All 20 DHBs to be axed

The Government will abolish all 20 District Health Boards and create a single health organisation, in a sweeping plan to centralise New Zealand’s fragmented healthcare system and end the ‘‘postcode lottery’’ of care.

Health Minister Andrew Little on Wednesday announced the Government will create a national health organisation, akin to Britain’s NHS, and also a Ma¯ori Health Authority with spending power, and a new Public Health Authority to centralise public health work.

The radical shake-up, which goes beyond the recommendations from the Governmentappointed Health and Disability Systems Review, could fundamentally change how New Zealanders receive healthcare.

‘‘The reforms will mean that for the first time, we will have a truly national health system, and the kind of treatment people get will no longer be determined by where they live,’’ Little said at an announcement in Parliament.

The replacement of the country’s District Health Boards (DHBs) appeared not to be anticipated within the health sector in the leadup to the announcement, and it was not a recommendation of the review.

The Government intends for the ‘‘first truly national public health service’’, called Health New Zealand, to be responsible for hospitals across the country.

Health New Zealand would have four regional divisions.

‘‘Our system has become overly complex. It is far too complicated for a small nation. We simply do not need 20 different sets of decision-makers,’’ Little said.

The reforms are expected to take three years to complete.

The Government intends to make appointments for positions in the new agency from the beginning of next year, and if needed it will legislate for the changes by April next year.

A major reform will see Health NZ commission primary and community health services, which Little hoped would ‘‘do away with duplication and unnecessary bureaucracy between regions’’.

It is hoped the focus on primary care will take pressure off the nation’s hospitals, which are working through a rising tide of illness.

‘‘We will treat people before they get sick so they don’t need to go to hospital, thereby taking the pressure off hospitals,’’ Little said.

There is also a GP shortage across the country that is expected to worsen.

On average, GPs are 53 years old and nearly half are due to retire over the next decade.

Last month, high patient numbers in Counties Manukau’s emergency department led the district health board to help pay for GP appointments to ease pressure on the hospital.

‘‘We are going to put the emphasis squarely on primary and community healthcare and will do away with duplication and unnecessary bureaucracy between regions, so that our health workers can do what they do best – keep people well,’’ Little said.

Alongside Health NZ will be the Ma¯ ori Health Authority.

The Government has decided this authority should be independent and have ‘‘joint decisionmaking rights’’ for healthcare strategies and policies which affect Ma¯ ori – who are currently chronically under-served by the healthcare system.

The authority will have some independent commissioning power, and it will work with Health NZ to decide where health dollars are spent for services for Ma¯ ori.

‘‘It will be able to directly commission services where needed, and to grow kaupapa Ma¯ori services and innovation,’’ Associate Minister of Health Peeni

‘‘Our system has become overly complex. It is far too complicated for a small nation. We simply do not need 20 different sets of decision-makers.’’

Henare said on Wednesday.

A Public Health Agency will replace the country’s 30 public health organisations, a network of agencies which have come under strain during the Covid-19 pandemic response.

The Ministry of Health will remain in overarching control of the health system, and the director-general of health, currently Dr Ashley Bloomfield, will continue to lead the health sector.

The ministry will not be responsible for running hospitals or commissioning healthcare spending. Instead, it will focus explicitly on providing policy advice to the Government.

Andrew Little