Health NZ's transparency clear as mud

There have been articles across news media suggesting the new health authority is operating in secret with closed-door meetings.

Some claim the new authority is governed by a "corporation culture".

The catalyst for these accusations was Health New Zealand’s (Te Whatu Ora) decision to keep the media and public out of its board meetings. 

In contrast, the now-abolished district health boards (DHBs) were required by their governing legislation to hold their board meetings in public, which allowed journalists and members of the public to attend. 

There were also private sessions for matters deemed to be confidential or commercially sensitive.

Health NZ’s defence is that it is a crown entity quite different from the DHBs it replaced on July 1. Specifically, unlike DHBs, Health NZ is not required by legislation to have public sessions at board meetings. Further, there was nothing unusual for a crown entity to have fully private board meetings.

This defence was reinforced by a provocative quip from its chair, Rob Campbell, on RNZ’s Morning Report on Aug 29, that Te Whatu Ora was not about providing “occupational therapy for journalists”.

However, Health NZ’s defence misses the point that transparency is critical for the credibility of health systems; at least, health systems that are universal and see healthcare as both a right and a public good rather than a commodity or privilege. 

Consequently, both perceived and real threats to transparency quickly ring alarm bells among both the public and many of those working in the health system.

The media picked up on the fact that Health NZ’s defence, reinforced by the Campbell quip, suggested that it was behaving like a corporation, thereby raising the wider issue of leadership culture.

Unconvincing approach

The argument that Te Whatu Ora’s approach is the same as other crown entities is not convincing in the context of NZ’s universal health system. DHBs were responsible for the healthcare of geographically defined populations. They prepared reports to their governing boards on how they were doing this. 

The media, interested organisations and everyday people could and did access the agenda for these meetings, which meant they could also access the reports listed on the agenda.

Over my three decades working for the Association of Salaried Medical Specialists, I was impressed with the way many journalists used this material to research good public-interest stories. 

But early signs suggest that either less is being written or less is being required to be reported to the Health NZ board. This has the immediate effect of reducing transparency.

The description of Health NZ as a corporation has an unfortunate resonance with the National government’s health restructuring of the 1990s. At that time, healthcare was, in effect, treated as a commodity in a competitive market, while disingenuously pretending it was still a public good.

Public hospitals were covered by the Commerce and Companies Acts, and had to compete against each other and against the private sector. 

Media and the public were excluded from the meetings of their governing boards. The formation of DHBs under new health legislation in 2001 marked a return to transparency.

Not a return to the 90s

The Pae Ora Act 2022, among other things, replaced DHBs with Te Whatu Ora. It is not a return to the 1990s, when health was treated as a commodity in an artificially created market. But it has consciously created an environment in which its body responsible for funding, planning and the provision of healthcare looks, smells and appears to be behaving like a corporation.

It was not an accident that the government repealed the requirement for board meetings to have public sessions (and all that flowed from that). It does not necessarily preclude public sessions, but at the very least this is disincentivised.

From January 2001 until July 2022, NZ’s health system was both vertical and horizontal. The latter reflected the reality that, overwhelmingly, healthcare is provided locally, so there should be some statutory decision-making at that level. That contributed to greater transparency.

The challenge to transparency is that the more that health systems are centralised and become vertical, the more their transparency is reduced. The more transparency is reduced, the more accountability is reduced.

Further, the more centralised and vertical health systems are, the more difficult it is to have a proactive culture of engagement with health professionals. They are the part of the health workforce that is the greatest driver of innovation and sustainable system improvement.

A universal health system suffers when it is under a corporation culture. 

Te Whatu Ora is not like other crown entities. It is responsible for a health system that at some point in their lives all New Zealanders will depend on. These same New Zealanders fund it.

It is too early to judge Health NZ. Although the signs are discouraging, it has only been in existence for less than three months. But it is in a quandary. 

On one hand, its governing legislation incentivises a corporation culture. 

On the other, to be effective, it needs a culture of greater – not lesser – public transparency and accountability.