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.

• READ MORE: ‘Clear’ inequity for Māori in health care – report

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.

There’s a lot at stake in this New Zealand general election tomorrow. We face huge challenges ahead, including tackling climate change and building a more equal society. The Greens have put transformative proposals on the table.

If we succeed in forming a government with Labour, we will usher in an era of progressive change for the benefit of all New Zealanders.

The climate change package is bold. It sets a target of zero emissions by 2050, embodied in legislation and an independent Climate Commission to set carbon budgets. The discredited Emissions Trading Scheme would be replaced by a transparent carbon tax (the Kiwi Climate Fund) that would phase in agriculture. We will provide incentives for planting 1.2 billion trees, including funding for an expansion of our indigenous forests.

Revenue will be returned to the public via a dividend to all New Zealand adults.

The climate package is supported by a far-reaching change of direction for our transport system. The funding priority will switch from road to providing public transport options. Transport in our cities will be re-shaped – we will have frequent, affordable and connected up rail, light rail and rapid busways, safe walking and cycling, and we will reduce the costs of EVs.

Our cities will have less congestion, less air pollution and a better quality of life in our communities.

Our energy system will be no longer be dominated by fossil fuel and the “gentailers”. We will get to 100 percent renewable energy by 2030, and will allow no new coal mines, deep sea oil and gas exploration, or fracking.

Cheaper, cleaner, smarter electricity
We will use the disruptions in our electricity system coming from solar, wind and storage options to provide a system that is cheaper, cleaner and smarter. Low income households will be supported for up to 75 percent of the additional costs of winter energy bills, along with energy efficiency and home insulation.

We aim to revitalise manufacturing and innovation, supported through a Minister of Manufacturing and the re-introduction of R&D tax credits. Clean technology and renewables will be scaled up through a Green Infrastructure Fund, and supported through the introduction of a Capital Gains Tax (excluding the family home) that reorients investment from speculating on assets towards the productive economy.

We will support the living wage, raise the minimum wage to 66 percent of the average wage (initially to $17.75 in 2018) and expand vocational training.

The Greens are also bold on the environment. We will clean up our polluted rivers. Polluters will pay if they pollute our rivers, in the cities and in rural areas. We will introduce a levy on nitrate run-off from dairy farms and recycle the funding back into riparian planting and smart farming.

These policies will support the transition to high value farming, rather than intensive production of low cost commodities. We will restore our clean green reputation, enhancing our exports, tourism and our sense of pride as New Zealanders.

Our most precious freshwater resources need better protection. Commercial water users are extracting the purest water for profit, without any payment for the use of our resources. The Greens will tax water bottling and use the revenues to support mana whenua and local communities through councils.

Our native species also need protection. One third of our native birds face extinction, along with a wide range of plants, fish and marine life. We will restore the role of the Department of Conservation as a defender of our wildlife and wild places, and increase their funding so they can manage protected areas. The drive to eliminate predators by 2050 will be supported through a $20 charge on incoming tourists, along with funding to Councils for infrastructure to manage the impacts of tourism.

Marine sanctuary
The Greens will create New Zealand’s largest marine sanctuary in the South Taranaki Bight to protect Maui’s dolphin, Antarctic blue whale and other marine life. And the Greens will put a price on plastic bags and a deposit on drink bottles to stop plastic from polluting our oceans and entering the food chain.

The Greens will end child poverty, lifting incomes and opportunities for all in our society and starting the transition towards a more equal society. The welfare package announced by the Greens is bold and ambitious, aiming to eliminate child poverty in New Zealand. The package increases all benefits, including student allowances by 20 percent, increases the amount than beneficiaries can earn before their benefit is cut, increases Working for Families, and extends the parental tax credit to beneficiary households.

These allowances and a reduction in the lowest tax rate (from 10.5 percent to 9 percent) is partially paid through the creation of a higher income tax bracket of 40 percent for those earning over $150,000.

Even more importantly, the Greens welfare policy would repair the broken social safety net. The Greens will end the punitive and compliance-oriented social welfare system so that it supports rather than punishes those who need help. It moves the system towards an adequate guaranteed income, following the model of unconditional basic income provided through NZ Superannuation.

These policies are supported by a package of measures to provide affordable housing for those on low incomes. Our Home for Life policy includes a rent-to-buy plan that helps those on low incomes get into their own home and supports community housing providers to offer affordable local housing.

The Greens would aim to help young Kiwis buy their own homes, and strengthen renters’ rights to create secure homes. We will tackle house speculation through a Capital Gains Tax (apart from the family home) and a ban on non-residents buying existing residential houses.

The basic public services of health care and education have been under-funded by the government over the past 9 years. The Greens are committed to working with Labour to re-invest in our public services. We have specific proposals to introduce free access to counselling for under-25s and to provide more support for community-based initiatives on mental health.

Boost for education
In education, we will significantly increase funding for special needs and invest in professional development for teachers. We will join with Labour in providing three years free tertiary education, increase student allowances by 20 percent and extend them to post graduate students.

The Greens are committed to upholding the principles of te Tiriti and will ensure that te reo is taught in all primary schools. We will entrench the Māori seats and improve the Treaty settlement process.

Internationally, we will uphold human rights and the Sustainable Development Goals, so that we act as a force for good in the world. We will send humanitarian aid and peace-keepers to the Middle East, not troops, and will push for peace and disarmament through a reformed United Nations.

We oppose the attempt to revive the Trans-Pacific Partnership Agreement and similar treaties that give rights to foreign corporations and remove our government’s right to regulate in the public interest. We will work with like-minded countries to promote fair and sustainable trade.

This is the Greens programme. We have a MoU with Labour and look forward to forming a strong and progressive government that will set our country on a path to realise our hopes and aspirations for ourselves and for future generations. Party vote Green!

Barry Coates is a list Green Party MP. His Daily Blog column is republished with permission.

Deported New Zealand missionary Douglas Tennent will hopefully be returning to Papua New Guinea in the next week.

This comes after the court ordered immigration services to issue Tennent a new visa last month which will see him return by or before August 8.

Tennent is scheduled to fly out on Friday, but is not confident his visa will come together in time.

“It doesn’t look like that’s happening,” he said.

Tennent was deported on June 12, 2017, over an alleged breach of visa conditions.

Authorities claim Tennent was deported due to “blatant abuse” of his special exemption/religious worker visa after engaging in “sensitive landowner issues in East New Britain Province”.

Tennent was deported after some landowners lodged a complaint regarding his involvement in such “sensitive landowner issues”.

‘Just doing his job’
It is believed the complaint comes due to Tennent’s involvement in remedying a special agricultural business lease regarding Malaysian multinational Rimbunan Hijau’s Sigite Mukus oil palm project in West Pomio.

Both Tennent and Archbishop Francesco Panfilo hold firm to the belief Tennent is “just doing his job”, however.

Returning to Papua New Guinea in the coming week will mark a seven week absence from his duties as the administrator for the Archdiocese of Rabaul.

Tennent told Asia Pacific Report the actions of immigration and the acting chief migration officer therefore have put not only himself, but Archbishop Francesco Panfilo under undue stress as the Archdiocese continues to settle disputes.

“The Archbishop is getting very stressed out. He’s had to put off a very much-needed holiday at 75 until I get back.”

“It’s just a matter of picking up the pieces,” Tennent said of negotiations with Rimbunan Hijau.

Tennent’s deportation has also “knocked off track” the giving back of 160 hectares of land to four local communities which was purchased illegally.

‘It needs to be sorted out’
The case was due to be heard in court on July 11, but that never happened due to Tennent’s absence.

“It needs to be sorted out in court and this has had adverse effects on the Kokopo community,” he said.

Despite criticisms he should be suing immigration for damages, Tennent is just looking forward to returning to work.

“The Archbishop and I have decided we’re not in to that. We just want to get back, carry on with the job.”

But Tennent will be making submissions to the Ombudsman, Constitutional Law Reform Commission and immigration calling for a change in the deportation process.

“I don’t want this sort of thing to happen again. If you’ve got a concern about somebody, you go to them firstly and you let them respond. That was not done at all.

“I think we’ve got a moral obligation to try and address that.”

Tennent said he would like to see potential deportees given fair notice around the reason for their deportation and ensure associated evidence is provided to them so they are allowed to respond to the allegations.

He would also like to see careful and thorough investigation carried out by immigration before people are deported and says reasonable time needs to be given for them to sort out their affairs.

“The number of deportations are not large in PNG, so there’s no excuse for not getting them right.”

• Missionary Doug Tennent’s PNG deportation – ‘a reality check’
• Deportation of NZ missionary ‘will not be taken lightly’, says archbishop
• Juffa blasts PNG for ‘hypocrisy’ over deportation of NZ missionary