The Week in Politics: High stakes in the health shakeup

By Peter Wilson*

Analysis - The government's health shake-up doesn't go down well with the opposition but it's generally well-received, and Foreign Minister Nanaia Mahuta deals with a delicate international issue around our relationships with Five Eyes and China.

The government gave plenty of notice that it was going to change the health system but few could have expected restructuring on such a scale.

Health Minister Andrew Little announced on Wednesday that the country's 20 DHBs will go, replaced by a single new body Health New Zealand, which will plan services for the whole country.

It will have four regional divisions and also district offices. A new Māori Health Authority will sit alongside it.

Little said it was about creating "a truly national health service" that "draws from the best we have now".

All the details are on RNZ's website, but the core change is towards centralisation and that's where there are sharp political differences.

Opposition leader Judith Collins took to Twitter: "National Party will reverse restructuring of public health announced by Labour today. Replacement of DHBs by a Wellington bureaucracy will not work, AND we (will) remove the Māori health authority. Public health provision must be based on individual need, not race," she said.

That's clear enough. If National holds to that policy it will demolish the new structure when there's a change of government. It won't have lasted very long, perhaps barely got off the ground.

This is clearly going to be a huge political issue and the stakes are high. Little could find himself in a world of woe if it goes wrong.

"The government's plan to scrap all 20 district health boards in favour of one mega health authority could make or break this government when it faces re-election in 2023," Stuff's Luke Malpass wrote.

"It also opens a battlefield between the forces of centralisation and those of localism."

Malpass said the problem the National Party has is that is that the current system is widely considered to be broken. "And, damning for the localists is that very few people know who the hell they are voting for to sit on these boards. It's a tough proposition to defend."

The Herald highlighted failures of the current system and the inequality of "postcode" levels of treatment. "Every day at least one New Zealander dies due to inequitable healthcare based on their age, income or where they live," it said.

The proposed Māori Health Authority is an obvious minefield for politicians.

The Herald's Audrey Young wrote that it must be transparent enough for anybody to see how the money is being spent and what the outcomes are. "Those questioning it should prepare to be labelled racist for even asking the question. But the answers are more important," she said.

The Waikato Times also focused on regional inequality. "Radical health shake-up just what the doctor ordered for Waikato," its headline said.

Outside Parliament reaction covered the spectrum. Just two examples, the first from Morning Report. Association of Salaried Medical Specialists former executive director Ian Powell: "The first thing that stands out to me is there is a lack of empirical evidence to actually justify the decision to abolish (DHBs). The argument about postcodes, for example, or access to… health services on the basis of where you live - this is not going to change that."

Hutt Valley DHB board member and gastroenterologist Richard Stein, quoted by Stuff: "I think the population as a whole will benefit and I think we will have more money that's better prioritised. It will be a lot more efficient."

Then there was the tired wisdom of the man in the street, talking to RNZ: "I don't expect much will happen really."

The future of New Zealand's membership of the Five Eyes international intelligence-sharing alliance was raised this week and Foreign Minister Nanaia Mahuta had to manage a delicate situation.

The government has been wary for some time about the way Five Eyes has widened its remit and started issuing joint statements criticising other countries for their human rights record and anti-democratic attitudes, particularly China.

The other members are the UK, the US, Canada and Australia.

Mahuta made a landmark speech this week about New Zealand's relationship with China and told media of her concerns about Five Eyes.

"We are uncomfortable with expanding the remit of the Five Eyes," she said. "New Zealand has been very clear, certainly in this term and since we've held the portfolio, not to invoke the Five Eyes as the first point of contact of messaging out on a range of issues that exist out of the remit of the Five Eyes."

In other words, New Zealand does not want to be tied to the collective view of its partners in every circumstance.

Writing in response to those comments, the defence editor of British newspaper the Telegraph, Con Coughlin, said Prime Minister Jacinda Ardern had a preference for "cosying up to China's communist rulers".

"Thanks to Wellington's naïve decision to prioritise trade with China over its membership of the elite Five Eyes intelligence-sharing network, Ms Ardern can expect her country's isolation to deepen further as New Zealand faces the very real prospect of expulsion from the alliance over its pro-Beijing stance," Coughlin said.

This was extensively reported by the Herald, which quoted New Zealand sources as saying no Five Eyes partner had raised expulsion or suspension with New Zealand.

Just as this was bubbling away Australia's Foreign Minister Marise Payne arrived for talks with Mahuta. Australia has been more sharply critical of China than New Zealand, and reporters questioned Payne about Five Eyes.

She described Five Eyes as a vital alliance but avoided criticising New Zealand's stance. "My view is that countries will choose to address issues of concern in whichever forum they themselves determine appropriate and consistent with their respective national interest," she said.

Ardern was interviewed by Australia's ABC news after Mahuta's comments and before Payne's visit. Her comments were reported by Stuff.

The prime minister denied New Zealand's attitude to issuing statements through Five Eyes was a backdown.

"Those collective voices are important, but let's make sure we do it with the appropriate platform," she said.

Those platforms could be wider, she explained, and include countries outside Five Eyes. She also noted that Australia and New Zealand had recently issued a joint statement, on their own, on China.

"Is that (issuing statements) best done under the banner of a grouping of countries around a security intelligence platform, or is it best done around a group of countries with shared values - some of which might not belong to Five Eyes," she said.

It will be interesting to see how this develops. So far there has been no official comment from Five Eyes partners, and given its nature there isn't likely to be.

The Telegraph's defence editor also wrote in his article that in 2003 London and Washington considered ending New Zealand's membership of Five Eyes in response to former prime minister Helen Clark apparently scaling back co-operation with Five Eyes because of her opposition to the Iraq war.

The Herald contacted Clark, who said she was staggered by the suggestion. She had no recollection of any scaling back. Clark also said she believed that Five Eyes straying out of the shadows and into more public positioning was problematic.

"That is trying to get everyone into a line, and New Zealand does value its independent foreign policy," Clark said.

*Peter Wilson is a life member of Parliament's press gallery, 22 years as NZPA's political editor and seven as parliamentary bureau chief for NZ Newswire.