Tony Ryall and National were quite clear in their election policy – they were not going to “reform” or restructure the public health system. They were just going to manage it a bit better, and set fewer, but better, priorities. The reason for this was the correct perception that after 25 years of reforms, the sector was reform wary.

Yet this week Minister Ryall announced what is in fact a major reform of both the 23 DHBs and the Ministry of Health. He was very careful not to call it a restructuring or a reform, but that is what it is.

Yet his announcement was not met with the usual opposition from health sector groups and unions. It was actually welcomed by them. One union even cited it as proof the Government was listening,

The reality is that Tony Ryall went down the reform path, because not doing so was going to continue such a huge amount of waste. The identified savings of $700 over four years may be optimistic, but even if they are just half that level that is a great return on a reform programme estimated to cot just $10 million.

The professional unions are supporting the reforms because they are not going down the most pure path. The new National Health Board could have been set up as an independent agency. Instead it will be within the Ministry of Health, avoiding significant transition costs.

One looks at the identified savings in health, and wonders at the level of efficiencies that could be found in the other big ticket areas of Education and Welfare. The author is still unconvinced we need a Tertiary Education Commission of around 400 staff to do the job that used to be done by two dozen people in the Ministry of Education.

One of the criticisms made of National by ACT supporters is that at times its policies don’t seem very different to Labour, and that all New Zealanders have got is the same policies with a different, slightly better, set of managers.

This week it occurred to me that even just having a better set of managers is no insignificant thing, if it means fresh Ministers will put through reforms that their predecessors were unable to either identify or support.

In some portfolio areas, the management has been sub-standard. But in the year since the election there has hardly been a hic-cup in the health portfolio despite this being the traditional graveyard for Ministerial careers.

This may also explain some of the Government’s high poll ratings. Health is always one of the killer issues for a Government when it is going wrong. In the UK more people think the Conservatives will be better for the National Health Service than Gordon Brown’s Government. Tony Ryall’s job is to have a credible message by the next election that National has delivered more for New Zealanders than Labour would have. He is off to a good start.