A system to depend on with pride

With the sincerest respect to the 72,000 hardworking people who provide care and attention, day in and day out, our health system is broken. That was made resolutely clear in the Fair Care campaign by this newspaper earlier this year and in the many articles over a wider period.

This was before the Covid-19 pandemic exposed further shortcomings, such as poor preparedness for a major health threat, a lack of emergency equipment and poor lines of communication to relay the right advice to health professionals on the front line.

Despite the review being carried out before the pandemic, the dire situation was acknowledged by chairwoman Heather Simpson yesterday: “To meet the challenges of the future, our population health focus has to be stronger, our preparedness for emergencies greater, and our system has to be much better integrated with clear lines of accountability and decision rights.” To decode this, simply read that the inverse is currently the case.

Under the Health and Disability System Review model, 20 district health boards would be reduced to between eight and 12 within five years. Such a reduction in unnecessary duplication and competition is long overdue and this newspaper has repeatedly called for it. However, eight would be preferable to 12.

The review points out that health boards are currently — and counter-intuitively — responsible only for what happens in their own district. “This should change and, while each DHB must take responsibility for their domicile population, they should also be expected to consider how their planning and delivery impacts the overall system.” Agreed.

Also proposed, board members would no longer be elected by the public but appointed by the Health Minister. “The review concludes that the effectiveness of elected over appointed boards is not compelling.”

Expect opposition from those who may lose their perches and fiefdoms. But anyone who has scrolled through the potted biographies provided with voting papers will know: There’s no telling whether any of these people will be good at running public health services. Some have longer conflict of interest lists than their actual bios. Is there anyone left who would defend the confounding Single Transferable Voting system for electing these boards?

Another recommendation is a new Crown entity, Health NZ, to lead delivery of health and disability services across the country. The Government has yet to commit to implementing the reforms, saying only it agreed with the “overall direction of travel”.

Simpson says: “The changes being proposed by this review have the potential to deliver a system which is a truly New Zealand system . . . a system where all New Zealanders . . . understand how to access a system which is as much about keeping them well as it is about treating them when they become sick.”

That’s something we all want, surely?