Bryce Edwards: Govt must make healthcare transparent again

Bryce Edwards: Govt must make healthcare transparent again

The new “Health NZ” centralised government entity, now rebranding as “Te Whatu Ora”, looks like it’s starting life as the epitome of the new public sector model of PR-led public service shielded from full accountability and transparency. 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. 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.


Dr Bryce Edwards is Political Analyst in Residence at Victoria University of Wellington. He is the director of the Democracy Project.

This article can be republished under a Creative Commons CC BY-ND 4.0  license. Attributions should include a link to the Democracy Project.  


Further reading today on healthcare transparency

Stuff Editorial: Te Whatu Ora needs to open the shutters if it’s serious about improving healthcare
ODT Editorial: Transparency an issue for health
Rachel Thomas (Stuff): New health authority accused of ‘operating in secret’ over closed-door meetings
Bridie Witton (Stuff): Health Minister Andrew Little defends Health NZ’s transparency


Other items of interest and importance today

Claire Trevett (Herald): Green Party co-leader Marama Davidson defends Whittaker’s chocolate social media post after PM raises issues
Madeleine Chapman (Spinoff): An incomplete list of ministers not endorsing* specific products
RNZ: Davidson’s bittersweet rebellion over te reo Māori
Eva Corlett (The Guardian): New Zealand minister defies Ardern in Māori language chocolate bar row
Maiki Sherman (1News): Davidson defiant over Whittaker’s post despite PM saying it should come down
Steven Cowan: Marama Davidson: Let them eat chocolate!
Lloyd Burr (Today FM): Prime Minister Jacinda Ardern needs to back off on Te Reo chocolate block beat up

Thomas Coughlan and Tamsyn Parker (Herald): Government quietly introduces $103 billion tax on Kiwisaver

Sam Stubbs (Stuff): Is GST on KiwiSaver fees a stealth wealth tax?
RNZ: Plan to charge GST on KiwiSaver fees ‘a wealth tax’ – fund manager

Rob Stock (Stuff): ‘Tax grab’: Government plans to levy GST of $225 million each year on KiwiSaver
BusinessDesk: Parker quietly tables proposed $225m KiwiSaver tax (paywalled)
Tom Pullar-Strecker (Stuff): GST on all Ubers and Airbnb bookings, but new tax break for public transport
Rachel Smalley (Today FM): Labour are not as transparent as they like to think

Susan Edmunds (Stuff): GST on KiwiSaver fees backlash ‘shows how passionate savers are’
RNZ: Christopher Luxon accuses govt of tax grab over KiwiSaver fees plan
Mark Quinlivan (Newshub): Government’s planned GST charge on KiwiSaver ‘a brand new tax’, specialist says

Gordon Campbell: On the centre-left’s reluctance to pursue radical options
Glenn McConnell (Stuff): Adrian Rurawhe’s job as Speaker could leave opening for Māori Party

David Farrar (Patreon): What to do with Uffindell (paywalled)
Claire Trevett (Herald): Cost-of-living payment Groundhog Day for Government(paywalled)
Amelia Wade (Newshub): Cost of living payment: Foreign property investors received first portion of money
Herald: Editorial: Will storm over cost-of-living payments blow over? (paywalled)
Peter Dunne: It’s the putting right that counts
Tim Murphy and Matthew Scott (Newsroom): Labour’s prizes: Art, wine and the Ardern Cup

Sam Sachdeva (Newsroom): Parliament funding squeeze may hit staffers
Geof Mortlock (Interest): Why we need a statutory framework that provides greater access to official information
Brigitte Morten (NBR): The dubious art of government problem solving (paywalled)
Guy Trafford (Interest): Voters will trust politicians if politicians will trust voters
David Farrar: 13 reasons why

Thomas Coughlan (Herald): Ngāi Tahu argues for Three Waters co-governance in Parliament
Herald: Why this year’s local elections are more important than ever

David Fisher (Herald): Wayne’s world: Meet the ‘rough diamond’ claiming to have a fix for ‘broken’ Auckland (paywalled)
Georgina Campbell (Herald): Tory Whanau on the Greens, cars, and election hoarding drama
Karl du Fresne: Just in case you forgot what Tory Whanau looks like, the Dom Post has some more photos of her

Susan Edmunds (Stuff): We’re halfway through biggest house price drop in decades: ASB
Newshub: House prices drop, costs increase: Expert paints grim picture of economy, warns it’s unlikely to improve any time soon
Greg Ninness (Interest): ASB expects house prices to keep falling until mid-next year and interest rates to remain high until 2024
Fran O’Sullivan (Herald): Agribusiness and Trade: Fran O’Sullivan – ‘Shameless’ Jacinda Ardern spruiks New Zealand (paywalled)
Sam Stubbs (Stuff): In defence of Reserve Bank governor Adrian Orr

Jenée Tibshraeny (Herald): A resignation and an apology accompany Reserve Bank board appointments (paywalled)
Richard Prebble (Herald): $2.1 billion for Kiwibank? You must be kidding (paywalled)
Keith Woodford (Interest): Dairy is fundamental to New Zealand’s future
Stewart Forsyth (Newsroom): The jostling winners in a dog-eats-dog high inflation world
Cameron Smith (Herald): Great Resignation: Survey reveals why quarter of Kiwis are looking to change jobs (paywalled)

Emile Donovan (RNZ): Judging the great immigration reset
Matthew Scott (Newsroom): Cabinet knew immigration changes could increase violence
John Braddock (World socialist website): New Zealand Labour government to expand exploitative migrant labour schemes

Jamie Ensor and Isobel Ewing (Newshub): Government doesn’t know if most of New Zealand’s imported solar panels made through slave labour
No Right Turn: Climate Change: Labour’s policy of murder

Niva Chittock (RNZ): Burned out or leaving for overseas: Midwifery sector in downward spiral, says union
Jayden Holmes (Today FM): Midwives left feeling ‘unrecognised and unrespected’ by Government