Government targets first ‘truly national health service’
All district health boards to be centralised and a Ma¯ori Health Authority introduced
The Government is setting its sights on the creation of New Zealand’s first national public health service, revealing its plans for a major reform of the health sector.
All 20 district health boards will be replaced by a centralised Crown entity, Health New Zealand.
This would create New Zealand’s “first truly national public health service”, while also ending the so-called “postcode lottery”, according to Health Minister Andrew Little.
A public health agency, which will monitor and be ready to respond to health threats to New Zealand has also been announced, as has an independent Ma¯ori Health Authority.
“This is a transformation that is necessary — and overdue,” Little said.
The shake-up drew criticism from National and Act, the latter calling the creation of a Ma¯ori Health Authority a “divisive move”. But the Ma¯ori Party and the Greens support the authority.
The proposed changes represent one of the biggest reforms of New Zealand’s health sector.
The Health and Disability report, released mid-last year, suggested that the number of DHBs should be slashed to between eight and 12.
“I reached the conclusion that the argument for reducing them [ DHBs] was the same idea as getting rid of them altogether,” Little told media.
New Zealand, he said, is too small to have 20 sets of decision-makers.
Health NZ will be responsible for running New Zealand’s hospitals — Little said this will not mean a loss of funding.
Although the new entity will be based in Wellington, it will have regional offices in Auckland and Northland, South Island, the Central North Island and the Lower North Island.
Each office will be responsible for hospitals in its region.
Little said a lot of jobs will transfer out of the Ministry of Health and into Health NZ but did not rule out job losses. Democratically elected DHB board members will, however, lose their jobs come June 30 next year.
The independent Ma¯ori Health Authority will be tasked with creating a national strategy to help improve Ma¯ori health outcomes.
It will be able to directly commission services, according to Associate Health Minister Peeni Henare.
For many Ma¯ori, their experiences of the health system have been negative: “That is why we must change”, he added.
The Ma¯ori Health Authority will have veto powers, according to the Cabinet paper approving the plan.
It will “act as co-commission for other health services accessed by Ma¯ori, working jointly with Health NZ to approve commissioning plans and priorities”.
“This would require the Ma¯ori
Health Authority to jointly agree national plans and operational frameworks [eg the commissioning framework], with clear approval rights including an ability to exercise a veto in sign-off.”
Act leader David Seymour said this was divisive and represents a “serious departure from the idea that all New Zealanders have equal rights”.
National’s health spokesman Shane Reti agreed, saying a Ma¯ori Health Authority would create a “twotiered system”, which would be worse for everyone involved.
That’s because it would mean Health NZ and Ma¯ori Health Authority would be competing for staff as well as funding.
National, he said, supported a health system where the emphasis is on those with the most need.
“We know Ma¯ori have the greatest inequity across health and, therefore, greater needs across many health metrics,” Reti said.
Te Pa¯ti Ma¯ori (the Ma¯ori Party), meanwhile, welcomed the plan but co-leader Rawiri Waititi said the “devil will be in the details”.
The final part of the Government’s reform announcement was a new public health agency, which will act as the “authority on public health knowledge in the system”.
That means it will monitor threats to the health of New Zealanders and ensure the Government is ready to deal with them.
There is no price tag for the reforms yet — Little said those were coming next month in the Budget.
But it’s likely to be expensive; 20 cents in every dollar of the Budget goes into health.