Doing it the hard way

Kaitaia's hospital must be the envy of many small towns, but it used to be managed by the community it serves.

It's taken more than three years. but Jacinda Ardern might finally be making good on her promise in 2017 to lead the most transformative government this country has ever seen.

Her administration certainly seems intent on transforming local government, with the decree that councils shall have Māori wards, whether the majority of people want them or not, and the '3 Waters' reforms, with the promise of more fundamental changes that some hope/fear will result in further amalgamations.

Now it is starting on the public health system, with a plan to replace the 20 district health boards with one national organisation, alongside a Māori Health Authority, another proposal that is lauded by some as long-awaited, by others as further evidence that the government is constructing a dual system, one for Māori and another for everyone else.

There can be no question that the DHB system, built by a previous Labour government, isn't working as well as it could and should be, but it is concerning that its failings are largely regarded as applying only to Māori. For too long politicians have focused too much on how Māori have been ill-served, in whatever field, and not enough on the fact that a much broader demographic is being disadvantaged.

In terms of health, it would surely be fairer to say that provincial New Zealand could be served better than it is. It would certainly be fair to say that all New Zealanders, whatever their ethnicity, deserve the best public health system that the country can afford, and provide.

For once, however, Te Hiku might have less to complain about than most provincial/rural communities. This district has felt the impact of the GP crisis, but Kaitaia at least seems well served in terms of primary health care, by 2021 standards, and can count itself blessed to be home to a hospital that must be the envy of many small towns in this country.

It's not what it used to be, when it was home to a resident surgeon, but the plan, more than 20 years ago, to reduce it to a super clinic was finally scuttled, and it continues to provide a very good level of service. For that we can and should be grateful, to the politicians who made the final decision, the DHB members who, to a degree, supported its retention, and to the local people, led by the likes of long-serving Mangonui County chairman and the Far North's first mayor, Millie Srhoj, then Northland MP John Carter and others.

No one who was there will ever forget the march through Kaitaia in support of its hospital, a march that was still moving off, 20 and more abreast, from the northern end of Commerce St after a huge crowd had assembled, and speeches were being made, outside what was then the old nurses' home.

People power ruled that day.

But for all the reforms that the current government is proposing (although Local Government Minister Nanaia Mahuta doesn't actually propose much - she just tells us how it's going to be) it seems that the bureaucracy that so often makes real progress difficult will remain unscathed. The abolition of the DHBs will surely cost some paper-pushing jobs, but no one, not even the most transformative government this country has ever seen, seems keen to take a scalpel to the rules and regulations that smother common sense. And that's the key, surely, to improving the public health system, not to mention allowing local government to do a better job.

It didn't used to be like this.

Far North District Council representatives were told by residents/land owners at Kaimaumau last month that the road to East Beach could be dated back to 1962, when then Mangonui County chairman Millie Srhoj asked a land owner if the council could use a family track as public access to the beach. Yes it could, providing it accepted that the track was on Māori land. So the story goes, and it has a very strong ring of truth to it.

Now ownership of the road is in dispute, and seems likely to be resolved only by the Māori Land Court. That will not be a quick process, but hopefully it will fix the problem, one way or the other. The point is that 60 years ago public access to the beach was achieved by two men with a hand shake. Now it will involve lawyers, court hearings and goodness knows how many years of toing and froing.

Things weren't perfect in 1962. If they had been, ownership of the road would not be an issue now. But in those days all sorts of agreements were reached with a hand shake. Things got done. These days they don't.

Bureaucracy, much of which serves little discernable benefit, is costing every one of us dearly. It is one of the major culprits in the housing crisis, and its fingerprints can be seen in health, education, local government, law and order, anywhere one cares to look. And while the health reforms, and to some extent the local government reforms that the government is talking about now might be overdue, and might sound promising, it is unlikely that that's going to change.

Prior to 1989, the Mangonui County and Kaitaia Borough councils did it very differently. Both met once a month, for a full day and half a day respectively. And they were very much in tune with the people they served, with very little sign of the blanket of bureaucracy that was about to be cast over their successor, the Far North District Council.

Those who wrote letters, more often to the county than the borough, could be assured that they would be read out at the next meeting. The odd farmer would turn up at the county's annual estimates meeting, and stick his oar in if he (always he) thought proposed spending in any given area was a bit generous or niggardly. The smallest of issues were discussed, and acted upon.

Now there is a process to be followed in every conceivable circumstance. Those who we elect to govern us locally are increasingly hamstrung by Wellington, and increasingly decisions seem to be made by staff rather than the elected members.

It is the same in health - Kaitaia used to have a Hospital Committee that made most of the decisions pertaining to the town's hospital - and whatever Andrew Little's current reform programme promises, it is unlikely that that level of local control will be restored. A Māori Health Authority might sound good in theory, and will hopefully go some way to addressing public health inequities that really do need to be addressed, but it will need the devolution of authority if it is to achieve anything meaningful. What we seem more likely to get is more bureaucracy.

We in the provinces know that one size has never fitted all, and never will, but we will continue to do things the hard way. Rearranging the bureaucracy isn't going to solve anything, but the days of local people making local decisions have surely gone forever. And if they did return, how would we respond?

Paula Bennett, when she was Minister of Social Development, tried to hand the reins over to Te Hiku, and we blew that opportunity to make genuine changes that would have benefited the people who live here. It is very unlikely that public health reforms will give us another chance to show that when it comes to how our health services are met, we know best. And that will be a very big opportunity lost.