Te Whatu Ora has taken over all the District Health Boards, and unfortunately the government has set it up in a way in which means it doesn’t need to be fully accountable or transparent to the public. They have decided that the decision-making over the billions of dollars for hospitals and healthcare will be conducted in secret, with only limited means for the public to discover what is going on. This has been done through the Pae Ora (Healthy Futures) Act 2022, which treats Te Whatu Ora (as well as Te Aka Whai Ora – the Māori Health Authority) as a simple Crown entity that is not obliged to operate with democratic elements like open meetings.
For example, this means the new Te Whatu Ora governing board has debated whether to hold their monthly meetings openly, as DHBs always did, and decided against it. Similarly, all associated board papers and documents will be treated as private rather than automatically public. Even minutes from the board meetings will only be made public one month after the meetings.
Controversially, the new board chair Rob Campbell has stridently explained that Te Whatu Ora doesn’t see openness as a core responsibility, but instead wants to just forge ahead, unimpeded by scrutiny: “We will continue to consider any issues about the business, but right at the moment getting on with the work is more important to us than providing occupational therapy for journalists.”
Yesterday’s Otago Daily Times editorial labelled Campbell’s statement “outrageous”. The newspaper said that instead of such “glib one-liners”, what is needed in the health sector “is a genuine commitment to openness”.
What Te Whatu Ora is offering instead, is a monthly press conference, in which Campbell and chief executive Fepulea’i Margie Apa will give their accounts of decision-making and field questions.
National’s health spokesperson, Shane Reti, says this isn’t good enough: “I think that will be sanitised spin and that it will be different, I would suggest, from the source when it was first delivered to the table”. Reti also explained that you pick up much more by attending health board meetings than you do simply from reading the reports and minutes. For example, he says: “You see the body language, you see the sighs, you see the rolling of the eyes.”
Similarly, the Otago Daily Times points out that the press conferences will be less informative than the open meetings because “journalists attending begin from a position of ignorance, not knowing the full details of what was discussed.”
The more open process of DHBs has been lost
To understand how inadequate the new model is, it’s important to realise that the now-abolished DHBs offered so much more. It was enshrined in legislation that each DHB had to release extensive agendas and reports for public consumption before each monthly meeting. These were normally put online at least two days before. The meetings were then open to the public, often with the ability for anyone to make submissions. Sometimes there were closed sessions, but these were the exception, not the norm.
NZ Herald investigative journalist David Fisher says the former system gave a “clear view of the inner workings of our health system” but this openness “has dramatically declined”. He claims, “In terms of transparency, our health system has gone from ‘drive’ into ‘reverse’ without slowing down. Our ability to see inside the health machine has gone from a monthly warrant of fitness check to turning up to be told what the board wants to tell us.”
Fisher provides a useful account of what the old meetings were like: “Those old health board and committee meetings provided an extraordinary amount of information about our health system. They were preceded by agendas and recorded in minutes, which provided those interested in a real-time narrative of our health system and health-related events in our communities. The 91-page agenda for the last Auckland District Health Board meeting is typical of its kind, containing details of operation of services and systems. Hospital Advisory Committee agendas, along with others, combined to tell a story of our health system that was rewarding and rich.”
He also points out that it wasn’t just information gained by openness, but it also produced a culture in which authorities were inherently self-checking and self-monitoring: “It required those health boards to look into their own organisations, and into their communities, lest they produce a document that overlooked either.”
In contrast to releasing expert and detailed reports to inform the monthly meetings, Te Whatu Ora officials will now put out bullet points about what is to be discussed. And the new ethos appears to be a starting point that nothing is to be released unless it can be proved to be legally necessary.
Corporate governors and PR professionals are firmly in control
Fears that Labour’s centralisation drive in health would result in more secrecy appear to be playing out. Also, the fashionable model in which corporate governors and PR professionals are firmly in control of all the public information appears to be well established in this new public mega-entity. As with other government agencies dominated by spin-doctors, Te Whatu Ora will only let the public know what the comms specialists think the public need to know.
It also means that healthcare workers won’t know what’s going on. A Stuff newspaper editorial today says, “It’s a terrible sign when healthcare workers have no idea what’s going on in the system that governs what they do. And when that system is at breaking point, secrecy looks incredibly suspect.”
Some health workers are now speaking out against this model. Today it’s being reported that Gastroenterologist Dr Richard Stein, a former Hutt Valley health board member, described Te Whatu Ora as a “huge entity that’s operating in secret” and says board chair Rob Campbell is “running this like a corporation”.
Another Hutt Hospital worker has spoken out today anonymously, saying transparency is declining, and that “it’s just getting worse … the public’s got a right to know what’s going on.” This “nightmare” on the frontline is contributing to the departure of staff, according to the clinician.
It’s also concerning that patient advocate groups are going to be shut out of the new decision-making process. Previously under the DHB model, their voices were an important input, especially because their submissions could be made to board meetings. But there no longer appear to be any avenues for this.
Campbell as chair and Apa as chief executive say the decline of open forums won’t matter because they will be available to answer questions. However, media have been reporting that the pair have so far been declining requests for interviews. For example, Stuff reports today that: “Repeated efforts to interview Te Whatu Ora chief executive Margie Apa for a major health investigative series last month were, after 25 days of trying, met with a 1200-word statement, with some questions ignored.”
Similarly, under the old DHB system data on health outcomes and other statistics were routinely made available, but now journalists have been told by Te Whatu Ora that they need to make requests under the Official Information Act, which will obviously mean delays and greater opaqueness.
What the Government needs to do
So far the Government has sided with Te Whatu Ora, with Health Minister Andrew Little saying he’s comfortable with the approach outlined by Campbell. Little says today: “For a large organisation with accountability requirements, it is conducting itself appropriately.” He has also suggested that the old DHB model wasn’t as open as journalists suggest.
Like Campbell, Little has also pointed out that Te Whatu Ora only has the same obligations as other Crown entities, who are not obliged to have the sort of openness that DHBs used to have. But is this good enough? David Fisher says health is quite different to other Crown entities: “There are few government agencies which have the reach and critical importance to people’s lives and well-being as Te Whatu Ora.”
The Association of Salaried Medical Specialists has also spoken out, saying the new board should open its doors. Executive director Sarah Dalton argues it would send an important signal to the public “that what they’re doing is visible, up for debate and open”.
The ball is in Labour’s court. They could either change the rules for all Crown entities, forcing them to have open meetings and transparency, or they could simply amend the Pae Ora (Healthy Futures) Act 2022 to give Te Whatu Ora the same responsibilities for open meetings that the DHBs used to have. The agency could also be directed in legislation to make sure it is not withholding information that is in the public interest.
Fisher has some other ideas for reform, too. He says an independent review could be established to look at how well Te Whatu Ora is doing in providing information to the public. For example, he says such an exercise could “review media requests to Te Whatu Ora and see whether journalists consider questions to be satisfactorily answered and whether interviews with its staff would do so more effectively than information filtered through its communications team.”
This might all seem very esoteric, but the supply of official information to the public is not just a core part of democracy, but also what makes systems provide better public outcomes. In this case, better healthcare.
One of the key lessons of the last few decades of government sector reforms is that it’s only through openness and accountability that public services can be protected from bureaupathic outcomes. With Te Whatu Ora, too much is at stake in terms of the billions of taxpayer dollars and the health of the nation for Labour to allow what is a fundamental decline in democracy to become embedded.
For example, this means the new Te Whatu Ora governing board has debated whether to hold their monthly meetings openly, as DHBs always did, and decided against it. Similarly, all associated board papers and documents will be treated as private rather than automatically public. Even minutes from the board meetings will only be made public one month after the meetings.
Controversially, the new board chair Rob Campbell has stridently explained that Te Whatu Ora doesn’t see openness as a core responsibility, but instead wants to just forge ahead, unimpeded by scrutiny: “We will continue to consider any issues about the business, but right at the moment getting on with the work is more important to us than providing occupational therapy for journalists.”
Yesterday’s Otago Daily Times editorial labelled Campbell’s statement “outrageous”. The newspaper said that instead of such “glib one-liners”, what is needed in the health sector “is a genuine commitment to openness”.
What Te Whatu Ora is offering instead, is a monthly press conference, in which Campbell and chief executive Fepulea’i Margie Apa will give their accounts of decision-making and field questions.
National’s health spokesperson, Shane Reti, says this isn’t good enough: “I think that will be sanitised spin and that it will be different, I would suggest, from the source when it was first delivered to the table”. Reti also explained that you pick up much more by attending health board meetings than you do simply from reading the reports and minutes. For example, he says: “You see the body language, you see the sighs, you see the rolling of the eyes.”
Similarly, the Otago Daily Times points out that the press conferences will be less informative than the open meetings because “journalists attending begin from a position of ignorance, not knowing the full details of what was discussed.”
The more open process of DHBs has been lost
To understand how inadequate the new model is, it’s important to realise that the now-abolished DHBs offered so much more. It was enshrined in legislation that each DHB had to release extensive agendas and reports for public consumption before each monthly meeting. These were normally put online at least two days before. The meetings were then open to the public, often with the ability for anyone to make submissions. Sometimes there were closed sessions, but these were the exception, not the norm.
NZ Herald investigative journalist David Fisher says the former system gave a “clear view of the inner workings of our health system” but this openness “has dramatically declined”. He claims, “In terms of transparency, our health system has gone from ‘drive’ into ‘reverse’ without slowing down. Our ability to see inside the health machine has gone from a monthly warrant of fitness check to turning up to be told what the board wants to tell us.”
Fisher provides a useful account of what the old meetings were like: “Those old health board and committee meetings provided an extraordinary amount of information about our health system. They were preceded by agendas and recorded in minutes, which provided those interested in a real-time narrative of our health system and health-related events in our communities. The 91-page agenda for the last Auckland District Health Board meeting is typical of its kind, containing details of operation of services and systems. Hospital Advisory Committee agendas, along with others, combined to tell a story of our health system that was rewarding and rich.”
He also points out that it wasn’t just information gained by openness, but it also produced a culture in which authorities were inherently self-checking and self-monitoring: “It required those health boards to look into their own organisations, and into their communities, lest they produce a document that overlooked either.”
In contrast to releasing expert and detailed reports to inform the monthly meetings, Te Whatu Ora officials will now put out bullet points about what is to be discussed. And the new ethos appears to be a starting point that nothing is to be released unless it can be proved to be legally necessary.
Corporate governors and PR professionals are firmly in control
Fears that Labour’s centralisation drive in health would result in more secrecy appear to be playing out. Also, the fashionable model in which corporate governors and PR professionals are firmly in control of all the public information appears to be well established in this new public mega-entity. As with other government agencies dominated by spin-doctors, Te Whatu Ora will only let the public know what the comms specialists think the public need to know.
It also means that healthcare workers won’t know what’s going on. A Stuff newspaper editorial today says, “It’s a terrible sign when healthcare workers have no idea what’s going on in the system that governs what they do. And when that system is at breaking point, secrecy looks incredibly suspect.”
Some health workers are now speaking out against this model. Today it’s being reported that Gastroenterologist Dr Richard Stein, a former Hutt Valley health board member, described Te Whatu Ora as a “huge entity that’s operating in secret” and says board chair Rob Campbell is “running this like a corporation”.
Another Hutt Hospital worker has spoken out today anonymously, saying transparency is declining, and that “it’s just getting worse … the public’s got a right to know what’s going on.” This “nightmare” on the frontline is contributing to the departure of staff, according to the clinician.
It’s also concerning that patient advocate groups are going to be shut out of the new decision-making process. Previously under the DHB model, their voices were an important input, especially because their submissions could be made to board meetings. But there no longer appear to be any avenues for this.
Campbell as chair and Apa as chief executive say the decline of open forums won’t matter because they will be available to answer questions. However, media have been reporting that the pair have so far been declining requests for interviews. For example, Stuff reports today that: “Repeated efforts to interview Te Whatu Ora chief executive Margie Apa for a major health investigative series last month were, after 25 days of trying, met with a 1200-word statement, with some questions ignored.”
Similarly, under the old DHB system data on health outcomes and other statistics were routinely made available, but now journalists have been told by Te Whatu Ora that they need to make requests under the Official Information Act, which will obviously mean delays and greater opaqueness.
What the Government needs to do
So far the Government has sided with Te Whatu Ora, with Health Minister Andrew Little saying he’s comfortable with the approach outlined by Campbell. Little says today: “For a large organisation with accountability requirements, it is conducting itself appropriately.” He has also suggested that the old DHB model wasn’t as open as journalists suggest.
Like Campbell, Little has also pointed out that Te Whatu Ora only has the same obligations as other Crown entities, who are not obliged to have the sort of openness that DHBs used to have. But is this good enough? David Fisher says health is quite different to other Crown entities: “There are few government agencies which have the reach and critical importance to people’s lives and well-being as Te Whatu Ora.”
The Association of Salaried Medical Specialists has also spoken out, saying the new board should open its doors. Executive director Sarah Dalton argues it would send an important signal to the public “that what they’re doing is visible, up for debate and open”.
The ball is in Labour’s court. They could either change the rules for all Crown entities, forcing them to have open meetings and transparency, or they could simply amend the Pae Ora (Healthy Futures) Act 2022 to give Te Whatu Ora the same responsibilities for open meetings that the DHBs used to have. The agency could also be directed in legislation to make sure it is not withholding information that is in the public interest.
Fisher has some other ideas for reform, too. He says an independent review could be established to look at how well Te Whatu Ora is doing in providing information to the public. For example, he says such an exercise could “review media requests to Te Whatu Ora and see whether journalists consider questions to be satisfactorily answered and whether interviews with its staff would do so more effectively than information filtered through its communications team.”
This might all seem very esoteric, but the supply of official information to the public is not just a core part of democracy, but also what makes systems provide better public outcomes. In this case, better healthcare.
One of the key lessons of the last few decades of government sector reforms is that it’s only through openness and accountability that public services can be protected from bureaupathic outcomes. With Te Whatu Ora, too much is at stake in terms of the billions of taxpayer dollars and the health of the nation for Labour to allow what is a fundamental decline in democracy to become embedded.
Dr Bryce Edwards is a politics lecturer at Victoria University and director of Critical Politics, a project focused on researching New Zealand politics and society. This article was first published HERE
3 comments:
"The Labour Government needs to force Te Whatu Ora to be transparent and open to scrutiny.
Te Whatu Ora has taken over all the District Health Boards, and unfortunately the government has set it up in a way in which means it doesn’t need to be fully accountable or transparent to the public."
Bryce has, perhaps unintentionally, exposed a massive hole in his own suggestion that Labour are somehow disconnected from the "opaque" workings of Health NZ (I'm not using the new Maori name) by then stating that the government has set it up to be exactly what Bryce suggests they don't want.
Come on, mate! We have so many examples of this awful government NOT being the most transparent ever. This is just one more and should be crystal clear to someone like yourself who is across all public policy issues.
Then again, there are none so blind that cannot see!
What did we really expect? The Auditor General has already slammed the likely public accountability, transparency, and organisational performance of the Three Waters governance structure, did we really think the Health reform, what with its other complexities, would be any different? Willie Jackson said we had nothing to 'fear' about co-governance - pity he didn't add that that it works on the basis - what you don't know won't hurt you (as in the latter causing apprehension and fear.)
Now here's an equally obvious wager for you, I'll bet anything you like that Maori Health statistics will not unsurprisingly show some improvement, (after all, as I think Disraeli opined, there are lies, damned lies and statistics), but the qualification and inevitable refrain will be, that they do need more resources.
Just another example in the long line of labour cult incompetence, secrecy and totalitarianism. Each and every ministry is under the influence of dictatorial ministers who have very low understanding of their relevant ministeries, little to no ability and very limited command of the English language.
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