. We're seeing it in Three Waters, where the need for change is not obvious to many.

Health Minister Andrew Little. Photo / Mark Mitchell

Whenever Health Minister Andrew Little offers a rationale for his reforms, he talks about "postcode" services, meaning the range and quality varies depending on where you live. But abolishing DHBs will not change that. It's a fact of life. In a city you will have more hospitals and specialist clinics nearby than if you live in the country.

Little overstates the "postcode" problem anyway. If I break my back in Auckland I'll be sent to the spinal unit at Burwood Hospital in Christchurch. No one part of New Zealand has a complete range of specialist hospital services and never will. It would be a gross waste of resources.

Previous restructurings of our public health system, 30 and 20 years ago, have had clear and well-understood strategic objectives, whether we liked them or not.

The first, by National in the 1990s, was an attempt to apply principles of economic efficiency to the system. Hospitals became crown health enterprises to bid for service contracts by lowering costs where they could and investing the savings for better measurable health returns.

That scheme was undermined by clinicians who resented management by "bean-counters" but it was on the right track. Public health services have an infinite appetite for taxation unless their costs are checked effectively.

The Clark Government replaced crown health enterprises with elected district health boards that were intended to make services responsive to the supposedly differing needs of disparate communities while living within limited budgets. That was the set-up that ended yesterday.

Nobody is mourning the loss of DHBs, certainly not voters. The democratic element was always something of a sham, the ministry dictated most health decisions for all districts. A country with a population no bigger than Sydney didn't need 20 boards.

So now we have a single national authority again. Not much else has changed, unfortunately.