Bye Bye DHBs: With an Axe Not a Scalpel

I have previously lamented that New Zealand politicians no longer believe in anything. That the energy and reforming zeal of past decades has been replaced by Much Talk and No Action. We were, I snarkily noted, living under the most inconsequential New Zealand Government since the second term of Sir Joseph Ward (1928-1930), with only Coronavirus hiding the fact.

Well, as of a couple of days ago, the Sixth Labour Government momentarily channelled the demonic ambition of the Fourth. We got a jaw-droppingly massive reform.

Namely, the abolition of the District Health Boards. Henceforth, the New Zealand Health Sector will be run from Wellington.

This is the biggest shake-up of the New Zealand Health System in nearly thirty years… though to be honest, I am actually unsure about whether this is a Good Thing or a Bad Thing.

To clarify, what happened under the DHB system was that people would elect a local Board to run Health Services in their area. There were twenty or so such Boards throughout the country, while the funding itself would come from the central government in Wellington.

While the idea was to put control of local services in the hands of locally accountable people, the dysfunction was infamous. DHBs would invariably get into glorious shouting matches with the Minister in Wellington. A DHB would insist that there was insufficient funding, while Wellington would insist that the DHB were muppets. Occasionally, the Minister could (and did) sack the elected DHB, and replace them with central government appointments. It happened to my own local DHB a few years back.

So abolishing the DHBs and replacing them with Direct Rule from Wellington eliminates that problem. I have also seen anecdotes from people elected to DHBs, who found themselves frustrated at being mere rubber-stamps for their local officials – sure, we lose democratic input with this change, but the real power was never with the elected representatives, who were reduced to window-dressing.

So that means the latest reform is a Good Thing, right? Well, as I mentioned above, I am unsure.

You see, the one thing the DHB model did achieve is that you had local people advocating for Health Services within their region. Famously, the West Coast always got angsty about any suggestion of a Health Board merger, since they saw that as an inevitable stepping stone to the loss of local services:

Those Coasters were worried that they would be merged into another area, which would not understand their needs. Well, as it turned out, everyone got merged… not just them. Will this lead to Wellington decision-makers cutting services in the regions? Who knows. And that is the potential downside – albeit, Wellington will now have to own political responsibility for cuts, in a way that previously could be blamed on the DHBs.

I would also note that this reform is getting cheered by both Right and Left in the media – which, again, makes me rather ambivalent. Sure, no-one is enthusiastically defending the DHB system because no-one was happy with it, but if the Right are happy with a Labour Government’s reform, that has too many historical connotations for my liking. Maybe we have reached the stage where the New Zealand Left – even with an absolute majority and the Coronavirus Crisis – can only enact big changes if the Right agrees. Which is not an encouraging thought about what those changes represent.

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