Will funding be fixed too?

The applause at the end was respectful, cautious. But hardly celebratory. Health Minister Andrew Little possibly expected a little more from an audience made up largely of over-stretched health professionals, having just announced ‘‘transformational’’ change: an end to 20 years of district health boards, reconfiguring and refocusing the Ministry of Health, and creating two new entities – a single Health NZ body to manage and deliver services throughout the country, and an ‘‘independent’’ Ma¯ ori Health Authority, with the means and money to commission services for its indigenous community.

The muted reaction matched the response of the Royal New Zealand College of General Practitioners, which, like us, commends the Government for addressing a system that has created inefficiencies and duplications across 20 DHBs, all fighting for a slice of the health pie. And all while failing to meaningfully improve the health outcomes of many, particularly Ma¯ ori and Pasifika.

The college admitted that Little’s announcement had ticked a number of boxes in moving towards a system delivering better ‘‘community health care regardless of where [people] live in New Zealand’’, and regardless of their ethnicity.

But, like us, it is curious as to how such reforms will be funded, especially the provision of community care in a country with longstanding shortages in critical areas and a history of underfunding. That may be addressed in next month’s Budget, which would no doubt bring more celebratory applause from the healthcare community.

But there are other, equally important questions that need to be answered before that approval finds a wider audience. Having decided to eliminate the inequities, inefficiencies, lack of innovation and counterproductive competition that has grown since DHBs were created in 2001, has Little merely transferred that unhealthy mix of conflicting agendas and potential dysfunction to three powerful new entities?

How will the ministry handle its changed role of governance and support while a new Health NZ body gets on with practical delivery of services around the country? And what role will the Ma¯ ori Health Authority play, given it is meant to be independent but will have a big say in the policy and provision of healthcare in the Ma¯ ori community, along with allocation of resources and its own healthcare services.

Each of these organisations will have a considerable budget and possibly divergent agendas. The success of managing that will have a huge bearing on the success of this new plan.

The proposed changes are overdue, but fail to acknowledge a key issue. Any efficiencies and savings from abolishing the DHBs are unlikely to change the basic maths: the health system is run down, shorn of the money to finance more surgery and hospital beds.

However, the most glaring shortage is in staff. We don’t have enough doctors, nurses, midwives and other critical care workers. And many of those we do have are likely to consider the newfound freedom of travel across the Tasman and the inducements of another wealthy country with its own skill shortages.

That shortage of staff remains a crucial issue in an already overstretched healthcare system facing an ageing population and what Little calls ‘‘more complex’’ health issues. If these and other changes address that inconvenient truth, the Government will have our applause.

We don’t have enough doctors, nurses, midwives and other critical care workers.