Just what the doctor ordered
An epochal change to the health system has been described as massive, radical, bold and bringing about changes the sector has desperately been waiting for.
That’s what we need to get different results, a Hamilton GP says, and New Zealand has the best chance of making it successful.
District health boards will disappear under changes announced by Health Minister Andrew Little yesterday morning.
They’ll be absorbed into national organisation, Health New Zealand, which would have four regional divisions and some say Waikato is a good base for one.
‘‘We simply do not need 20 different sets of decision-makers,’’ Little said in a speech.
The reform also ushers in a longdemanded Ma¯ori Health Authority with some spending power and a centralised Public Health Authority.
The new model will be doomed to fail if it’s ‘‘designed in Wellington and then delivered in Coromandel Town’’, University of Waikato professor of rural health Roger Strasser said.
But it could be great if people in local areas can have a say in how it’s developed.
He’s hoping to see less fragmentation, paperwork and reporting, so more resources can be put into caring for patients.
With plans to keep people healthy at home and give more treatment near home, the primary care workforce will need to be beefed up, he said.
And while he has no idea what the four regional divisions will be, Waikato ‘‘must be one of the options they’re considering’’ given its tertiary hospital and wider regional connections.
This bold idea is what’s needed for different outcomes, Tui Medical GP Dr Navin Rajan said.
‘‘Everything about the plan can go either terribly right or, if it’s managed poorly, can go terribly wrong. But if any place has got a chance of doing it right, we’re in that place.’’
‘‘Obviously, there’s a fine balancing act ... having a centralised authority to make things happen, an autocratic method of working, you might miss the nuances that are specific to
specific regions.’’
He hopes the new system will separate the roles of deciding on and funding services and providing them – the DHB currently does both.
He’s also keen to see Ma¯ ori direct where to spend money on Ma¯ ori health.
‘‘I think that for the first time we will see some real equity. Maybe a taste of it.’’
If patients don’t notice a difference ‘‘then we’ve completely failed, because that’s the whole point of [the changes]’’, Pinnacle chief executive Helen Parker said.
The idea is a one-system approach with consistent levels of service and local variation based on need.
But the restructure will need strong leadership, Parker said.
Hospitals have long absorbed a disproportionate amount of funding, she said, so the primary care sector is happy to hear there will be more focus on care in the community.
The Government’s direction aligns with what Waikato DHB was doing, commissioner Dame Karen Poutasi said.
That includes putting equity of outcomes under the microscope and looking at how best to deliver healthcare in different parts of the region, or localities.
‘‘If you can have local dialysis services or local chemotherapy services and you don’t have to come into Hamilton Hospital itself, that’s going to be hugely helpful,’’ Poutasi said.
‘‘At the end of the day, what matters is services for our people.’’
A single health authority will help make services consistent, but there will be a balancing act, University of Waikato professor of population health Ross Lawrenson said.
‘‘How you’re going to get a local voice into a national-run service is going to be one of the challenges.’’
The transition will be stressful senior managers at health boards, he said.
‘‘On one hand, they have to keep the show on the road. On the other hand, they have been signalled their jobs are disappearing in 12 months’ time.’’
Changes proposed are similar to the Health Funding Authority of the 90s, and there has previously been a national public health authority – it only lasted a few years, he said.
Anglesea Pharmacy owner Ian McMichael said it was about time for the massive change.
Having 20 health boards became ‘‘an incredible waste of money’’, and he had seen bad decisions lead to situations such as former Waikato DHB boss Nigel Murray’s $25.7m SmartHealth project being dropped with few results.