In Pyongyang there is a public service which would appeal to our own Public Service Commissioner in Aotearoa New Zealand. It never makes any dissenting or controversial view known.

Rather it readies itself for any potential change in the face of the Kim family leadership. Ever ready to resume the daily grind of boot-licking and box-ticking of a docile public service.

It is, as I like to say, neutered rather than neutral, but from above it can be very hard to tell the difference.

• READ MORE: Health NZ chair fired over ‘political’ post, but says govt ‘overreacted’
• Rob Campbell on thin ice after Three Waters comments
• Rob Campbell ‘very disappointed’ over removal as EPA chair – ‘Muldoonism in action’

In the ideal world that seems to be preferred in “PyongPoneke”, there is no room for open debate and each word means what the Public Service Commissioner says it means.

It is rather like the world described by Lewis Carroll: “When I use a word”, Humpty said in a rather scornful tone, “it means just what I choose it to mean — neither more nor less.”

“The question is,” said Alice, “whether you can make words mean so many different things.”

“The question is,” said Humpty Dumpty, “which is to be master — that’s all”. Thank you Commissioner Humpty for your work taking the word “impartiality” out of the dictionary and into the public service world.

Imperial and colonial past
I am not against the public service. I am strongly for an excellent, efficient, equitable and effective public service. But you do not get that in a modern and complex society from a model of public service derived from a monocultural, inequitable and dare I say it (yes I do) imperial and colonial past.

In the real world what they like to call our public service is in fact a politically subservient service, far removed from the public it is supposed to serve.

This comment is not directed at the many thousands of public servants working closely with those they serve.

These people, the real public service, are often underpaid and overworked. They spend much time battling with the rules and processes and prejudices imposed on them by those at the top of the tree. Many are scared to speak up, so they leave or stay quiet.

I understand why, they need the job too much to risk being branded difficult. Not a few of them write to me, call me, or stop me in the street. And it is not to say “get back in line”.

They and the mandarins themselves know what the problem is. There is a square mile or so around the Beehive in Wellington, which is like the Vatican in Italy. A different country within a country. The world looks totally different from there.

Those there are mainly there for the same reason, and they are faced inwards, mentally at least, towards what they see as power and away from the people, the public they are supposed to serve.

They cannot understand Ōtara, or Cannons Creek . . .
They cannot see, hear or understand those in Ōtara, in Te Tai Tokerau, in Tairāwhiti, in Cannons Creek, on the West Coast or rural Southland.

Alongside the big consultancy firms that share their buildings, their CVs and their views, senior advisers draw up plans for the rest of us on whiteboards.

These are parsed by the “tier one” people who over coffee, wine, or whisky cosily massage these into an acceptable form for politicians. Just enough choices to create an illusion of political control, but not so much as to upset the system.

Are these people impartial or neutral ? No, they do not need to be. They have strong views which reflect the caste they belong to. Some of them even jokingly refer to this as “Poneketanga”.

They engage rafts of “communications” people to sell the story — often poorly as in Te Whatu Ora, where there are more than 200 such people and where despite that overload PR firms are often called in to sell better.

Back to basics
This is not a way to create an efficient, effective, excellent and equitable public service. To do that we will have to go back to some basics about the purpose of public service today and in the future.

To my mind this would include:

• Opening up jobs to a much wider range of people with real world experience, be that commercial or social, in forms that are not all for a lifetime, but which enable free and ongoing interchange;
• Opening up policy-making to start from the “bottom up”, and which are not based on “top down”, carefully framed, bogus consultations;
• Allowing people to speak their minds and debate difficult issues without having to assume that future political winners are not so prejudiced and narrow-minded as to refuse to work with anyone with a different opinion to theirs; and
• Paying real attention, not playing pretend attention, to the professional bodies and unions which represent staff, who mostly will prefer rightly to get on with their jobs.

None of that seems hard or dangerous to me. After all, it is only changing a public service model which has produced or failed to prevent all of the many crises we can observe around us.

Rob Campbell is former chairperson of Te Whatu Ora (Health New Zealand) and the Environmental Protection Agency (EPA). This article was first published by Stuff and is republished by Asia Pacific Report with the author’s permission.

Manukau Urban Māori Authority (MUMA) is welcoming the government’s health reforms as an important first step to improving Māori and Pasifika health in south Auckland.

But some in the health sector say the jury is still out on what will be achieved in Counties Manukau.

Under the reforms, the country’s 20 district health boards have now been replaced by Te Whatu Ora (Health New Zealand).

• READ MORE: Other Health New Zealand reform reports

The new Crown entity will be responsible for running hospitals, primary and community health services.

The government says it will allow for more consistent delivery of health services nationwide and help stop the postcode lottery people face accessing healthcare based on where they live.

The reforms also include the establishment of Te Aka Whai Ora (the Māori Health Authority) to improve indigenous health which will work in partnership with Health NZ.

Muma chairman Bernie O’Donnell has seen the country’s district health boards work first-hand, as a member of the now-defunct Auckland DHB.

Greater responsibility for Māori
He said establishing a Māori Health Authority would give Māori greater responsibility for the delivery of their own health services.

“For too long the health system hasn’t addressed the wellbeing of Māori, or those at the bottom of the cliff,” O’Donnell said. “The reality is we couldn’t continue with what we had. Something had to be done and this is it.”

He said critics of the health reforms are defending a system which had to be replaced.

“The old way the DHBs were run didn’t work for our people. For too long it’s been non-Māori telling us what’s best for us.”

He said ongoing issues left by the Counties Manukau DHB, such as Middlemore Hospital’s under-pressure emergency department and its workforce shortages would all have to be addressed under the changes.

“But what we’re expecting is that Māori and Pasifika health in south Auckland will get better under the reforms,” O’Donnell said.

However, he admitted there’s a lot at stake.

‘Time will tell’
“If that doesn’t happen we won’t have achieved anything of significance,” he said. “But only time will tell.”

Yet not everyone is as certain as O’Donnell on what impact the changes will have.

Turuki Healthcare chief executive Te Puea Winiata said there were still a lot of unanswered questions about the reforms.

Winiata said the creation of the new authority dedicated to indigenous health is an important first step.

But she said it was vital that the new entity had the ability to make its own decisions and help support Māori self-determination.

“The resourcing of the Māori Health Authority is going to be critical to its success,” she said.

Many reform attempts
Winiata said she had worked in the health sector for the past 30 years and in that time had seen a number of attempts by the government of the day to restructure the health system.

She said it was hard to predict what impact the health reforms would have in south Auckland.

“But I think in 12 months’ time we will be able to look at what changes have been made and see what’s been achieved.”

Local Democracy Reporting is Public Interest Journalism funded through NZ on Air. Asia Pacific Report is an LDR partner.

More than two million New Zealanders will get a one-off $350 sweetener as part of the Budget’s centrepiece $1 billion cost-of-living relief package.

The temporary short-term support is counterbalanced by a record $11.1 billion for the health system as the government scraps district health boards (DHBs) and replaces them with a central agency.

“Our economy has come through the covid-19 shock better than almost anywhere else in the world,” Prime Minister Jacinda Ardern said in a statement. She is in covid isolation.

• READ MORE: RNZ coverage of the Budget 2022 and reaction
• Ardern hails ‘budget for uncertain times’ as pandemic subsides
• Political parties respond to NZ Budget 2022
• Other Budget 2022 reports

“But as the pandemic subsides, other challenges both long-term and more immediate, have come to the fore. This Budget responds to those challenges.”

Ongoing uncertainty over inflation, covid-19 and the Russian invasion of Ukraine continue to cast a pall over the economy until at least the end of the year.

A large $19 billion deficit is expected this year, returning to surplus in 2025.

Treasury is forecasting house prices to ease and unemployment to drop as low as 3 percent.

Cost-of-living sweetener
New Zealanders aged 18 and over will be eligible for the $350 payment unless they earn more than $70,000 a year or already receive the Winter Energy Payment.

The sum will be paid in three instalments over August, September and October, working out at roughly $27 a week.

The temporary payment is estimated to cost $814 million — funded out of the remaining money in the covid-19 war-chest which is now being wound up.

NZ Finance Minister Grant Robertson delivers Budget 2022. Video: RNZ News

The support comes with a two-month extension to the fuel tax reduction and half-price public transport given the current high fuel prices.

New Zealanders who have a community services card will continue to get half-price public transport permanently from mid-September.

“While we know the current storm will pass, it’s important we do what we can to take the hard edges off it now,” Ardern said.

The government will also rush through legislation under urgency over the next few days to crack down on supermarkets in an effort to reduce grocery bills.

The legislation will ban supermarkets from using restrictive covenants to prevent competitors from accessing land to open new stores.

Ministers flagged further announcements in response to the Commerce Commission’s recent report in the sector “in the coming days”.

Health service
The Budget contains “the largest investment ever in [the] health system” — $11.1 billion — as the government presses ahead with its plan to replace DHBs with a centralised health service.

An initial $1.8b annual investment this year will help clear DHBs’ debt, giving the replacement Health New Zealand service and Māori Health Authority a “clean start”.

Health Minister Andrew Little said the 20 DHBs had collectively run annual deficits in 12 of the 13 years since 2008.

“As Health NZ takes over the books from the 20 DHBs on 1 July, a funding boost is being provided so the national system can start with a clean slate.”

The Māori Health Authority will get $168m over four years to directly commission hauora Māori services.

New Zealand’s drug-buyer Pharmac will also get an extra $191m over the next two years – in what Little says is the medicine budget’s “biggest-ever increase”.

It brings total funding to $1.2 billion which is 43 percent higher than when Labour was elected in 2017.

“Pharmac has assured me it will use this funding to secure as many medicines on its list as it can, with a focus on better cancer treatments, to ensure as many New Zealanders as possible benefit from this biggest-ever increase to its medicines funding,” Little said.

More than $166 million has been put aside over four years for ambulance services, adding more than 60 vehicles to the road fleet and about 250 more paramedics and frontline staff. Another $90.7 million will go towards air ambulance services to replace ageing aircraft with modern helicopters.

The Budget increases dental grants for low-income families from $300 to $1000 in line with Labour’s 2020 campaign promise.

A new Ministry for Disabled People is also being established at a cost of $100 million.

Housing support
While the housing market is showing signs of slowing, the Budget includes more support for first home buyers with funding available for about 7000 more grants.

House price caps across regions have been increased to line up with lower quartile market values for new and existing properties.

It means some significant shifts — both Wellington’s cap and Queenstown’s jump from $650,000 to $925,000, and Tauranga’s jumps from $600,000 to $875,000.

The income caps remain the same but will be reviewed every six months along with the new house price caps.

A new $350 million housing fund has also been set up where not-for-profit developers can apply for grants to build affordable rental accommodation.

Education equity
Replacing school deciles is the single biggest area of new spending for education.

The Budget provides more than $80 million a year for the equity index which replaces deciles as the measure of disadvantage in schools.

Most of the money, $75 million a year, will go directly to schools, adding to the $150 million they currently receive through the decile-based system.

The budget increases school operations grants and tertiary and early childhood education subsidies by 2.75 percent.

There is also $266 million over four years to give early education teachers pay parity with school teachers.

In tertiary education, the Budget provides $56 million a year to pay for an expected increase in enrolments next year and in 2024.

There is also $40 million for modernising polytechnic facilities.

Māori health, wellbeing
More than half a billion dollars is being pumped into the Māori Health sector with $579.9 million going towards Māori health and wellbeing.

The Māori Health Authority, Te Mana Hauora, is set to be launched July 1 and will receive $188.1 million over four years for direct commissioning of services.

Some $20.1 million will go to support iwi-Māori partnership boards, and $30 million will be invested into Maori providers and health workers to provide support and sustain capital infrastructure.

Lack of workforce capability has been identified as a key factor in being able to bolster Te Mana Hauora — and $39 million will be used for Māori workforce training and development to support them within the new health system.

The $579.9 million invested in Māori health and wellbeing is on top of the $11.1 billion health allocation.

This article is republished under a community partnership agreement with RNZ.

New Zealand is scrapping district health boards and creating a new Māori health agency in a radical “fairer and smarter” shake-up of the medical system.

Health Minister Andrew Little announced details to health leaders at Parliament today.

The 20 district health boards which run services for individual areas around the country will be replaced by one new body, Health NZ, which will instead plan services for the whole population.

• READ MORE: ‘Clear’ inequity for Māori in health care – report

Health NZ will have four regional divisions but also district offices.

It will delegate authority to local levels so regional services have a say in what they need and how they work, Little said.

“The system must work in true partnership with Māori… Māori still suffer, on average, worse health than others.”

There will also be a new Māori Health Authority, sitting alongside that, to both set policies for Māori health and to decide and fund those who will deliver services.

Direct commission
The new authority will “have the power to directly commission health services for Māori”.

“There are other equity challenges as well … the system must listen to the voice of Pacific people, disable people, rainbow … and all other people,” Little said.

“We can and must do better.”

The country’s 30 primary health organisations – large regional networks of GPs and primary care – will also be ditched.

And, on the back of covid-19, there will be a new Public Health Agency which will target widespread health problems – like smoking – and try to prepare for pandemics and epidemics.

• WATCH:

RNZ News video of the national health shake-up announcement.

Little said today’s announcement was a plan to create a “truly national health service” that “draws on the best that we have now” but reduces pressure on healthcare workers and hospitals and specialist services.

“By making the changes I am announcing today, we will have the chance to put the focus on primary health care,” he said.

“We can start giving true effect to tino rangatiratanga and our obligations under Te Tiriti O Waitangi.

‘System under stress’
“It’s a system under stress. Our health and care workers strive every day … but demand is growing … and the job is getting harder.”

The changes being announced go further than the Health and Disability System Review, the basis for today’s plan.

That recommended halving the DHBs, and having a Māori health authority but with fewer powers and less autonomy that the one announced today.

The changes have been made to try to stop what is called the “post code lottery of care”, where people get different care – or have different changes of survival – depending on which DHB area they live in.

The report released today says a lot of those problems are caused by the fact that hospitals and specialist care are often managed in isolation from each other, not in a coherent network.

Instead of district health boards, the new Health NZ, will oversee the health needs of four regions.

And there is an increased focused on primary – or GP-level community care.

Primary care funding
The report says at the moment specialist or hospital care draws away a lot of primary care funding and it wants that to stop.

It also wants those community services – including GPs, midwives and pharmacists, to work more together

And the Māori Health Authority is aimed at overcoming the huge health disparities for Māori as a whole, with lower life expectancy and higher rates of disease in many areas.

Associate Health Minister (Māori Health) Peeni Henare said many Māori did not like going to the doctor because their experiences of the health system is negative.

“This authority will drive hauroa Māori and make real change,” he said.

It would represent Māori from all iwi.

“This is where we make a start,” Henare said.

Public health units
“Regional public health units, long underfunded, will stay but under the new Health NZ entity.

Little said he had heard calls for change, quickly.

“The current system no longer serves our needs well. Our goal is a health system that helps all New Zealanders to live longer in good health,” he said.

“We need a system that is not only fairer but also smarter.”

Smarter means making the most of the money and resources available, Little said.

He was not underestimating the challenges faced, he said.

“Our system has become overly complex. It is too complicated for a small nation.

‘Operate as one system’
“We need to operate as one system. Organisations working together should be the norm, not the exception.”

The Ministry of Health would be strengthened, Little said.

But it will no longer directly fund and commission health services.

Health New Zealand – a new Crown entity – will run hospitals and commission primary health care.

It will replace the existing 20 health boards, Little said.

“DHBs have served their communities well.”

But they have their failings, he said.

‘About doing better’
“I want to stress this reform is about doing better with what we have. It is not about cutting services,” Little said.

Little said the fourth element of the announcement was about public health, including “Pacific people, disabled people, rainbow … and all other people”.

“Disability issues span the full range of issues any community faces. That’s why I have more work being done in this area,” he said.

Little said technology would play a part in the new system.

That would include improving access to things like virtual diagnostic tools.

“Health NZ will work with communities … to develop the priorities for their areas, making sure people have a say in the services they get.”

“You should be able to turn up anywhere in the health service and know the health professional has access to information relevant to you.”

New health charter
There will also be a new health charter.

“We will start work on this soon.”

Some aspects of change would take years, not months, Little said.

He acknowledged the challenge of making change during a global pandemic.

He was confident they could safely take place at the same time.

“Covid-19 is not a reason to preserve a system that is not fit for purpose,” he said.

“I am mindful we need to proceed carefully and not disrupt day-to-day services.

“I expect the new system to come into effect in July 2022.”

Establishing interim versions
In coming weeks, work will begin on establishing interim versions of Health NZ and the Māori Health Authority.

New legislation for them will be worked on and Little expects that legislation to be passed by April 2022.

“Together we have an opportunity to make a once in a lifetime change, to put in a new system and improve the health of this, and future, generations.”

DHBs will continue in their roles for now.

“I want to reassure new Zealanders that the care they rely upon will still be available.”

The changes are overdue, and “this time, it must be different”, Little said.

During the process of the reform plan, Little said he had been thinking of those working in the system, and those who needed healthcare.

“We are a small nation, and we can make this change working together, and we can make this change in the spirit of Te Tiriti (O Waitangi).”

This article is republished under a community partnership agreement with RNZ.