The art and craft of government: Tools for the political leader’s every need, but which to choose?

Experience has shown, and is showing again in 2023, that organisational change can be fiendishly complex to implement

While waiting for my morning coffee brew, I decided to tackle a household job – fixing the venetian blinds in the lounge.

No one would describe me as a natural handyman. But I patiently diagnosed the problem and settled upon a solution (find a longer screw for fixing the blinds to the window frame), proceeded to the garage workshop and found exactly the right screw within 10 seconds – a rare success to savour over my coffee.

It’s common to think of public policy as an exercise in finding the right tool for the job. The image of a policy toolbox was first popularised by an English public administration scholar, Christopher Hood, in the 1970s.

Professor Hood suggested there were four basic types of tools in the policy toolbox: authority; “treasure”; organisation; and “nodality”.

Others later relabelled nodality as information. Each instrument type has a particular set of pros and cons.

Authority refers to the use of legislation and regulation – the capacity of governments to set rules and enforce them. Legislative change can be highly effective: a great example is the Smoke-free Environments Amendment Act 2003, which banned smoking in bars, restaurants and clubs.

However, in many contexts, writing rules that strike the balance between clarity, simplicity and avoidance of unintended consequences is an extremely demanding task.

While government has the constitutional authority to introduce legislation and see it passed through Parliament, there are many laws on the books in which practice does not reflect legislative intent (think of work health and safety as an example).

The two main reasons are the cost and complexity of enforcement, and the active or passive resistance of those who are regulated, which sets up regulatory games in which poacher and gamekeeper seek to outwit each other.

Such games are often expensive for all parties and can result in bewilderingly complex rules. As such, we should be careful not to confuse authority with power.

In Professor Hood’s toolbox, treasure involves the raising and spending of public money. In the current environment, it is clear many health services are significantly underfunded. Government capacity to use “treasure” is clearly constrained by the resources it has at its disposal, and the competing demand for resources across the whole of government, so bonanzas of increased funding are infrequent events. Even when government does put significantly more into the kitty, these increases often feel like drops in the bucket.

But funding tools are not just about increases or decreases. Funding mechanisms, such as the move from reimbursement to capitated funding for primary care in the early 2000s, can be just as effective as, if not more effective than, tools that can change the behaviour of health providers.

Such funding design tools have a downside for governments because it is easier to identify the winners and losers in advance, allowing potential losers the time and opportunity to rally their troops well before decisions are made.

Organisation involves creating, dismantling and tweaking organisational structures. When it comes to health sector reforms, organisational tools have been the go-to option for New Zealand governments over the past 40 years.

Compared with authority and treasure-based instruments, organisational instruments seem easier to design – at least initially – and are often less politically contentious because winners and losers are harder to identify.

When former health minister Andrew Little announced the latest structural changes in April 2021, it became something of a Rorschach inkblot in which most health sector leaders and commentators saw the possibility of something better.

Nevertheless, experience has shown, and is showing again in 2023, that organisational change can be fiendishly complex to implement.

We have decades of experience showing that organisational restructuring, in isolation, is rarely effective at bringing about the changes governments want – whether these be about efficiency, integrated care or equity.

Nodality involves the use of information to persuade. Use of informational tools was valuable in the COVID-19 lockdowns of 2020 and 2021. Convincing people to behave differently in response to the threat of the virus was even more important than setting rules, which would never have been enforceable if the majority of the population weren’t persuaded of their legitimacy

But, too often, nodality has been the preferred soft option in public health policy in which governments of both stripes continue to perpetuate the fantasy that persuading people to eat well and exercise is enough to tackle the growing epidemics of noncommunicable diseases.

Much of the politics around policy-making is really about which type of policy tools should be used and which should be eschewed. The food, alcohol and gambling industry’s lobbying is directed at ensuring that government does not resort to tools of authority.

Most interest groups in health are quite happy to see governments adopt funding instruments, particularly if that involves funding increases. But the neoliberal economic and political reformers of the 1980s and 1990s convinced many inside and outside of government that rule-making and public funding lead to an “overblown” State sector. It is little wonder that in the 30 or so years since, governments have preferred organisational and informational tools in both public health and health services policy.

There is a broad consensus among public policy scholars that governments need a full repertoire of tool types at their disposal. The art of government is in designing and finding the right mix and balance between the types.

But it’s fair to say that most policy issues are far more complicated than the task of fixing a venetian blind. As such, we shouldn’t expect the right tools to be sitting around waiting to be found.

Tim Tenbensel is professor, health systems, in the Faculty of Medical and Health Sciences at the University of Auckland