Heather Simpson declined an interview with POLITIK yesterday at the conclusion of the Beehive Banquet Hall presentation of the Government response to her report on the Health and Disability sector.
That by itself is not unusual.
Simpson is a notoriously media-shy public figure.
But what could she have said?
Two of her most significant recommendations had been tossed aside by Andrew Little and the Health reforms transition team led by Stephen McKernan.
The signs were there within her review team. There was debate over the future of the District Health Boards with some members wanting a more radical restructuring and Maori members of the review are on record opposing recommendation on Maori health.
It is a measure of how bold the reforms proposed yesterday are that they have outflanked Simpson, Helen Clark’s long time advisor and political sounding board.
POLITIK has been told there was considerable debate within the review team about the future of the DHBs, with some favouring a reduction to only a handful. Simpson apparently argued that would not be politically possible. Instead, she proposed that the 20 be reduced to between eight and 12.
Covid has been a big influence on this.
The early experience with the distribution of Personal Protection Equipment (PPE) as outlined in an Auditor General’s report last June showed that the fragmented DHB system meant there was no consistency in who got PPE or how it was distributed and that the Ministry of Health had only a partial picture of what was going on away from Wellington.
In his March Cabinet paper confirming the reforms go-ahead, Health Minister Andrew Little said what required was required was a simpler, more coherent and coordinated structure of organisations, which was clearly led and accountable for achieving national objectives.
“The current status of district health boards as individual Crown entities, with significant operational independence, inhibits this future state and risks perpetuating fragmentation and misalignment,” he said.
“In the future, Health NZ should be a single Crown agent and have sub-national groupings that are internal divisions rather than separate entities.
“These divisions would hold both the regional commissioning and service delivery arms.
“Health NZ will hold public assets including hospitals and equipment and employ public sector workers and health professionals. “
This, of course, was Simpson’s second bite at reforming the health sector.
Ironically she was Helen Clark’s Chief of Staff when the 1999-2008 Labour Government converted 23 Crown Health Enterprises into 21 District Health Boards in 2000. That Government also abolished the centralised Health Funding Authority, which had been established by the National Government in 1997.
However, POLITIK has been told that her reason for opposing the shrinking of the DHBs was pure political pragmatism; she did not think the public would accept it.
But she may have been too conservative.
Though National’s health spokesperson Shane Reti came out saying Little’s proposal was another example of “this Government’s centralise and control ideology”, National’s pollster and Kiwi blogger, David Farrar said: “Overall this is a very bold (even brave) reform which will significantly improve the status quo, if done well.”
The Auckland Employers and Manufacturers’ Association said if the goals of the health reforms were realised, productivity would increase as people would have a better base level of wellness which would enable them to work.
Simpson proposed that a Maori Health Authority be established but that it have powers only to “advise the Minister and monitor system performance with respect to Maori health outcomes.”
But parallel with her report has been a Waitangi Tribunal Inquiry into Hauora Maori (Maori Health).
It has focussed on primary care, mental health and suicide.
But one of Little’s Cabinet papers on the Review said the Māori Advisory Group and some members of the Review panel while agreeing with the Review proposals, wanted additional strengthening of 50/50 governance arrangements to oversee and co-commission with their DHB partners all health services to their populations,” it said.
POLITIK understands that the decision to go for a strengthened MHA was made by the Cabinet rather than the review team within the Department of Prime Minister and Cabinet, and it would seem Associate Health Minister Peeni Henare was a key player in that decision.
“This is a huge personal triumph,” he told reporters yesterday.
“For me and indeed for my people, I’m extremely proud.
“And which is why I said at the end of the speech, this is our day.”
Henare and Little were pressed to provide targets for the Authority, but they declined, with Henare saying what he wanted to see first was a Maori Health Authority that has the right function, form and design.
In fact, POLITIK understands that present thinking is that once the Authority has been established and the Ministry of Health has set the global health targets, the Maori Health Authority will work with the New Zealand health Authority and local iwi to determine priorities which may vary from rohe to rohe.
The agency will essentially be a commissioning agency rather than a provider.
One gap in the outline produced yesterday was the future of primary Health Care Organisations. Simpson proposed that they go and be replaced by GPs contracting directly with DHBs.
But now there are to be no DHBs what is likely to happen is that some PHOs will continue as they do now, and in other cases, “locality networks” of a number of health providers will function as a sort of de facto PHO.
An indication of how flexible these networks might be able to become came in comments from the Minister for Pacific Peoples, Aupito William Sio, who said that people needed to remember the reforms were about trying to address the inequities and the barriers that both Maori and Pasifika faced “and actually it’s gotten worse.”
“Our view is a holistic view,” he said.
“Pacific people are not one people but a number of peoples, and so the challenges for us are overwhelming.
“It isn’t just going to be health that has to address this.
”What I’ve looked at is that our focus isn’t just about physical health.
“It’s mental health, spiritual health; it’s cultural health, It’s economic health.”
It will be up to Andrew Little to steer the fine print and details of the reforms through both Parliament and the bureaucracy. That could be a huge challenge, but he is not daunted by it.
“I think being scared of the size of the problem and the solution is not good government,” he said.
“We have taken on some big challenges as a government in our first term, and now we’re biting off another huge chunk and another massive challenge.
“But actually, if we’re truly acting in the best interests of all New Zealanders, of all people, we have to take this step; we’ve waited too long.”
And it was Peeni Henare who perhaps defined the impact of the reforms the best.
“We talk a lot about being a transformational Government,” he said.
“Some imagine this statement means big infrastructure builds, massive policy commitments all leading up to a single grand reveal.
“But this is what I see as transformation.
“Something quite simple and yet so very complex.”