Thursday 22 April 2021

 

At first glance, there is a strong back to the future flavour to the government’s just announced health sector reforms. National in the 1990s abolished elected area health boards and replaced them with a single national Health Funding Authority, supported by four Regional Health Authorities, reporting to the Minister of Health through the Ministry of Health. Labour in turn in the early 2000s abolished that structure and returned to elected district health boards. Now, Labour plans to overturn its own model in favour of a new national health authority, Health New Zealand, with four regional divisions, reporting to the Minister of Health through the Ministry of Health.

The irony of this will not be lost on long-term observers of the New Zealand health system. It goes deeper than just the structural changes. When Labour upended the previous model in the early 2000s, amongst the primary officials driving change were Heather Simpson, the then Prime Minister’s chief of staff, and Stephen McKernan, Director-General of Health from the mid-2000s. The latest health changes which unwind the system they set up emerge from a task force led by Heather Simpson, with Stephen McKernan leading the implementation unit responding to the taskforce’s recommendations.

However, this is not to say that the new reforms are merely a carbon copy of the system in place over 20 years ago. While the structures look broadly identical, there are some significant changes to take note of.
Whereas National’s 1990s changes were about driving better efficiency through controlling costs, the current changes seem more about removing duplication and inefficiency and driving policy more directly from the centre than has been the case in recent years.

There is also the added dimension of the independent Maori Health Authority. Conceptually a good idea, its challenge will be, like Whanau Ora has faced in social services provision, to maintain the freedom to promote “by Maori, for Maori” solutions without heavy-handed bureaucratic intervention concerned that it might be going “too far”.

The re-establishment of a new separate Public Health Agency has been long signalled. However, some aspects of it raise concern and are probably worthy of further consideration before final decisions are made. For example, while it is perfectly understandable that in the wake of the pandemic a group be established to oversee current and future pandemic preparedness plans, it is questionable whether that should be within the narrower focus of the Public Health Agency or more broadly based. One of the criticisms of the current pandemic approach, especially as we begin to move to a post-pandemic phase, is that continued sole focus on a public health approach is too narrow and inflexible. It may therefore be more prudent to establish a dedicated multidisciplinary separate pandemic response team outside the Public Health Agency, but able to work across the full health sector and the machinery of government as a whole.

Similarly, the plan to absorb the Health Promotion Agency within the new Public Health Agency is problematic. When the Health Promotion Agency was established to replace previous stand-alone agencies like the Alcohol Advisory Council and Smokefree NZ, there was criticism that this could impact upon the credibility of the public health messages being promoted. Public health messages coming from an overtly government agency always look far more authoritarian than when promoted by stand-alone bodies. The complete absorption of the Health Promotion Agency that was just starting to find its own feet after several years, into the Public Health Agency might lead to a very Orwellian, counter-productive approach to future public health promotion.

The government may well point to the response to the “official government announcements” we have been subject to on Covid19 over the last year in defence of this move. However, that would overlook the fact those messages have become more easily discounted as time has gone by. More worryingly, they have become less about purveying information and more about pushing propaganda. While that may have been fine for the Covid19 response, it is unlikely to work over the longer term on more broad public health themes like healthy living, diet and exercise. The last thing people will take kindly to or treat seriously is government dictums about what they should eat and when they should exercise!

There is plenty of time over the next two to three years to iron out some of these wrinkles as the new system is put in place, and the government should seek to work closely with affected communities accordingly.

However, there is one over-arching aspect to this reform which it is difficult to escape. This is fundamentally a statement of Labour philosophy about the role of government in the delivery of health and social services. At its heart, Labour believes that the primary responsibility here lies with central government, and that community initiative, let alone personal responsibility and self-management, come a distant second. The health reforms are a clear statement of that belief.

It is no coincidence that the heavy centralisation inherent within them mirrors similar recent moves in the education sector to centralise more control in central agencies like the Ministry of Education, at the expense of school boards of trustees. Likewise, performance failures in aspects of local government as well as new emerging responsibilities in water management, and forthcoming changes to resource management legislation make it virtually inevitable that major local government reforms, including perhaps a streamlining and further reduction of local authorities, lies ahead.

While the health reforms are being promoted as a necessary response to a system that is failing they are also a strong reminder that this is probably the most fiercely ideologically flavoured Labour government since the 1970s. That alone will make for an interesting public response.

19 comments:

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  5. I was haven herpes 2 on my genital area . I have had them for about 2 and a bit years. I am so scared what my mates are going to says if there should fined out i have herpes on my genital area and due to the virus my partnal broke up with me. I have been to the Doctors 9 times to get it treated. They all come back. I have been using Tee Tree Oil and Wartner (You freeze them at home) and they seem to be keeping the smaller herpes small but they can't seem to treat the larger ones. They don't get any bigger, but then they can't shrink as much. They get smaller a little part at a time. At least they are getting smaller! As soon as I see a new herpes appearing, then I treat it. At the moment I have been using Tee Tree twice a week and then using Wartner every 2 weeks. I was wondering if there was any other information about how to get rid of it. I am only a teenager and I hate it most when it get pi-chins me to scratch it, it get sweets when scratching it most times! I want to get rid of it so bad! DR. Odion website has been a huge help and has helped me realize a lot more about me and my family of genital herpes! so that was when I switch for natural remedy to see if there could be any help by herbal remedy, I search and I saw a great posts by Sarah devise Martha, Mignon Wright and shanttel Merritt on about the great herbal doctor that get them rid of there disease infection. and this great herbal doctor was called DR. Odion so that was when I contacted him for my own treatment and he prepared me some herbs which I takes for some couples of days, and I take it as he says before I am to no me and my family was perfectly cure for it and never experience it again. please friends if you have herpes virus and you really wants to get rid of it, please contact this great DR. Odion for herbal treatment and you will get rid of it. EMAIL. drodionherbalhome12@gmail.com OR WhatsApp number +2349019421176

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  11. Hello Everyone out there,I am here to give my testimony about a Herbalist doctor who helped me . I was infected with HERPES SIMPLEX VIRUS in 2011, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution out so that my body can be okay. One day I was in the river side thinking where I can go to get solution. so a lady walked to me telling me why am I so sad and i open up all to her telling her my problem, she told me that she can help me out, she introduce me to a doctor who uses herbal medication to cure HERPES SIMPLEX VIRUS and gave me his email, so i mail him. He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES SIMPLEX VIRUS that was in my body got vanished . so if you are also heart broken and also need a help, you can also email him at {oliha.miraclemedicine@gmail.com}
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    ReplyDelete
  12. How I Got My Ex Husband Back..Am so excited to share my testimony of a real spell caster who brought. We were happily married with two kids, a boy and a girl. 3 months ago, I started to notice some strange behavior from him and a few weeks later I found out that my husband is seeing someone else. He started coming home late from work, he hardly cares about me or the kids anymore, Sometimes he goes out and doesn't even come back home for about 2-3 days. I did all I could to rectify this problem but all to no avail. I became very worried and needed help. As I was browsing through the internet one day, I came across a website that suggested that Dr Aluya can help solve marital problems, restore broken relationships and so on. So, I felt I should give him a try. I contacted him and told him my problems and he told me what to do and I did it and he did a spell for me. 48 hours later, my husband came to me and apologized for the wrongs he did and promised never to do it again. Ever since then, everything has returned back to normal. My family and I are living together happily again.. All thanks to Dr Aluya Powerful Love Spell that really works. If you have any problem contact him and I guarantee you that he will help you. He will not disappoint you. Email him at: aluya.48hoursspelltemple@gmail.com or WhatsApp contact +1 (760) 566-7757

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  14. I really want to thank Dr Emu for saving my marriage. My wife really treated me badly and left home for almost 3 month this got me sick and confused. Then I told my friend about how my wife has changed towards me. Then she told me to contact Dr Emu that he will help me bring back my wife and change her back to a good woman. I never believed in all this but I gave it a try. Dr Emu casted a spell of return of love on her, and my wife came back home for forgiveness and today we are happy again. If you are going through any relationship stress or you want back your Ex or Divorce husband you can contact his whatsapp +2347012841542 or email emutemple@gmail.com website: Https://emutemple.wordpress.com/

    ReplyDelete
  15. Very interesting read. I've suffered with herpes ever since I was a child but it's only been the last few years that I discovered that I have genital herpes. So I started looking for a way to get cure permanently from this deadly virus I visited so many hospitals in search for a solution but it never worked out.so I started searching for cure to my herpes virus.Few month ago I came across a site where a lady was sharing a testimony about Dr OHIKHOBO about how he cured herpes and all kinds of diseases with is natural herbs so I decided to give it a try so I email the Dr he told me how I was going to get the herbs so I did as he instructed few days later I received the herbs and I started taking the herbs as instructed by the Dr.I was shocked two weeks after when my doctor told me that I was free from herpes so I decided to let the world know how I was cured from herpes by Dr OHIKHOBO you can reach him through his email: drohikhoboherbalcenter @ gmail .com if you want a cure for herpes or any of the diseases listed below because the Dr says he also has a cure for them.
    1.CANCER


    2.HEART FAILURE


    3.DIABETES


    4.HPV


    5.EX BACK


    6.LOTTERY LUCKY NUMBER


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    ReplyDelete
  16. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS . I was positive to the deadly Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw Dr LOCA testimony online on how he was cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i’m so happy! that’s the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email:(drlocaspellhome@gmil.com) you can contact him on WHTASAPP +2348110856113
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    ReplyDelete
  17. I contacted herpes' I was told there is no herpes cure except treatment to
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    ReplyDelete
  18. Are you having issues in your relationship, or finding it difficult to have a child of your own or are you the type having any diseases in your body. I will advice you to contact Dr. Abolo of Abolospell@gmail.com . The potency of his spell is so effective and can reunite broken relationship and can also make one get pregnant know matter the situation and not only that, he also has the power to cure all type of diseases within the period of 48hours.. Contact him today and thank me later.
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  19. This comment has been removed by a blog administrator.

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