New Zealand’s collective smugness at apparently beating Covid19 earlier than most took quite a hit when new cases started to appear at the very time separate questions were arising about the efficacy of current border control and quarantine practices. Some of the national sense of relief felt when the country moved to Alert Level 4 a couple of weeks ago dissipated suddenly, harming the restoration of confidence that was becoming a critical part of the economic and social recovery needed to restore a sense of the normality so many have been yearning for.

Now, there are fresh challenges to be met. Amongst the most dramatic of these is the likelihood of even stricter measures to control who is coming into the country. Rather than looking forward to a relaxation of border controls and the possible establishment of travel bubbles with other countries or regions, it now appears we are going to have to put up with a much longer period of international isolation than was previously considered reasonable or desirable.

And this brings us hard up against a hitherto unquestioned reality. New Zealand citizens and residents, wherever they may be in the world at present, have an inalienable right to return to the country they call home. Just as we accept the international obligation to support those who hold a New Zealand passport, whatever political or legal strife they may be in and wherever they are, so too do we have an obligation to ensure those citizens and residents who wish to return here are able to do so.  

Now that we require all those coming to New Zealand, including citizens and permanent residents, to go through a period of managed isolation or quarantine before being released to their homes, families and friends, a serious issue has arisen regarding the costs of managed isolation and quarantine. As these escalate, and show no signs of reducing any time soon, it is being suggested that the price of managed isolation and quarantine should shift to a user pays basis. Cabinet is reported to be about to consider the proposition within the next few weeks.

It is time to draw a line in the sand here. Any New Zealand citizen or permanent resident returning to this country and being required to enter a period of managed isolation or quarantine because of government policy on the management of Covid19 should not be required to pay for the costs of that period of effective detention, under any circumstances. The commitment New Zealand makes to protecting those to whom it accords citizenship or permanent residence cannot be compromised in this way, and it is intolerable that the issue is even being considered. Making New Zealanders pay in such circumstances would be the start of a very slippery slope.

However, given the nature of the current national emergency it would not be unreasonable for the government and authorities to expect there to be full co-operation from all those returning, and for some sanctions to be applicable when that co-operation is not forthcoming. But that is quite different from charging citizens and residents directly for being quarantined upon arrival.

While the rights of citizens and residents are virtually inalienable in these circumstances, the same does not necessarily apply in the case of other people coming here, especially those whose visits are for private reasons, not directly related in some way to New Zealand’s national interests. In such circumstances, it may be quite appropriate to consider some form of payment to help defray the costs of their isolation or quarantine, although even then full cost-recovery is unlikely to be entirely appropriate.

But a measure of reciprocity would need to be considered. Many countries are presently facing similar questions. At the very least, it would be prudent for us to be keeping an eye on what they are contemplating and then making sure any actions we take on this score are at least consistent with those being taken elsewhere. The last thing we would want is for costs to be imposed on a retaliatory basis – if you impose these costs on our people entering New Zealand, then we will do likewise to your people entering our country. That would be a very silly and short-sighted approach on the part of both countries, and one we would be best to avoid.

As with so much of Covid19 the question of what to do about the costs of managed isolation and quarantine sounds easy. The complexities become more apparent when it comes to actually doing something. It appears we fell into that trap originally regarding managing the border, and now we have to extricate ourselves from what has become a messy, inconsistent and generally unsatisfactory situation. We should learn from that when it comes to the questions of the costs of managed isolation and quarantine and avoid populist and apparently solutions likely to bite us very hard a little later on. 

In a distant corner of the national fairground sits an old piece of equipment that has been around for years, but only gets turned on every decade or so. It never quite manages to do all the things it was supposed to, and so, in frustration, it is closed down after a while, and put aside for years, until someone decides it is worth having another attempt to make it work properly. It is called the health sector reorganisation merry-go-round, and it has just been wheeled out again this week.

Prior to 1983, health services in New Zealand were primarily structured through 19 District Health Offices and 29 elected Hospital Boards. A further 230 Territorial Local Authorities had basic responsibility for wider environmental health and town planning issues. By 1980, there were over 180 public hospitals in New Zealand and a further 163 private hospitals offering a total of just over 31,000 hospital beds.

It was a bureaucratic and financial nightmare, and the heavy emphasis on hospital-based approaches dealt poorly with the growing challenges in public and community health and general diversity. So, from 1983 the process was streamlined through the establishment of 14 Area Health Boards to replace the Hospital Boards and District Health Offices, and to deliver a wider focus than the previous intensively hospital-based system had proven capable of. The Boards were still elected, to ensure there was sufficient regional and cultural diversity.

However, financial constraints in the wake of the 1980s economic restructuring followed by the 1987 Sharemarket Crash and the slow pace of change meant that the new model never quite worked. In 1990, for example, the Minister of Health was forced to sack the Auckland Area Health Board and replace it with a Commissioner to try to get it back on track.

At that time, there was a brief focus on getting a more business-like approach to the provision of health and hospital services, and more integration between the public and emerging private sector healthcare providers, but the Gibbs Report – which was supposed to lay out a pathway for meeting these goals – went too far. Its recommended virtual American-style privatisation scared the politicians, who ran a mile from it.

However, the problems identified by the Gibbs Report and the failure of the Auckland Area Health Board could not be ignored indefinitely. So, the merry-go-round was unveiled in the early 1990s and produced, after a few splutters, the centralised Health Funding Agency, four Regional Health Authorities, 23 Crown Health Enterprises, and a stand-alone Public Health Commission. None of these agencies was publicly elected, with the Minister of Health making all the board appointments. A split between the provision of funding and services was established, with public hospitals funded on the basis of the volume and quality of services that they had been contracted to provide by the funding agencies.

However, once again the model did not work out quite as intended. Arguments quickly arose over the Public Health Commission. Its autonomy brought it into conflict with the government, irritated by its advocacy for various public health issues, and the autonomous Regional Health Authorities who saw the Commission’s role duplicating and cutting across their own responsibilities. So, it was abolished in 1995.

As Crown Health Enterprises started closing down small, usually rural, hospitals that were often poorly attended and financially troubled, there was mounting public pressure to restore local democracy through directly elected local boards. Therefore, out came the merry-go-round once more after 1999, and the Health Funding Agency and the Regional Health Authorities were replaced by initially 21 (now 20) partially elected District Health Boards. By 2000, the numbers of hospitals had risen to around 400, but the numbers of beds provided had reduced about 25% from those available in 1980.

Over the last twenty years, complaints about the adequacy and fairness of the funding model, the duplication inherent in a large national system of autonomous District Health Boards, the unevenness in workforce planning across a number of key disciplines have intensified. In short, although the health system has grown immensely, is generally better funded and resourced than it was, and has become far more innovative, flexible and capable of ensuring people have access to the best care available to ensure that they can maintain a decent quality of life, the challenges that have bedevilled it for almost the last half-century remain.

Therefore, the merry-go-round has been cranked into life again and has produced the Health and Disability System Review which released its final report this week. In many ways, its diagnosis of the system’s weaknesses is not all that removed from the findings of the Gibbs Report, over thirty years ago, although its solutions differ markedly.

The real question, however, is what, if anything of substance will emerge once the government has had a chance to consider the Review’s recommendations. If history is any guide, the decisions eventually reached will fall well short of the problems identified by the Review, so will fail to get to heart of the problem. Add to that, this government’s serial incapacity to get any reform process right or underway, and the likelihood of significant change diminishes even further.

Meanwhile, the merry-go-round has been given a good clean, wrapped in its tarpaulins, and shifted back to the edge of the fairground, to rest quietly, until next time.  

   

The Police decision to abandon its Armed Response Teams trial was a no-brainer. The concept was never going to work or be acceptable to a sufficient section of the community to make it viable. Indeed, the only mystery is that it took the Police so long to come to that conclusion. Although Police officers are not routinely armed as they go about their daily duties, unlike, for example, their colleagues in Australia or the United States, they do have ready access to firearms if required, including high-powered rifles, and receive firearms training.

Also, a dedicated Armed Offenders Squad was established in 1964 after four Police officers had been killed in two separate incidents. Its role has been to attend incidents requiring an armed response, often situations where some form of confrontation has taken place.  Over the years, the Armed Offenders Squad has been involved in many difficult and serious incidents. While no Armed Offenders Squad members have been killed in the line of duty, many have been injured, some seriously. The Squad attends around 800 incidents each year, with shots being exchanged at about 260 of these.

But, like all policing, an effective response by the Armed Offenders Squad relies on there being quality information available and an ongoing situation for them to respond to. They are not the right response team in all situations. For example, even though they were quickly on the scene of the Christchurch mosque shootings, just ten minutes after being deployed, they were too late to stop the slaughter. This is in no way intended to denigrate their courage or their efforts, but rather to make the point that the Armed Offenders Squad may not always be the appropriate response.

It is against that type of background that the Armed Response Team concept should be considered. Policing today relies on two elements – the support and compliance of the public, and the nimbleness of response. The early stages of the Covid19 crisis showed that people were unlikely to take positively to heavy-handed policing of the restrictions being imposed, but were far more  positively and co-operatively disposed towards an educative approach that sought their compliance rather than just demanded it. And in their daily work, Police officers in New Zealand are frequently seen working alongside their local communities, gaining their trust and confidence, quite unlike their counterparts in the United States, for example, whose multiple deficiencies have been dramatically exposed in recent days. Community involvement is an important link our Police cannot risk being disrupted.

However, the harsh style and tone that would automatically be associated with the presence of an Armed Response Team would destroy much of that goodwill local Police have built up with their local communities over the years. It would have placed an unnecessary barrier in the way of Police securing the ongoing compliance of the community and created very unfortunate stereotypes. Overall, it is by no means clear that the presence of Armed Response Teams would have had a positive impact on the safety and security of the community.

A retired senior British Judge observed recently that it was the role of the Police to be the community’s servants, not the government’s agents. The community-focused role of the New Zealand Police over the last 30 or 40 years is testament to the wisdom of that view. Police are better trained and prepared to deal with a range of complex and unusual problems, with the overriding ambition of building safer communities. The new Commissioner of Police appears to personify many of those positive values.

But, for all that, the very nature of the Police’s work means they will always face a challenge gaining the confidence of every sector of society. That is an impossible task. But the risk of alienating sectors of the community by getting it wrong is also a very real risk. Police therefore are constantly involved in a community balancing act. Minimising or avoiding unnecessary risks is an important aspect of that. Getting things wrong can create rifts that take years to mend, as the aftermath of the abortive Urewera raids in 2007 has shown. None of that is conducive to good policing.

While there remain unanswered questions about aspects of the Armed Response Teams trial, including the level of political involvement, and who knew what, when, the decision to abandon the plan is nevertheless the proper one. The Commissioner has claimed the decision was reached after community and sector group consultation, although it is far from clear how widespread this was, or when it took place.

Nevertheless, the outcome is a positive one, and the tone the Commissioner has set bodes well for the relationship between the Police and the wider community over the next few years.          

Universal public compliance has been one of the major reasons why New Zealand has apparently been so successful in curbing the spread of the Covid19 virus. Fundamentally, people complied with the restrictions imposed during Alert Levels 4 and 3 because of an overwhelming fear of the risk they could catch the virus. The clear and decisive rules of engagement from the government backed up that fear. With only a few exceptions everyone knew where they stood, what they could and could not do, and what the risks of non-compliance were.

The invocation of the idea of “team of five million” built up a culture of our all being in this together, and the individual privations we were all enduring being an individually small but overall important part of a wider national picture. In an almost wartime atmosphere, we were encouraged to believe that we were all playing our part towards the achievement of a greater national goal, and we all apparently believed it. Consequently, we accepted a level of intrusion upon our personal freedoms most of us would never ever have imagined occurring in our lifetimes. Somewhat more darkly, some even embraced the notion of snitching on others whom they felt were not playing the game. But, in the interests of the greater good, such concerns were quickly pushed aside because it was comparatively easy to go along with what was happening.

However, those days now seem past us. That initial spirit has dissipated and will be difficult to recapture as we start to think about life beyond Alert Level 2.  In no small part, that is due to the unexpectedly rapid success in virtually stamping out Covid19 in New Zealand, at least for the time being. After all, if there are no new cases being reported, now day after day, how can there possibly be a crisis to be concerned about anymore? Or, so the argument goes.

But a bigger factor is that the urgency around Covid19 has waned. The absolute imperative of uniform national compliance has all but evaporated.  When the Prime Minister and the Director-General of Health – the two faces of compassionate reassurance but unflinching authority during Levels 4 and 3 – are photographed conversing with groups of people, the way we used to, it is difficult to maintain the line that for everyone else strict social distancing rules must continue to apply. Likewise, when a demonstration of several thousand people takes place and the Director-General says it poses no threat to public health, because we have no cases occurring, it becomes very hard to tell business premises that they still need to regulate the numbers of people on their sites in the interests of preventing Covid19’s possible spread.

The issue here is not whether these things should be occurring – the government, after all, seems to be giving clear hints that a move to the far more relaxed Alert Level 1, when virtually the only restriction still in place will be a closed national border, is maybe barely a week away – but rather the mixed messages currently being sent, and the difficulties they are causing for compliance. Where we once were united in the pursuit of a common goal, we now seem to believe we have achieved that, and are increasingly frustrated that we cannot get back to life as we knew it more quickly.

It is probably also a clear indication that as the numbers of Covid19 cases have virtually disappeared the public interest has started to move on too. It is now becoming much more focused on the impact on individual circumstances – jobs that have disappeared, the struggle to pay the rent and the mortgage, the long winter ahead, and what happens when the wage subsidies run out. Worrying about catching Covid19 is increasingly taking second place to these more immediate domestic concerns, especially when it appears that, even at an official level, things are not being treated as seriously as they were just a few weeks ago.

While none of this should come as any great surprise it also shows that the government’s authority on this issue has now peaked. As things start to become more relaxed, the unique authority the government possessed and demonstrated so effectively during the lockdowns will ebb away and New Zealanders’ natural instinct to be less automatically obedient to every government call will return. So too, one hopes, will the genuine contest of ideas so necessary to a functioning democracy, especially in the lead-up to an election.

The mixed messages of recent days notwithstanding, most New Zealanders will welcome and take in their stride the pending return to something approaching the normality they knew, albeit with a typically quiet sense of pride at what they have been able to achieve. They will be hoping Covid19 shows no sign of a significant return during the coming winter months, as we begin to reopen our border. So too will the government and the public health authorities. For they know only too well that the level of sudden public compliance and acquiescence achieved during the lockdowns was but a moment in time – a shocked reaction to what was happening overseas and the abrupt arrival of circumstances that no-one had properly anticipated. It is unlikely to be achievable to the same extent even if future circumstances warrant it.