Transparency must be implanted throughout Te Whatu Ora

We can’t afford transparency which relies on individuals alone to set the tone for the openness and debate

I’ll be honest, government transparency, access to official information, media freedom – love it all. They play a role in keeping democracy sweet and while democracy can be fickle, it beats the alternatives.

For years I’ve been banging on about the need for transparency in decision making in the health sector.

In my early years as a reporter, I travelled to the US and Canada and looked at how their official information laws worked. For both countries, they were the sunshine years, where the overriding principle for information release was – release unless there is a good reason to withhold.

Following the rollout of the 1990s health reforms that saw the demise of area health boards, I looked at how the introduction of market-focused health agencies and communication advisors led to information that was massaged and media that was managed.

In 2018, courtesy of an nib health journalism scholarship, I spent time collecting data on secrecy in DHBs and asked why it was that no one – media or public – was attending DHB meetings any more. A system designed to encourage transparency was broken but, I argued, it could be fixed.

In recent years, in my desire to encourage conversations about health reform going on in the public domain, I set up a series of web events known as Popcorn Panels.

Then I took to Googling “how to make a podcast” and launched System Fix – the podcast for health reform junkies. We’ve just recorded our 21st episode – out soon.

And when it became apparent the new central health agency Te Whatu Ora - Health New Zealand would not be required to hold open meetings as its antecedents the DHBs were, I made an oral submission on the matter to the pae ora legislation committee. It fell on deaf ears but I wasn’t surprised. I knew at the time it was pie-in-the-sky; DHBs had become extremely risk averse and I saw little sign their successors would be any different. But I thought it was important not to just give up on a piece of the democratic process, even if it was flawed.

That brings me to the now where, aided I like to think by some coverage from us, other organisations and media have noticed that the new central agency is not a super-duper DHB but a new beast and they have called out Te Whatu Ora on the “secrecy” of its meetings. It’s been a little late in coming but it’s nice to know people do care.

Te Whatu Ora chair Rob Campbell defended the board’s practice and points to its decision to provide brief summaries of the agenda, a post-meeting media briefing and now also to release minutes and some board reports (all material available after the fact if you have the time to wait for an official information request response).

I had to laugh when Mr Campbell commented to RNZ that he had more important work to get on with at the moment than “than providing occupational therapy for journalists”; laugh because there is a kernel of truth there if you consider occupational therapy to be something to keep us occupied.

I think back to my early years as a health reporter at the Otago Daily Times where my workload revolved around fortnightly area health board meetings; starting with picking up the agenda, rummaging through for story ideas, heading off to the back-to-back meetings, trying to sift the news from the bluster as the board members parried.

It was a different beast back then – elected members had few qualms about being partisan towards the "constituents" who elected them. Some readers might be surprised to hear that I was often able to sit through "in committee" parts of the meeting.

The chair had this strange idea that allowing the media to understand the nuts and bolts of an issue might aid in its eventual coverage. Sometimes I chose to exit to avoid being compromised when I happened upon the "secret" information elsewhere.

It is a long way from where we landed with DHBs, whose elected (and appointed) members answered first and foremost to the minister of the day. It is easy to look back with rose-tinted glasses on the DHB meetings but ultimately, by the time it was announced their time was up in 2020, few meetings were being attended by members of the public or reporters. And little attempt was made by the boards to rekindle interest through the use of live streaming when, in those pre-pandemic days, many local councils were using the technology.

Te Whatu Ora is a crown agency. Its board has no elected members. But that’s not to say it couldn’t do something spectacular in the transparency space.

The health reforms are about achieving equity in healthcare and the culture change that needs to happen throughout the system for that to occur.

A switch from risk-averse policy making, risk-averse communication strategies and risk-averse individuals starts at the top. If Mr Campbell and crew can show that they are open to providing easy access to information, be it on paper or in the flesh, that will flow through all of the agency. As it is at the moment everyone is still reeling from DHB days where a call from the media is pretty much met with a gnashing of teeth. And actually it’s become worse.

I can understand Mr Campbell’s incredulity at the criticism over secrecy when other government agencies of a similar ilk do not hold public meetings, while his agency is providing post-meeting briefings. But health has always been different. Still, I don’t think we simply want to go back to what we had with DHBs. Remember, it wasn’t working.

Mr Campbell appears committed to engaging with the public and media, just not by opening up the board meetings. Does that matter? Yes. It makes it harder to understand how the board works as a team and how it reaches decisions. And there’s the issue of what happens when change takes place at the top.

Mr Campbell might be sincere in his approach but what about the next person. We can’t afford transparency which relies on individuals alone to set the tone for the openness and debate that is needed for a robust, collaborative health system.

Transparency needs to be resourced financially, monitored for excellence and actively promoted. It needs to become part of the DNA.