NZ plans ‘fairer’ health sector shake-up – DHBs scrapped, new Māori agency

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NZ Health Minister Andrew Little
NZ Health Minister Andrew Little ... "The system must work in true partnership with Māori... Māori still suffer, on average, worse health than others." Image: RNZ

By Rowan Quinn, RNZ News health correspondent

New Zealand is scrapping district health boards and creating a new Māori health agency in a radical “fairer and smarter” shake-up of the medical system.

Health Minister Andrew Little announced details to health leaders at Parliament today.

The 20 district health boards which run services for individual areas around the country will be replaced by one new body, Health NZ, which will instead plan services for the whole population.

Health NZ will have four regional divisions but also district offices.

It will delegate authority to local levels so regional services have a say in what they need and how they work, Little said.

“The system must work in true partnership with Māori… Māori still suffer, on average, worse health than others.”

There will also be a new Māori Health Authority, sitting alongside that, to both set policies for Māori health and to decide and fund those who will deliver services.

Direct commission
The new authority will “have the power to directly commission health services for Māori”.

“There are other equity challenges as well … the system must listen to the voice of Pacific people, disable people, rainbow … and all other people,” Little said.

“We can and must do better.”

The country’s 30 primary health organisations – large regional networks of GPs and primary care – will also be ditched.

And, on the back of covid-19, there will be a new Public Health Agency which will target widespread health problems – like smoking – and try to prepare for pandemics and epidemics.

  • WATCH:

RNZ News video of the national health shake-up announcement.

Little said today’s announcement was a plan to create a “truly national health service” that “draws on the best that we have now” but reduces pressure on healthcare workers and hospitals and specialist services.

“By making the changes I am announcing today, we will have the chance to put the focus on primary health care,” he said.

“We can start giving true effect to tino rangatiratanga and our obligations under Te Tiriti O Waitangi.

‘System under stress’
“It’s a system under stress. Our health and care workers strive every day … but demand is growing … and the job is getting harder.”

The changes being announced go further than the Health and Disability System Review, the basis for today’s plan.

That recommended halving the DHBs, and having a Māori health authority but with fewer powers and less autonomy that the one announced today.

The changes have been made to try to stop what is called the “post code lottery of care”, where people get different care – or have different changes of survival – depending on which DHB area they live in.

The report released today says a lot of those problems are caused by the fact that hospitals and specialist care are often managed in isolation from each other, not in a coherent network.

Instead of district health boards, the new Health NZ, will oversee the health needs of four regions.

And there is an increased focused on primary – or GP-level community care.

Primary care funding
The report says at the moment specialist or hospital care draws away a lot of primary care funding and it wants that to stop.

It also wants those community services – including GPs, midwives and pharmacists, to work more together

And the Māori Health Authority is aimed at overcoming the huge health disparities for Māori as a whole, with lower life expectancy and higher rates of disease in many areas.

Associate Health Minister (Māori Health) Peeni Henare said many Māori did not like going to the doctor because their experiences of the health system is negative.

“This authority will drive hauroa Māori and make real change,” he said.

It would represent Māori from all iwi.

“This is where we make a start,” Henare said.

Public health units
“Regional public health units, long underfunded, will stay but under the new Health NZ entity.

Little said he had heard calls for change, quickly.

“The current system no longer serves our needs well. Our goal is a health system that helps all New Zealanders to live longer in good health,” he said.

“We need a system that is not only fairer but also smarter.”

Smarter means making the most of the money and resources available, Little said.

He was not underestimating the challenges faced, he said.

“Our system has become overly complex. It is too complicated for a small nation.

‘Operate as one system’
“We need to operate as one system. Organisations working together should be the norm, not the exception.”

The Ministry of Health would be strengthened, Little said.

But it will no longer directly fund and commission health services.

Health New Zealand – a new Crown entity – will run hospitals and commission primary health care.

It will replace the existing 20 health boards, Little said.

“DHBs have served their communities well.”

But they have their failings, he said.

‘About doing better’
“I want to stress this reform is about doing better with what we have. It is not about cutting services,” Little said.

Little said the fourth element of the announcement was about public health, including “Pacific people, disabled people, rainbow … and all other people”.

“Disability issues span the full range of issues any community faces. That’s why I have more work being done in this area,” he said.

Little said technology would play a part in the new system.

That would include improving access to things like virtual diagnostic tools.

“Health NZ will work with communities … to develop the priorities for their areas, making sure people have a say in the services they get.”

“You should be able to turn up anywhere in the health service and know the health professional has access to information relevant to you.”

New health charter
There will also be a new health charter.

“We will start work on this soon.”

Some aspects of change would take years, not months, Little said.

He acknowledged the challenge of making change during a global pandemic.

He was confident they could safely take place at the same time.

“Covid-19 is not a reason to preserve a system that is not fit for purpose,” he said.

“I am mindful we need to proceed carefully and not disrupt day-to-day services.

“I expect the new system to come into effect in July 2022.”

Establishing interim versions
In coming weeks, work will begin on establishing interim versions of Health NZ and the Māori Health Authority.

New legislation for them will be worked on and Little expects that legislation to be passed by April 2022.

“Together we have an opportunity to make a once in a lifetime change, to put in a new system and improve the health of this, and future, generations.”

DHBs will continue in their roles for now.

“I want to reassure new Zealanders that the care they rely upon will still be available.”

The changes are overdue, and “this time, it must be different”, Little said.

During the process of the reform plan, Little said he had been thinking of those working in the system, and those who needed healthcare.

“We are a small nation, and we can make this change working together, and we can make this change in the spirit of Te Tiriti (O Waitangi).”

This article is republished under a community partnership agreement with RNZ.

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