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Progressive
thinking
ten perspectives:
Possible futures for public and community services
Dedication
To our members who work so hard to ensure
everyone in our country can participate
fully in society, and whose work ensures our
communities can flourish and thrive.
Published October 2020
Edited by Kirsten Windelov, Andrea Fromm
and Sarah Austen-Smith.
Design and layout by Dan Phillips.
Printed by Pivotal Thames
This resource is also available online at
www.psa.org.nz/progressivethinking
New Zealand Public Service Association Te
Pūkenga Here Tikanga Mahi
PSA House, 11 Aurora Terrace, PO Box 3817,
Wellington. Phone 0508 367 772
Email enquiries@psa.org.nz
www.psa.org.nz
ISBN 978-0-908798-13-1
Contents
3 Foreword
5 Learning and unlearning 27 The future of environmental
coronavirus lessons regulation
Max Rashbrooke Dr Mike Joy
8 The State and Social Marketing: 30 Reimagining New Zealand’s
can we embrace change? journey to a zero carbon future
Tracey Bridges
Sophie Handford
12 Raising waka, and
33 Local Government
not just yachts
Dr Amohia Boulton and Deb Te Kawa
and Wellbeing in a Post-
COVID-19 World
16 Our health system and Peter McKinlay
services: A best possible future?
Dr Jacqueline Cumming and Dr Lesley Middleton 36 Should we revive the
Ministry of Works?
22 The welfare state beyond Geoff Bertram
COVID-19 – the case for a
step-change 39 Reimagining Government
Jonathan Boston Adrian Brown, Toby Lowe and Thea Snow
23 Progressve thinking at the centre:
more contributors
43 Author bios
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 2
Foreword
He aha te kai ō te rangatira?
He Kōrero, he kōrero, he kōrero.
What is the food of the leader.
It is knowledge. It is communication.
Our strong public and community services, funded
collectively through our taxes, are essential in our fight
against COVID-19.
Glenn Barclay,
Kerry Davies, and 2020 has provided urgent and unique with PSA members we tackled the big
Erin Polaczuk challenges for public and community and complex issues those services, and
National secretaries of services. While many of our members we as a country, face.
the New Zealand Public are working at the frontline, working
As a collective our vision is clear:
Service Association to keep our communities safe and
Public and community services are
Te Pūkenga Here supported through the pandemic,
pivotal in how Aotearoa creates
Tikanga Mahi those of us who can dedicate time to
and meets it's future. We are united
advocacy have done so.
in identifying that there are now
We decided to write this book on the opportunities for change and that
eve of our first lockdown. We wanted to we are well positioned to make that
keep the wider PSA whānau connected change.
while advocating for progressive,
This book is being launched on the
union-led change at a critical moment
cusp of the 2020 General Election. We
in our history. It has paid off. Through
hope its thinking will inspire members
the webinar series, from which the
and leaders to influence and champion
ten chapters of this book are drawn,
the change we need to see.
we spent 14 hours in conversation
with more than 3000 members and That’s not to say we haven’t seen
supporters. These discussions brought progress. The recently passed Public
together the wider union movement at Service Act is world leading. It defines
a time when we all needed connection the democratic role and the purpose
and support. of the Public Service as including
supporting governments to pursue the
We want to start by thanking our
long-term public interest and facilitate
contributors who have each thought
active citizenship.
deeply about possible futures for
our community and public services, Here, we seek to build on progress. Our
sharing their expertise and energy with contributors put the challenge to those
us. In this book, and in conversation of us working in, and shaping, public
3 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services
Foreword
and community services, to transcend It is worth noting that the views in this
form and habit and work together as book are those of the contributors and
part of an integrated system designed the PSA has undertaken this work not
around the people we serve. to promote or endorse specific ideas
or views but to spark a discussion. It
The problems we are working together
is through debate and considering a
to solve, like inequality and climate
range of views that PSA members and
change, can be messy and complex –
others can organise to do better.
but as our youngest contributor writes,
they are not beyond us. Our contributors have put forward
actions we can take, such as;
Resting on past achievements is not supporting diverse teams and bottom-
an option. Our health system
might once have been the
up innovation, championing As a collective
transformative
envy of the world, but policy reform, and our vision
how will it fare in
the coming years?
acknowledging and is clear: We
working to address
Our efforts in the inequalities understand
face of obvious
and persistent
exacerbated by public and
COVID-19.
inequalities must community
be “how can we do Change can be
even better”? created where people services are
Whether we are
and services meet. We pivotal in how
want people working
wrestling with the in public and community Aotearoa creates
right time to speak to the
importance of climate action in
services to be empowered to and meets
humbly and proactively learn from
our work (now), calling for a more the people we are serving to improve it's future.”
active and dynamic government, or services and policy. Our institutions
removing roadblocks to equal access need to change so that this kind
and outcomes in health and wellbeing, of human learning continuously
each of us has a role to play in improves both service design and
building more progressive public and policy.
community services.
Here in Aotearoa and across our
The ideas in this book challenge and union movement we value equality,
excite us and we hope they will act as a compassion, and justice. The
catalyst for action in your own areas of decisions we take now about public
passion and focus. At the PSA we will and community services can help
certainly be thinking about what they deliver on these values and ensure that
mean for our movement. everyone is better off.
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 4
Learning and unlearning coronavirus lessons
Anyone who thinks that the State’s role will “inevitably”
change post-coronavirus is probably wrong.
Government’s reach into our lives inequalities are all evidence of
has suddenly expanded, it is true. that. Coronavirus rams home that
But this could easily be portrayed lesson: Its ultimate cause is our
as negative, because authoritarian; economically-driven incursions into
or temporary, because unaffordable the virgin rainforests where such
in the long term. So change will diseases spread amongst animals.
have to be fought for, and the exact COVID-19 is a symbol of a world out
shape of that change will need of balance. Yet balancing competing
Max Rashbrooke careful thought. Nonetheless, we can demands has always been at the core
Max is a Wellington- combine pre-existing ideas about the of the State’s role, ever since the early
based writer with twin State’s role with specific lessons from modern philosopher Thomas Hobbes
interests in economic the crisis to create a vision for a more suggested it was needed to stop
inequality and democratic active, dynamic and resilient kind of “warre of every one against every
participation.
government. one”.
He is currently the 2020 J
D Stout Fellow at Victoria Even before coronavirus, alternative The human development that
University of Wellington. visions were emerging from the Raworth envisages can, in turn, be
He is also the author of work of several thinkers. Oxford guided by philosopher Amartya
Wealth and New Zealand, economist Kate Raworth’s ‘doughnut Sen’s vision of wellbeing, in which
and edited the best-selling economics’ suggests humanity needs everyone has the resources for a
work Inequality: A New to land in the safe space represented flourishing existence and can lead
Zealand Crisis
by the flesh of the doughnut, where lives “they have reason to value”. New
human development is balanced Zealand’s ‘wellbeing government’
with environmental protection. is so far just a skeleton, but it holds
Undershooting into the hole of promise: pursuing holistic wellbeing,
the doughnut would represent the whole wide range of things that
insufficient human development; humans truly need to flourish, gives
overshooting into the space beyond governments far stronger grounds
it would represent environmental to act than, say, the simple pursuit of
degradation. GDP.
This provides an overarching role Pursuing wellbeing for all also
for government in balancing these requires us to be attentive to
two core demands, because people inequality, something that
acting by themselves – or in markets coronavirus exposes – and could
– will not get that balance right. exacerbate. Without strong
Mass extinction of species, runaway government action, economic crises
climate change and widening will always hit the poor hardest,
5 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services
Learning and unlearning coronavirus lessons
while the rich can escape relatively Mazzucato shows, are often made
unhurt. Coronavirus reminds us of in public laboratories; the 12
government’s core role in redressing key technologies on which the
the inequalities left to us by luck and smartphone relies were all developed
the market. or funded by the public sector. By
picking important public “missions”,
Only government action, in the
like Germany’s massive 1990s shift
form of taxes and other ways to
to renewable energy, governments
share resources, can avert a return
can shape markets, create new ones,
to Victorian-style imbalances of
wealth. And the crisis has shown
and do much of the patient work Closer to home
that underpins innovation. They are
just how rapidly the State can
wealth creators. there are clear
act on inequality. It turns out
that governments around the Closer to home there are clear lessons for
world can double benefits, can lessons for government post- government
house the homeless, can build coronavirus. Māori have, in declaring
hospitals quickly. These actions rāhui and manning checkpoints, post-coronavirus.
aren’t guaranteed to last: they can exercised tino rangatiratanga in Māori have, in
plausibly be dismissed as emergency striking ways. But Mihingaarangi
measures by those who oppose Forbes and others have noted that declaring rāhui
active government. But their memory Māori have largely been recipients of and manning
can be kept alive; we can argue that the disaster response, not the drivers
such measures should be adopted of it. “Once again,” Forbes wrote, checkpoints,
and extended. And if the state of “the actions of the government exercised tino
the public finances is held up as an have been more paternalistic than
objection, we can argue for the slow … partnership.” We will all have to rangatiratanga in
and sensible paying down of debt support Māori in arguing for a future striking ways.”
– Britain only paid off the last of its that holds more autonomy and less
World War II debts in 2006 – while paternalism.
funding social measures through
Central to the COVID-19 fight have
taxes on wealthy households largely
been our frontline public sector
unscathed by the crisis.
workers, two-thirds of them women.
How should the State pursue such Surely the calls for them to be better
goals? Confidently and dynamically, paid, and more adequately staffed,
suggests Marianna Mazzucato, will now be much harder to resist.
author of the groundbreaking We have seen public services more
‘The Entrepreneurial State’ and generally, especially in health,
one of the world’s most sought- perform wonders during this crisis.
after economists. The initial But we have also seen how badly
breakthroughs behind new drugs, stretched those services were – and
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 6
Learning and unlearning coronavirus lessons
in some cases, how poorly prepared in which citizens are more directly
they were for the pandemic. involved in decision-making. This
better answers the promise of
So we will need to make the case
for a far more resilient state: one democracy, which is that citizens
that is better funded and has more should have a say over all the major
reserves of ‘fat’ – such as ICU beds decisions that affect them. It also
that normally sit empty – to be called delivers better policies, because they
on in times of crisis. As well as being are more closely informed by the
resilient, this kind of government reality of individuals’ lives; it makes
would, in the words of Victoria decisions feel more legitimate,
University’s Jonathan Boston, be since more people have genuinely
anticipatory, future-focussed. It participated in them; and it increases
would look ahead, scanning the confidence in the whole system. In
The post- horizon for creeping problems and that sense, we will have to unlearn
coronavirus hard-to-detect dangers, and prepare some of the lessons of coronavirus.
accordingly.
vision is clear. Still, the post-coronavirus vision
Not everything about this crisis is clear. We need government that
We need will teach us the right lessons. The is more active, more dynamic and
government that government’s response has been more resilient. And at a time when
successful precisely because it was our dependence on government has
is more active, so authoritarian. But crises are the been laid bare, and every sector of
more dynamic exception not the rule, and in general society runs to the State for aid, the
we will need to argue for more opportunity to make that case has
and more deeply democratic government, one never been greater.
resilient.”
7 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services
The State and Social Marketing: can we embrace change?
Social marketing – the use of commercial marketing and
communication techniques for social purposes – is a
powerful tool for positively and voluntarily changing the
behaviours of individuals and populations.
Social marketing is more than Three enduring features of
the use of just social media, or good practice
advertising, or any other single
The success of the Government’s
tool; it is the strategic choice and
COVID-19 communication and
use of a combination of techniques,
marketing programme, causing Tracey Bridges
products and technologies to
nearly the entire population
achieve voluntary behaviour change Tracey has 25 years’
to change working, social and
for social good. experience working
recreational habits almost over in social marketing
Social marketing in New Zealand night, is evidence of just how and behaviour change
has a varied recent history. It has powerful this tool can be, and how in New Zealand and
come in and out of fashion with capable the public sector is of Australia. She has
different administrations, and wielding it effectively, alongside worked on programmes
the public sector’s institutional strong policy and regulatory across a range of topics,
including family violence
understanding of the evidence initiatives.
prevention, mental health
base and key tenets of good The actions of the New Zealand and injury prevention.
practice has waxed and waned. Government in March 2020 set Tracey was the founding
Achieving social behaviour change out almost a case book for how to Chair of New Zealand’s
is complex and there are many Social Marketing Network.
approach behaviour change. That’s
traps for inexperienced or careless not to say they’ve got everything
players: underinvestment, over- right – and hindsight will no doubt
communication, and short-termism be the critic’s friend – but the scale
to name just a few. of public behaviour change and
The pandemic and the long term the rapidity of it, is unlike anything
social-impacts it will create provide we’ve seen before.
fresh challenges for social marketing In part, we can attribute this to the
and behaviour change practitioners clear and obvious need to act, that
in the public sector. But these was playing out on the global stage.
challenging times also bring an But in mid-March the Government
opportunity to reflect on lessons of was walking a tightrope: if it had
the past and change how we work; to moved too soon, it would have
modernise our practice and make it moved ahead of public willingness
more progressive. to respond and comply. If it had
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 8
The State and Social Marketing: can we embrace change?
moved too slowly it would have risked of the COVID-19 response was “stay
panic, confusion and losing the trust home”.
that was so crucial in bringing people
The third tenet of best practice (and
along.
perhaps the most important) is a focus
So the COVID-19 programme is a great on the audience, or citizens. The UK’s
case study for the enduring features of National Social Marketing Centre’s
behaviour change best practice. Benchmark Criteria make this clear,
First, it took a multi-layered placing Customer Orientation as their
and integrated approach to first criterion. Successful behaviour
communications, ensuring they were change programmes understand
unmissable for the target audience and respond to what will motivate
(in this case – and perhaps for the people; and what will stop them from
behaving the way you need them to.
First we have an only time in history justifiably – all
We have seen with the COVID-19
New Zealanders). Rather than relying
opportunity to on one mechanism (for example, communications a powerful
balance held between the policy
really examine television advertising), the campaign
changes required by the science and
was visible through news media,
how social social media, advertising on a very economics of the pandemic; and the
emotional and practical needs of
marketing wide range of channels; through
the citizens who would be asked to
partnerships and use of collateral;
practice through word of mouth and aligned implement those changes.
contributes spokespeople from every agency of Not every programme over the years
Government (and beyond). And it has had the success of the COVID-19
to or reduces was repetitive and enduring — with communications, in part because not
inequalities.” briefings to media and the public all programmes have been designed
happening daily and all other forms of in a way that is consistent with good
marketing and commentary sustained practice; but other difficulties have
throughout the lockdown phase and also been in play. Less perceived
beyond. urgency, less investment, less
The second key tenet of best practice, combined expertise in the creation
where the COVID-19 campaign is so of the programme and less strength
strong, is its clear focus on behaviour in leadership have all been a feature
(and a single, “non-divisible” of our practice’s history – and will
behaviour at that). The Government likely be so in the future, for we are all
didn’t ask people to “be virus-wise” or human, and human behaviour change
promote a bundle of behaviours (e.g., is particularly complex and difficult.
“protect our community”). Instead,
the simple catch cry that headlined An invitation to change
every communication from the start As we imagine the post-COVID-19
9 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesThe State and Social Marketing: can we embrace change?
future, some features stand out more they are in place in some programmes
than others as potentially challenging and some areas. But until now they
for public sector behaviour change have been the domain of the brave
practice; and open the door to some and the patient; they demand a degree
interesting new ways to work. of flexibility and openness that isn’t
always easy to achieve.
These features were not absent in the
past, but our practice has generally A second area for reflection for
been slow to respond to them. behaviour change practice lies in our
response to the deepening complexity
First we have an opportunity to
of social problems. Another
really examine how social marketing opportunity we can seize now is to
practice contributes to or reduces act on what UK think tank Demos
inequalities. Despite generally setting has called the public sector’s “moral
out to reduce inequality, in some cases obligation” to collaborate.
social marketing practice has had the A second area
Collaboration has been an unresolved
opposite impact; either by increasing
question for social marketing
for reflection
inequality; or increasing the stigma
that is associated with inequality. To a and behaviour change practice for behaviour
for many years. It’s an area where
degree, it is in the very nature of social
intention and action have been slow
change practice
marketing, which targets communities
perceived as being most in need to connect, as the time needed to lies in our
collaborate generally works against
of change; but this is exacerbated
the sometimes urgent (and perhaps
response to
in the way many programmes are
initiated, conceived and conducted; by artificial) deadlines for many the deepening
behaviour change programmes.
reinforcing dependency and deficits,
COVID-19 has shown us that
complexity of
and taking an expert-led, rather than
community-led approach. collaboration can happen, even in social problems.”
genuinely urgent circumstances,
With the very real risk of deepening and that determined leadership
health, social and economic can make it happen. The benefits of
inequality as a result of COVID-19, that collaboration are obvious, and
we have the opportunity and the enduring.
obligation to ask ourselves, how can
The third challenge and opportunity
our practice contribute to reducing
that the pandemic and its aftermath
inequality? What can we do differently
invite us to consider is an external
to shift the balance of power? How can
one. Like the others it is not new;
we shift out practice from paternalism
and like the others, the current
to partnership?
environment makes it more urgent
Community-based practice and true to confront than ever – and more
co-design are not new concepts, and possible.
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 10The State and Social Marketing: can we embrace change?
How does the rapidly changing more that address root causes of
media environment change our harm. In a future of greater citizen-
ways of reaching people with our centricity, we may see greater
behaviour change programmes? shared ownership of problems and
What opportunities and risks arise solutions; in a future of more diverse
from the voice that social media communication channels we may see
has conferred on people previously a wider range of voices sharing social
invisible in a heavily mainstreamed good messaging in more intimate and
media and entertainment context? If trusted ways.
good communications is “simple clear
messages, repeated often, by a variety Marketing and communication are
of trusted sources ”, how can we take powerful tools government can use
advantage of the new environment to generate real and positive change
to identify, empower and motivate for New Zealand citizens. Right now
a greater variety of trusted sources? – when so much has changed; and we
Can we elevate real and diverse
It’s a bright community voices through a rich
are rethinking what our future might
look like – we have the opportunity
future, if we portfolio of channels? to embed good behaviour change
are patient and In a future of greater collaboration practice more consistently, and create
we may see fewer social marketing new approaches that put communities
brave.” programmes initiating from and citizens at the centre. It’s a bright
Government, and at the same time, future, if we are patient and brave.
11 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesRaising waka, and not just yachts
While the COVID-19 crisis has reminded us of how underpre-
pared the world was to detect and respond to emerging infec-
tious diseases, it simultaneously revealed how well placed,
and effective institutions in Te Ao Māori are in being able to
react decisively and positively on behalf of their people.
While Government leaders remain care and hygiene packages to
focused on navigating the current whānau.
crisis, we argue that making smarter Deborah (Deb) Marie Te
While no formal evaluation of the
investments in Iwi, in Māori
“Māori response” has yet been Kawa
institutions and in the Whānau Ora Ko Pohautea te maunga, Ko
conducted, what is known is, that
Commissioning agencies could Waiapu te awa, Te whānau a
through these Māori-led initiatives
accelerate our COVID-19 response Hineauta me Pokainga hapū. Nō
many whānau would otherwise have
without increasing or exacerbating Rangiora ahau. Deb Te Kawa is
received little or no targeted support a governance and public policy
inequality.
during the pandemic, had their consultant working between Te
The initial Māori response immediate physical, emotional and Whanganui-a-Tara, Ōtautahi and
package got it right spiritual needs met as Iwi and urban Rangiora.
groups mobilised resources, including
As part of the lockdown, the
online karakia, food parcels and even
Government developed a Māori
firewood.
response package focussed on
supporting hard-to-reach and What is also of interest is just how
vulnerable whānau. The initial focus effective and efficient whānau,
was on supporting health and social hapū, Iwi, marae and local Māori
service providers to help whānau providers were, when officials
stay at home to break the chain of worked with a sense of urgency, a
transmission of the virus. To support shared mission and gave way to local
this package, a deliberate policy decision-making. It shows the sort of Dr Amohia Boulton
decision was made to take advantage handbrake the kāwanatanga can be
Ngāti Ranginui
of those institutions in Te Ao Māori on rangatiratanga when it is moving Ngāi te Rangi
best placed to deliver to whānau. at its own pace and working in its Ngāti Pūkenga
silos.
Throughout the lockdown 132 Dr Amohia Bolton is the Research
Māori health and social service Before the pandemic, the Director at Whakaue Research
providers became the primary conventional wisdom was that for Māori Health & Development
with a career that has spanned
delivery agents to whānau and hapū decisions needed to be made in
public policy and academia.
across the motu. The Whānau Ora Wellington, by senior officials.
Commissioning Agencies were also What appears to have worked
involved, delivering over 100,000 well is flexible, shorter, and more
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 12Raising waka, and not just yachts
local decision-making chains and role development is met within a
acceptance that by-Māori-for-Māori Māori worldview and whānau ora
initiatives have worked well. context.
Time to acknowledge the value We need to prepare interventions
and mahi of Māori community that address the inequity that
health workers and Whānau Ora follows pandemics
Navigators The COVID-19 pandemic is
We believe Māori community health transforming labour markets across
workers and Whānau Ora Navigators the world. COVID-19 will raise
are an integral part of the health and income inequality and depress the
social services workforce. employment prospects of the
They work in a culturally vulnerable, including low-
distinctive manner, skilled and low-wage
using a specific workers according to
The COVID-19 context, that findings by Furceri, D.,
Loungani, P., Ostry,
gives effect to
pandemic is Māori health J.D. and Pizzuto, P
transforming development on how previous
aspirations as well pandemics create
labour markets as rangatiratanga income inequality.
across the world.” (Reid and Cram, Tens of millions of
2005). workers will lose their
jobs, millions more will be
Throughout the COVID-19
pushed out of the workforce
lockdown, they proved their
altogether, and some occupations
value. In a complex and demanding
will face an uncertain future. Aotearoa
environment, with the leadership and
is not immune.
support from various institutions in
Te Ao Māori, they were an incredibly Social distancing and border control
effective element in the Government’s measures threaten industries and jobs
COVID-19 response. that require a physical presence or
kanohi ki te kanohi in the workplace.
It’s time to give Māori community
Said differently, those unable to
health workers and Whānau Ora
work ‘remotely’ or ‘online’ will face a
Navigators greater recognition of the
significantly higher risk of reductions
unique role they play in the delivery
in hours or pay or permanent layoff.
of public health, primary health care
services and social services while Schulze and Hurren for Tokana Te
linking this recognition to appropriate Raki and BERL (2020) find that sixty-
remuneration and ensuring ongoing six per cent of Māori workers will
13 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesRaising waka, and not just yachts
be negatively affected by COVID-19. We would like to see a Public Service
They also find an entire generation focussed on leading and working with
of rangatahi (72%) are working in its Treaty partner to create a better and
industries and occupations that are different future.
adversely affected by the response
A close reading of the review
to COVID-19 resulting in a lost
commissioned by Whānau Ora
generation, amplifying the existing
Minister Peeni Henare in 2018 is
intergenerational inequality.
illuminating. That review, Tipu Mātoro
Some of the gains in gender equality ki te Ao, paints a vision of progress and
that the PSA has helped secure could positive changes for the whānau and Politicians,
be undone. That is because women families who engage with the Whānau commentators,
are disproportionately concentrated in Ora agencies.
the frontline roles which are regarded and policy
The review found a passive Public
as ‘essential’. In effect, these women
Service and senior leadership ensured advisors alike
bear the burden of being some of
the least well-paid employees, while
mainstream agencies did not adopt need to stop
whānau-centred approaches or
also carrying the risk of exposure to understand the positive outcomes assuming
COVID-19, and the substantial burden
of childcare and domestic chores.
being delivered by the Whānau Ora the impact of
agencies.
Politicians, commentators, and COVID-19 is
Noting that most of the public
policy advisors alike need to stop policy capability now resides in the shared evenly.
assuming the impact of COVID-19
is shared evenly. It is not. We are not
private sector, tertiary institutes It is not. We are
and community sector, the Public
all in this together. Some will do Service needs to rethink its approach not all in this
more lifting than others. Every major
epidemic this century has raised
to developing its Māori workforce. It together. Some
cannot keep expecting its Māori staff
income inequality and lowered the to do all the heavy lifting or assume will do more
population-to-employment ratio
for those with basic education but
Māori public servants and Māori lifting than
consultants will do work for free.
not those with advanced degrees. others.”
We need to start keeping an eye on Alongside these moves we also believe
vulnerable populations, including the public sector needs to address its
Māori, rangatahi, women in low-paid institutional racism and its attitudes
professions and part-time employees. that entrench negative attitudes about
whānau, hapū, Iwi and Māori roles and
Accelerate whānau centred our contribution to society.
policy and whānau ora delivery Officials need a deliberate process
models, while decolonising public that enables them to challenge the
institutions dominance of colonial views of
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 14Raising waka, and not just yachts
knowledge production and service owners are already examining how
delivery. to keep the positives associated with
This might involve service delivery remote working while maintaining a
approaches that use local context to small office or front counter presence.
prioritise needs, experiences, and Building and construction teams
beliefs – rather than generic national are designing new production lines,
response delivered from Wellington. team arrangements and schedules.
It might also include the acceptance Universities are moving classes online.
that different theoretical perspectives
We think there will be a new normal for
on what works and does not work
the way the public sector thinks about
exist, rather than dismissing them
policy and service delivery to whānau,
as outdated or lacking evidence or
accountability. hapū and Māori. To be successful, it will
need to raise the waka, boats, canoes, as
More likely, given the privileges that
It is hard to accrue in public sector bargains, it
well as the yachts.
believe that will also include officials who want In doing so it will need to take the
best of the COVID-19 experience
Aotearoa can go leadership and senior management
roles having to demonstrate a and move away from short-term,
back to its old number of core competencies such politicised policy responses to always-
normal.” as: an understanding of the history of on partnerships and systems that are
Aotearoa; cultural competency in Te Ao focussed on balancing kāwanatanga
Māori; knowledge and understanding and rangatiratanga. This will mean
of kawa and tikanga and their locking in decision-making processes
importance to Māori society; fluency in that ensure decisions are made closest
te reo Māori; and equity analysis. to the problem as well as the solution.
On the positive side, the public sector It also means analysing and speaking
has been talking about collaboration, about the differential harm COVID-19
inclusion and shared accountability will have on some – but not all.
for many years, with some progress in
Finally, it involves the public service
pockets. It is possible that the change
accelerating whānau-centred policy
underway as a result of COVID-19 can
help accelerate practical changes to and Whānau Ora delivery models while
brings these values to life. starting to long journey to decolonise
itself. The blueprint for both streams of
Summary work is in Tipu Mātoro ki te Ao (2018)
It is hard to believe that Aotearoa can and the Waitangi Tribunal’s health
go back to its old normal. Business outcomes report (2019).
15 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesOur health system and services: A best possible future?
Aotearoa has a health system that is the envy of many
other countries. It delivers high quality care at a
reasonable cost; has an approach that enables citizens and
residents to be covered for most health care costs and has
a highly skilled and dedicated workforce.
However, significant changes are As the complex task of
being observed in the health systems implementation begins, we
of most developed countries, and consider the potential for the health
New Zealand is no exception. system to enter an eddy of change Dr Jacqueline Cumming
characterised by a swirl of debate and
In thinking about change, it is often
over structures and the sequencing Dr Lesley Middleton
easy to imagine an inevitable and
of reform. Jackie has qualifications in both
smooth forward trend. In practice,
economics and public policy. She
change is much more likely to be a Where we have come from previously worked for a number
meandering river with slack water, Through to the rapid-filled 1990s of government departments
pools, dams as well as disruptive and agencies, including the
rapids (Hickson, 2020). Aotearoa has been aiming to have Department of Labour (including
a free, integrated health service a secondment to the Employment
Overview focused on prevention since a Equity Taskforce)
This chapter considers the history national health service was first
of organisational change in the proposed in the 1930s. We weren’t
provision of health services in able to achieve this, but we did
Aotearoa New Zealand, the rapids get full government funding and
endured, the tributaries followed and ownership of hospitals with free
the potential paths ahead. hospital care, along with government
subsidies to support primary
We draw on past futures thinking, care delivered by independent
current assessments of the state of professionals, albeit with user
health services and the disruptive charges for many services.
potential of COVID-19. In the light of Lesley has held previous senior
Many reviews since the 1930s have management, policy and research
the recent recommendations of the roles in the Ministry of Research,
Health and Disability System Review supported the original aims and have
suggested significant reforms, but in Science and Technology and
(Health and Disability System the Ministry of Health. She has
Review, 2020) (aka The Simpson practice governments here tend to
a particular interest in health
Report ), we are entering a period change structures, focusing on the policy and evaluating complex
parts of the system that they run. interventions that benefit from a
where we are pinning our hopes on
a new health structure to deliver Reforms in the 1960s and 1970s realist logic of enquiry.
better outcomes, including reduced amalgamated hospitals, while those
inequities. in the 1980s linked public health
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 16Our health system and services: A best possible future?
with hospital care to encourage 2020 tributaries: Alternatives mapped
a focus on health promotion and out in 1997
disease prevention.
In 1997 a futures project set out
The 1990s involved a complete to develop scenarios for the New
overhaul of the system, separating Zealand health sector in 2020.
roles in policy, purchasing and Looking back at the five scenarios
provision and emphasising developed in 1997, early signals
contracting and competition of the importance of concepts
to improve efficiency and of wellbeing rather than illness
responsiveness. Those 1990 reforms and the importance of consumer
cost a considerable amount of empowerment were outlined in one
money, as well as angst, and scenario entitled Power to the People.
were never fully able to be fully
The report implemented – resulting in many Another scenario – “Two tiers” –
changes to the original plans. presented a health sector in 2020
particularly Emerging from these rapids of the where New Zealanders had given
emphasised 1990s was a single health funding away any desire to have a universally
authority to ensure consistency and accessible publicly funded and
the lack of reduce contracting costs, and an owned health system, with the State
attention to and emphasis on provider co-operation providing only an inadequate safety
rather than competition. net for the uninsured.
accountability
for reducing
inequalities in Areas we must address to improve our health system
health.” • Major inequities in health and • Poor cousins – Primary mental
access health, disability support,
• Major inequities between ACC and and dental care are not well
Health supported
• A narrow concept of health and • Fragmentation of services –
health services Too often, services are being
organised around those
• Complex funding rules that differ delivering care rather than
across services and programmes the needs of those receiving
• Significant barriers to access services
to primary care – Through user • Lack of community and
charges service user roles in decision-
• Inequitable funding in primary care making.
17 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesOur health system and services: A best possible future?
In this scenario, public confidence a sequence of strategic directions
in the publicly funded and owned urging more attention towards the
health system fades and a focus on health needs of populations, stronger
individual rights and entitlements collaboration between different parts
prevents progress towards more of the system, and managing within
collective goals and an emphasis on the resources available.
social and economic determinants
In the early 2000s, we re-established
of health. The arc of health policy
a population health focus through
change since 1997 has avoided this
(now) 20 local District Health
scenario; however, one can point to
the more nuanced ways in which Boards (DHBs) with elected Board
the private sector has made inroads members and worked to strengthen
into health delivery, such as in aged primary care, including through
residential care and the more recent the establishment of new Primary
corporatisation of primary health Health Organisations (PHOs) which Having pointed
aimed to enhance community and
care.
consumer engagement.
out problems
The titles of the final three scenarios
The result has been expansions in
with system
sum up further possible futures and
these centred on: a technically highly the role of primary care, including a complexity and
tuned and less politicised version of wider range of health professionals, fragmentation,
the present system (A Technocrat’s and a recent introduction of better
Dream); a system driven by the primary mental health services. suggesting
introduction of private health care There have also been some there should be
plans similar to the original 1990s improvements in consumer and
plans (Positively Private and Global); community engagement in this new agencies is
and ad hoc adjustments to current setting, but not as far as originally remarkable.”
challenges (Muddling Through). envisaged.
The calmer 2000s and 2010s The introduction of Whānau Ora
as a philosophy of holistic health
A combination of Power to the People
and development operationalised
and Muddling Through would be
by Māori and Pacific providers is
the best way to describe what has
one obvious example of the ways in
happened in Aotearoa New Zealand
which ideas around wellbeing have
in recent years.
received health policy attention
In part to avoid the turmoil of the since 1997 (Smith et al, 2019).
1990s, there has been a period of
relative organisational stability 2020
from 2000 onwards: for the past 20 The Health and Disability System
years, policy change has relied on Review
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 18Our health system and services: A best possible future?
Signalled as a once in a generation delivery of services, especially
opportunity, for the past two years a primary care services. PHOs would
Health and Disability System Review no longer formally exist. It also
(the Review) has been taking stock recommended the establishment of a
of our health system. In an Interim new Māori Health Authority to work
Report (Health and Disability at all levels of the health care system
System Review, 2019), the Review
In the COVID-19 both recognised the strengths of the
to plan and prioritise Māori health.
era, it is harder, system but also pointed to a number Having pointed out problems
of key problems – most particularly with system complexity and
however, to the lack of progress in reducing fragmentation, suggesting
spot what inequities in health. It also pointed there should be new agencies is
to poor long-term planning; a lack of remarkable. As time is absorbed in
the limits to certainty for key planning, funding setting these up and working out the
State spending and delivery organisations over various relationships between them,
future funding flows; a lack of clarity
actually are. around the roles and responsibilities
as well as developing new plans
to guide the system, the potential
Economic of key organisations (e.g., DHBs and is high that we enter an eddy of
PHOs); as well as to poor integration
orthodoxy is and a limited role for consumers and
change with the opportunity to bring
decision making and services closer
not as strong as communities in decision-making.
to communities further and further
it has been, as The Final Report of the Ministerial away.
review recommended a series of new
governments structures as important to achieving Another risk, given the lack of detail
demonstrate key policy goals. The report on what these various new agencies
particularly emphasised the lack of will do, is that they suffer the fate of
little difficulty attention to and accountability for previous organisations. For example,
(or opposition) reducing inequalities in health. It a major issue with the 1990s reforms
recommended the establishment was a double-up in policy making
to financing of a new agency – Health NZ roles across the Ministry of Health
significant – to enhance planning and and Health Funding Authority;
commissioning, to more clearly while twenty years on from the
government set priorities, to support DHBs implementation of the Primary
action.” in their work, and to strengthen Health Care strategy that set up
accountability for achieving PHOs, we were still debating what
key goals such as reductions in the roles of PHOs are or should be.
inequities. DHBs would be reduced
in number to between 8 and 10 but The impact of COVID-19 – how slow
would also emphasise a locality or fast might be the eddy we end up
approach in the planning for and in?
19 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesOur health system and services: A best possible future?
Health policy is always difficult for of privately owned providers to
governments, as many different support a collective interest with
needs compete for scarce resources, programmatic funding, and in
including funding. Just to keep up connections with Māori and Pacific
with current service delivery costs communities. The voice of unions,
significant amounts of money and such as the PSA, also seemed to
aiming to fill key gaps in service be missed in formal deliberations.
delivery could chew up even more How different parts of the sector
resource. have stronger input into regular and The Aotearoa
In the COVID-19 era, it is harder, emergency decision-making is a key
however, to spot what the limits issue for the future. New Zealand
to State spending actually are.
Conclusions response to
Economic orthodoxy is not as strong
as it has been, as governments Internationally, COVID-19 has starkly COVID -19 has
demonstrate little difficulty (or exposed deep health inequities and shown, however,
opposition) to financing significant underlined structural disadvantage.
government action. The health While Aotearoa has yet to see a that when
sector is but one area crying out for death toll that directly reflects this, governments
new funding – particularly in public the second wave of cases has shown
health as well as in aiming to catch that the potential is there for some really want to
up in areas where we have fallen of our least well off populations to achieve things,
behind as a result of COVID-19, suffer more from the virus, while the
such as in elective surgery and economic impact of the pandemic
they can move
cancer screening and treatment. will also impact hard on less quickly and fund
Nonetheless, we can imagine that financially well-off communities. The
financial pressures will re-emerge in potential is there for a redoubling
accordingly –
the not-too-distant future. of the debate of how we should best we would love
work to reduce inequities in health,
During the pandemic in Aotearoa
and where to spend our scarce
to see such a
New Zealand, some previous
barriers between secondary and resources to best improve health and determined
primary care dissolved, and the role wellbeing. approach
of communities in supporting the
response and the consequences was
The Aotearoa New Zealand response to reducing
to COVID-19 has shown, however,
highlighted. that when governments really want inequities in
But gaps were also exposed in to achieve things, they can move coming years.”
terms of public health planning and quickly and fund accordingly – we
resourcing, in service providers’ would love to see such a determined
connections with community approach to reducing inequities in
health providers, in the ability coming years.
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 20Our health system and services: A best possible future?
Future directions populations, including more
equitable funding arrangements
Our focus must turn to the broader
that better ensure greater needs are
determinants of health, health
funded concomitantly.
promotion and disease prevention,
with an enhanced and well- Whilst none of these issues are
integrated primary care sector ignored in the recent Review, details
with global funding (as opposed to on how to get there are sketchy. Best
programmatic funding) and fewer practice in policymaking involves
barriers (including financial) to targeting the right intervention in
Best practice in access to services. Community and the right context, rather than a broad
consumer engagement must increase scattergun approach.
policymaking to build on the knowledge of local
With governments eager to
involves needs and what works to improve
demonstrate they are taking action,
health in those communities.
targeting structural changes launched
There must be greater ethnic under the guise of fixing the
the right diversity in health personnel, system are tempting. However,
intervention in to match current and future without sufficient attention to the
population demographics. Finally, implementation details we are at risk
the right context, equity needs to be front and centre, of entering an eddy of change and
rather than a with a stronger, independent, miss spotting the existing key points
well-resourced leadership and of community leverage that will
broad scattergun funding role for Māori and Pacific improve the system.
approach.”
References
1. Cumming J, McDonald J, Barr C, Martin G, Gerring Z, Daubé J. (2014). New Zealand:
Asia Pacific Observatory on Health Systems and Policies and the European
Observatory on Health Systems and Policies. Health Systems in Transition, v.4 (2).
2. Health and Disability System Review. (2019). Health and Disability System Review
- Interim Report. Hauora Manaaki ki Aotearoa Whānui – Pūrongo mō Tēnei Wā.
Retrieved from Wellington:
https://systemreview.health.govt.nz/interim-report/download-the-report
3. Health and Disability System Review. (2020). Health and Disability System Review -
Final Report - Pūrongo Whakamutunga. Retrieved from Wellington:
https://systemreview.health.govt.nz/final-report
4. Hickson, R. (2020). The Long and Winding River of Social Change. Retrieved from
https://sciblogs.co.nz/ariadne/2020/07/06/the-long-and-winding-rivers-of-social-
change
5. Smith, V., Moore, C., Cumming, J., Boulton, A. (2019). Whānau Ora: An Indigenous
Policy Success Story Chapter 21 in Successful Public Policy: Lessons from Australia and
New Zealand eds. Joannah Luetjens, Michael Mintrom, and Paul ‘t Hart. Canberra:
ANU Press: 505-529.
21 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesThe welfare state beyond COVID-19 – the case for a step-change
It is over 80 years since the Social Security Act in 1938
solidified and extended the foundations of New Zealand’s
welfare state. But this landmark legislation never fulfilled the
ambitious goals of its instigators for a fair and inclusive society.
The COVID-19 pandemic has not have included: comprehensive wage
only laid bare various long-standing subsidies; a modest increase in core
problems; it has also generated benefit rates and the Winter Energy
substantial new policy challenges. Payment; changes to the in-work tax
Equally, however, the pandemic credit; and a new, temporary COVID-19
has demonstrated the capacity for income relief payment. Realistically, Jonathan Boston
prompt and effective governmental New Zealand can expect much higher
Jonathan is a Professor of
measures to protect the public interest unemployment over the medium-term,
Public Policy in the School
when societal need and political will with greater income insecurity and of Government at Victoria
coincide. material hardship. University of Wellington.
With the worst of the health impacts of Secondly, there are multiple housing His research interests
the pandemic hopefully behind us in issues. There is an inadequate include: climate change
New Zealand, there is an opportunity supply of good quality yet affordable policy (both mitigation
to rethink the design of our welfare rental accommodation, there are and adaptation); child
poverty; governance
state. significant levels of homelessness and
(especially anticipatory
overcrowding with long waiting lists governance); public
COVID-19 has exposed a series
and waiting times for social housing, management; tertiary
of problems with current welfare
and homeownership rates are at their education funding
state arrangements. First, the level
lowest in three generations. (especially research
of income support for many of the
funding); and welfare state
country’s most vulnerable citizens is Thirdly, the welfare state is beset design.
utterly inadequate. To quote the 2019 with injustices, inconsistencies and
report of the Welfare Expert Advisory perverse incentives:
Group, ‘many New Zealanders are
• the country lacks a principled and
living in desperate situations’ with
comprehensive approach to the
existing income support arrangements
indexation of all forms of social
failing ‘to cover even basic costs for
assistance and income tax rates
many people’. As a result, there are
significant rates of material hardship • income support arrangements
and financial stress. differ for those who suffer equally
disabling accidents and illnesses
The Government’s various economic
support packages since March 2020 • dental services are poorly funded
have helped mitigate the worst impacts relative to most other health
of the pandemic. The measures services
Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community Services 22Putting Progressive Thinking at the centre
Fourteen brilliant contributors joined our webinar series between March and September and
more than 3,000 members and supporters tuned in. The purpose of the webinar series was to
reach out to and connect with our members throughout and beyond lockdown, providing a
place for thought and collaboration as we map our way through this unprecedented time.
Our Progressive Thinking format demanded we abridge each contribution, and feature just
10 of 14 chapters. You can read every chapter in full at:
www.psa.org.nz/progressivethinking.
Janie Walker, Be Collective include a Master’s degree in community climate
change adaptation in Fiji, and translating Sanskrit
Janie’s chapter; Being a
into Tibetan. She currently works for Be Collective, a
fisherwoman or a gardener:
community organisation with a technology solution
How COVID-19 lockdown
that supports engagement and action through
turned Community on its
volunteering.
head looks into the ways
we are each rethinking our
Troy Baisden, New Zealand
roles and responsibilities
in our communities, in our Association of Scientists
workplaces, in our families, Troy’s chapter; Restoring
and in our union movement in the context of research for the restoration
COVID-19. Janie presented her webinar alongside of wellbeings looks
Leora Hirsh ( Manager of DIA’s Strategic Programmes at the role of science
and Partnerships), Megan Courtney (Inspiring and research in a post-
Communities), Rebecca Morahan (WELLfed) traversing coronavirus world. Troy’s
the potential community presents in crisis, community chapter examines the
as a place of work, and how the future design and health of our research system in
delivery of our public and community services can achieving three main goals: building and delivering
support new and emerging roles – from volunteering new knowledge, growing and maintaining expertise,
to senior leadership. and providing society with access to and engagement
by experts. Troy argues the heart of what we need is
Biography
diverse, young Kiwis at the heart of dynamic teams
Janie’s life has been a mix of paid and unpaid work leading bottom-up innovation across the research,
opportunities. Highlights include running a creative government, and business sectors.
writing workshop for the Wellington Mosque
Biography
community post-March 15; senior engagement roles
with local and central government and writing a Troy is a Professor at the University of Waikato and
children’s play called An Elephant Never Forgets is the President of the New Zealand Association of
for Wellington Zoo. Her academic achievements Scientists. He holds a PhD from the Department of
23 Progressive Thinking: Ten Perspectives on Possible Futures for Public and Community ServicesYou can also read
