However merited the original policy intent, creating new uncertainties on top of already contentious unfolding plans in health and Three Waters reforms is not good politics
Opinion: The phrase the "devil is always in the detail” often ranks alongside "unintended consequences" when considering major government reform programmes. Circumstances that have arisen in the past week with health and Three Waters reforms are good examples.
It was announced at the weekend that four major hospital upgrade projects at Dunedin and Southland Hospitals, including an expansion of Southland’s emergency department, and upgrades to Dunedin’s medical assessment and central sterilisation units, were now on hold. The two Southland projects had been approved under the old district health board structure, and the Dunedin work had been under consideration for some time, without any final decisions.
However, the new national health agency, Te Whatu Ora, has now decided the Southland projects ought more properly to be considered as one. And because the combined cost exceeds $10 million, it must now go through Te Whatu Ora’s Health Investment Unit process before final approval.
The Dunedin projects are being re-examined in the light of the development of Dunedin’s new public hospital, which is not due to open to inpatients until 2028, including whether the medical assessment unit could be transferred to the new outpatients’ building which should open in 2025. Whatever else, these delays are significant setbacks for the region.
Although the case for streamlining the delivery and planning of health services and getting away from the duplication and bureaucratic inertia that typified the old district health board structure is strong, there has always been the latent fear this could occur at the cost of local input. In the Otago/Southland case, where the two former district health boards had been effectively operating as one for some time – after the replacement of the old Southland District Health Board by a Commissioner in 2015 – the likelihood of more integrated regional planning has been far greater in recent years than in many other parts of the country, making the weekend’s decision more aggravating.
Te Whatu Ora’s actions suggest that, at least for the moment, it is more focused on the structure and planning of a national public health service, than supporting previously agreed regional priorities. If these delays are indicative of the way Te Whatu Ora will approach regional matters in the future, the new system looks like it will be far more unresponsive to meeting regional needs than the cumbersome district health board system it replaced.
Virtually every party agrees there needs to be a better way of managing water resources, but only Labour and the Greens agree with the Water Services Entities Bill. With the polls the way they are, that is a very shaky basis on which to proceed with major change of this type.
Previously, there was a legitimate argument about the inherent inequity of the old population-based funding model for health services, which meant the bigger population centres always got the largest slice of the cake, often at the expense of the regions. A nationally based funding model such as Te Whatu Ora was intended to provide more equitable outcomes, across the country –something people in Otago/Southland, and other regional centres, will now surely be questioning in the light of last week’s decisions.
Also last week, Parliament’s Finance and Expenditure Committee submitted its final report on the controversial Water Services Entities Bill – Three Waters as it is colloquially known. The committee had received more than 88,000 submissions on the bill but heard only 237 in person. It recommended by majority – with National and ACT members dissenting – the bill proceed with substantial amendments. But the most controversial parts relating to “Governance accountabilities”, the so-called co-governance provisions, remain carefully woven through the bill.
These proposed governance arrangements are to be shared jointly between territorial local authorities and mana whenua representatives, who will be drawn from local hapu and iwi, while local authorities will retain a veto right over any asset divestment proposals. The process is complex and convoluted, with a careful set of checks and balances on how it will operate.
The Government has not yet won its argument that upgrading water services across the country can only work with the new co-management provisions. Many remain suspicious the Government is using this legislation to address wider issues simply because this may be its last opportunity. A wider and more open process of public consultation would allow the opportunity for a better-informed public debate.
But by using its large majority, the Government is merely ensuring the bill will be more far more politically divisive than is necessary. Moreover, this bill is but the first of three intended to reform the structure of water delivery. That, plus National’s and ACT’s repeated commitments to repeal the governance provisions, makes the situation even more fraught and uncertain.
Virtually every party agrees there needs to be a better way of managing water resources, but only Labour and the Greens agree with the Water Services Entities Bill. With the polls the way they are, that is a very shaky basis on which to proceed with major change of this type.
There is another aspect that has been slipped in by the select committee. The Te Mana o te Wai principles in the current bill have now been extended beyond freshwater to include coastal seawaters, including estuaries, harbours, fiords, and bays. This is ostensibly to deal with issues of water discharges and geothermal waters, which is not unreasonable. But, given its extent, it will raise eyebrows about whether the common ownership of the foreshore and seabed, guaranteed in the Foreshore and Seabed Act, will now be compromised. The select committee’s report is silent on this point.
Health reforms that appear to negate the capacity to reflect regional priorities in the development of national public health services, and water services reforms that leave the central issues of concern unaddressed, while establishing new uncertainties about their scope and application may well prove the devil is indeed always in the detail. However, creating new uncertainties on top of already contentious unfolding plans – however merited the original policy intent – is not good politics.
And it will be political management, not well-meaning intent, that will ultimately determine their success or failure.
