Ian Powell says the excessively centralised health system that officially took effect on 1 July was not the only reason for him deciding to stand for Kāpiti Coast District Council as a district-wide councillor.
“But it was the tipping point, reinforced by my experience of over 30 years in the health system representing salaried medical specialists.”
From 1938 to June this year, healthcare provision was a national system that also included important statutory points of decision-making at a local level. This recognised the unchanged reality that overwhelmingly healthcare was provided locally through hospitals and in communities (mainly general practices). Therefore a reasonable degree of decision-making should operate at this level.
District health boards established in 2001 were consistent with this principle. But they were also given an explicit and sharper responsibility for integrating healthcare between hospitals and communities for geographically defined populations.
Mr Powell says this recognised that the better the integration, the better the coordinated provision of healthcare, and therefore the better its accessibility and quality.
“The biggest problem was the failure of central government (through the Ministry of Health) to provide national cohesion. However, rather than improve the leadership culture of the health ministry to provide this cohesion, the government instead unwisely decided to abolish DHBs.
“DHBs are replaced by a new highly centralised additional national bureaucracy called Te Whatu Ora (Health New Zealand – HNZ). This restructuring included the abandoning of integrating healthcare provision as a priority (possibly completely),” says Mr Powell.
“One thing I learnt from my years in the health system was the importance of voice – from health professionals and communities. Voice can influence decisions. This voice can be either behind closed doors (DHBs often did this with government) or in public (or both). In summary, no or muted voice means no or little influence.”
He says the increased centralisation of New Zealand’s health system will now make it much more difficult for a Kāpiti voice to be effective over improving healthcare access in our district compared to what it was like with Capital & Coast DHB.
So where does local community voice over healthcare access come from now?
“The government and HNZ would say the 80 new localities to be established will meet these needs reinforced by the locality plans that will be developed under their names.
“But there are serious problems with this claim. First, only 9 have been announced. This includes ones that are not even functioning. They can be compared with builders’ scaffolding covering a non-existent building. Further, the 80 total is not scheduled to be in place until July 2024.
“Second, the geographic areas of localities will be determined by HNZ as will their leadership. Third, the locality plans will also be determined by HNZ. In other words, localities will be top-down creations required to follow a top-down line.”
Mr Powell says despite this, KCDC should endeavour to work with the eventual locality covering Kāpiti.
“There will be an immediate fight to ensure that our locality is for Kāpiti rather than a much larger region, either northwards or southwards (or both). Either way, Kāpiti’s healthcare priorities would be at risk of being watered down right at the beginning of the planning stage.
“Kāpiti Coast District Council’s advocacy of better healthcare access has to shift to a new level because excessive centralisation has led to a local leadership vacuum. Working with the Kāpiti Health Advisory Group and others in the community, KCDC needs to shape the narrative of what healthcare access in Kāpiti should look like and advocate for its implementation.”
He says if the new locality supports KCDC’s vision, great.
“But, if the locality is too compromised by centralised control, then regardless, KCDC must provide the voice on how access to healthcare in Kāpiti should be improved. No one else can do this with as much effect and resources behind it.”
