Campbell lays out the problems facing reform; not too late to make changes

The approach took only limited account of Māori health views and world view and did not provide anything like the funding and power to enable mana motuhake and tino rangatiratanga

Former Te Whatu Ora chair Rob Campbell describes as a “critical error” the rolling out of health reforms without a new funding model for primary care.

In a speech prepared for delivery to the Fabian Society in Wellington this evening, Mr Campbell, who was sacked as chair by health minister Ayesha Verrall for making political statements, spells out in detail where he sees the reforms going wrong.

The failure to define a new model for funding limited the ability to engage primary services in the reform process, he says.

Te Whatu Ora treated the funded primary sector as they had been treated before and did not engage effectively with them, listen to or involve them sufficiently, treating them as something to be managed, he says.

And despite the legislation’s strong focus on achieving equity in health outcomes for Māori, Mr Campbell is highly critical of the reform approach which, he says, stepped past existing sector structures, such as Whānau Ora and kaupapa Maori providers, and imposed structures on Māori that were not driven by iwi and hapu. The approach “took only limited account of Māori health views and world view and did not provide anything like the funding and power to enable mana motuhake and tino rangatiratanga”.

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In his speech, Mr Campbell identifies a wide range of problems facing the reforms, from the vacuum created by the loss of the DHBs and shared services agencies and the gap created while “poorly defined” localities and iwi Māori partnership boards are established, to the inadequate involvement of unions and professional organisations.

Transferring all the old roles and management to the new entities showed an inadequate appreciation of the scale and depth of change required and restricted the capability to quickly drive real culture change, Mr Campbell says.

Te Whatu Ora did not fight energetically or effectively enough against legacy projects that were no longer appropriate priorities, he says.

Mr Campbell talks of the board confronted with managers at all levels who are “indecisive or inadequate or even opposed in terms of being active change leaders”.

He is also critical of the politicians. “It felt as if having created and passed the legislation, those in political control lacked the will to see it succeed,” he says.

Under his leadership, Mr Campbell says, the board should have been more demanding, resolute and courageous.

In its current form, Te Whatu Ora cannot deliver the required level of radical change, he says.

“Inadequacies and things which are just plain wrong will persist and in many cases get worse unless there are substantive changes.

“I do not say this to give any succour to political parties which want to turn back the clock or to deny equity or to those who welcome further demise in public health services for commercial reasons. I say it because we all have common cause in having a much more equitable, excellent, efficient and effective public health service than we currently have.”

Mr Campbell is not completely lacking in hope for the reforms. He says despite there being important aspects of the reform package "inadequate to the task”, these are not incapable of repair.

He provides practical suggestions, including to “directly involve the funded agencies in urgent review of contracts and funding to consistently apply equity and accountability systems, effectively decommissioning the current commissioning system”.

Other suggestions range from establishing a planned transfer of substantive funding to Te Aka Whai Ora sufficient to support effective Māori health services and immediately concluding the various pay equity, pay parity and holiday pay issues.

“There are funding issues, but delay is simply harmfully delaying the inevitable.”

READ THE FULL SPEECH HERE