RNZ obtains two OIAs - one redacted, one not

Analysis: The right hand not knowing what the left hand is doing can be a good thing.

My colleague Anusha Bradley and I did not know we had put in similar requests for information about the outsourcing of operations from public to private hospitals.

She got back a memo from Health Minister Simeon Brown with two of its four pages of details of risks and mitigations blanked out.

I got the same four pages back from Health New Zealand with nothing blanked out.

This itself was unusual from an agency the Ombudsman recently told off for too often taking too long to release too little.

If you compare the two memos, you get a rare glimpse inside the process of deciding what the public can know and what they can't.

Brown said this was "standard", to redact officials' free and frank views about risks and issues.

The minister has defended from the top, the withholding of information that his officials, on the other hand, released without his knowledge in full.

The outgoing Chief Ombudsman Peter Boshier in March, reflecting on how the law called the OIA (Official Information Act) was going across the public sector, summed up:

"The real issues are not with the law. They centre on 'culture' and that involves trust, behaviour and leadership. Bad behaviour undermines the OIA. The Act's not the problem - it's the attitude that needs to change."

He had seen far too many "taking a defensive approach to OIA requests".

Ironically, given the case here of HNZ not redacting the memo about outsourcing surgeries, Boshier singled out Health NZ over delays and "its refusal to release parts or all of the requested information".

But its leadership - Brown - has demonstrated in his memo where he sets the threshold for sharing information, even about fundamental shifts in health delivery of utmost importance to patients and whānau, who often protest they want to know what is going on, not just for their own operation but around everyone's access to public health care.

Should they and the wider public be able to also access information about the risks and mitigations ahead, via reporters using the OIA?

The unredacted memo stresses outsourcing more surgeries could have benefits - and there is no reason to delay - but points out there are risks in hurrying, and there is every reason to get the right risk mitigations in place.

The unredacted memo was one of two documents released about the private hospitals outsourcing strategy.

Another six documents about it were not released, on the grounds that Health NZ would "soon" make them publicly available.

The same grounds for refusal were used last month when RNZ health reporter Ruth Hill asked Brown for the advice he got about putting $50 million into more operations.

The advice would be released "in due course", his office said.

That advice and those six documents have not been released yet.

Brown's office entirely refused to release the emails Hill also asked for, on the grounds - allowed under the OIA - that this would take too much work.

One way of learning more without relying on ministerial memos is to look at the experience of outsourcing elsewhere.

The UK's public health service, the NHS, has rapidly expanded outsourcing since 2008 to try to cut public waitlists. It now relies on the private hospitals for some types of elective care.

One peer-reviewed study last month of elective primary hip and knee replacement concluded: "The introduction of private providers into the NHS is associated with a contraction in in-house NHS provision, increasing waiting times for all patients and a two-tier system operating in favour of the rich."

Another last year that surveyed 40 studies, said waiting times had been reduced "in certain contexts" and that private hospitals could provide quality care in high-volume, low-complexity cases, but with "implications" for access.

Its main conclusion though was more research was urgently needed, because there had been no "comprehensive evaluation of the implications for healthcare professionals and the wider healthcare system over the longer-term", even after 20 years.

"It is crucial that the ongoing debate regarding the implications ... is evidence-based rather than driven by rhetoric or politics."

Will the implications in New Zealand, and the ministerial memos about those, be able to be part of the debate here?

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