Fixing the postcode lottery in health

My previous job, monitoring child health, largely came about because of inefficiencies in the district health board (DHB) system.

DHBs were required to assess the health needs of people in their regions every three years, and then plan their services accordingly.

Health needs assessment was a complex task, and it quickly became clear that in child health it was much more efficient for someone to pull together all the available information and then create a customised report for each DHB, rather than having every DHB inventing their own process from scratch.

In addition to saving time, a standardised approach meant DHBs could talk to each other about how they were doing, and plan joint initiatives, as the information they received was readily comparable.

However, local knowledge was still always required for planning services on the ground.

The health reforms announced last month adopt a similar approach, by removing unnecessary duplication and bureaucracy, so more things can be done once and well nationally, while still allowing for community input into the planning of local services.

Here in Southland, it’s clear the DHB model hasn’t always delivered the best access to healthcare for local residents, particularly since the previous National-led Government merged the Southland and Otago DHBs back in 2010 without the proper support.

Despite the Labour Government investing hundreds of millions more into the Southern District Health Board over the past three years, problems with accessing basic health services – things such as specialist appointments, scans and operations – remain one of the commonest reasons people visit my Invercargill office. Many others have difficulty accessing affordable GP services, particularly after hours.

The proposed reforms will remove much of the duplication in the current system, with all 20 DHBs being replaced by a single entity, Health New Zealand, which will be responsible for running hospitals and commissioning primary and community health services.

Responsibility for public health, the importance of which has been highlighted in our response to Covid-19, will rest with a new Public Health Authority; and a new Ma¯ ori Health Authority will monitor Ma¯ ori health and wellbeing outcomes, with the ability to commission services directly.

Four regional divisions, including one covering the South Island, as well as district offices in former DHB localities, will ensure decisions can still be made close to the ground; and new locality networks and plans will mean communities and local health providers can have more say in the way local health services are delivered.

The reforms are a real opportunity to improve access and fix the postcode lottery that has characterised previous approaches. In the short term, people will continue to access their GP and hospital services as they always have. In the longer term, the aim is to ensure local services are better tailored to community needs – for example, by developing sustainable models for after-hours GP services and ensuring people can access surgery and specialists, no matter where they live.

For a country of 5 million, having 20 different approaches to the delivery of health services has, at times, hindered our ability to provide the kind of equitable care we need.

I’m optimistic the changes announced last month will ensure better access to services for Southlanders, as well as more local input into how these services are delivered.

Here in Southland, it’s clear the district health board model hasn’t always delivered the best access to healthcare for local residents.