Health changes take shape

The possible shape of a long-awaited shakeup of New Zealand’s health and disability system has finally been revealed. The Health and Disability System Review promises to deliver some of the most significant changes we’ve seen in a generation, in terms of the way healthcare is delivered to our communities.

It’s the result of face-to-face meetings, and expert analysis, pulled together by a panel headed by Heather Simpson, a former chief of staff during Helen Clark’s nine years as prime minister.

The timeframe for implementation of the review’s recommendations is unclear. It is important in this regard that expeditiousness and effectiveness are carefully balanced. New Zealanders, especially those who have historically felt less well served by our health system, won’t want to see the process dragged out too much, but equally they will want implementation to be effective.

In introductory remarks to the recommendations, Simpson said the review was completed before the Covid-19 pandemic but the experience of the past few months would only add strength to the panel’s recommendations. She said New Zealand’s focus on health has to be stronger, the country has to be better prepared for emergencies, and the health system has to be better integrated, with clear lines of accountability and decisions.

The panel determined that there need to be changes to ensure equity in health care, especially for Ma¯ ori and Pacific people, for rural communities and for disabled people who have felt left out and let down by the current system.

The review recommends keeping the Ministry of Health but introducing Health NZ, a new Crown entity to lead health and disability services across the country.

A Ma¯ ori Health Authority is to be established and should be welcomed, though it appears the panel was split over aspects of its role. The authority will advise the minister of health on policy, to ensure ma¯ tauranga Ma¯ ori, or Ma¯ ori knowledge, is part of all aspects of healthcare. Four of the panel members wanted it to have more autonomy to fund and commission its own services for Ma¯ ori – an independent entity rather than a reflection of the Ministry of Health.

One of Health NZ’s first jobs will be to reduce district health boards, from 20 to 8-12, within five years of being established. DHBs that remain will be served by appointed members only, with members no longer voted in by the public.

In the past, governments have removed elected members from Environment Canterbury, and the Hawke’s Bay and Waikato DHBs, in favour of commissioners. While the review contends that the appointed members will have the governance, health and Treaty partnership experience to run the health boards, the decision begs the question whether removing the ability for the public to democratically elect representatives is a smart move.

Health Minister David Clark, presenting the review’s recommendations, said he is not sure when DHBs will be restructured. However, there are just two years left before the next local government elections.

Clark said reducing DHBs wasn’t a job-cutting exercise but a shift in the way services are provided to the country. It’s not about money, it’s about how the money is spent, he told reporters.

With the coalition Government’s three-year term coming to a conclusion soon, the responsibility of implementing the changes will fall on the new Government.

One of Health NZ’s first jobs will be to reduce DHBs, from 20 to 8-12, within five years.