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Health system governance changes to Health New Zealand, and other news

In this post, a longer form news piece, we explore different views on the restructure of the governance bodies for the New Zealand health system. NZ’s 20 district health boards have been disestablished and replaced by Health New Zealand – Te Whatu Ora and the Māori Health Authority - Te Aka Whai Ora.

Health New Zealand will be in charge of day-to-day running of the health system in NZ, with functions delivered at local, district, regional and national levels. There will be about 80 locality networks, and iwi-partnership boards to guide decision-making. Primary health, wellbeing and community-based services will be planned and then purchased through the four regional divisions of Te Whatu Ora.

Te Aka Whai Ora will work with Iwi-Māori Partnership Boards, Māori health providers and professionals, iwi, hapū and Māori communities to understand Māori health needs and aspirations across New Zealand, and then ensure these are reflected in the priorities and plans of the health system, and how services are designed and delivered to meet those needs, including through the use of kaupapa Māori models and the application of mātauranga Māori in the system.

Health Minister Andrew Little said of the reform

Having 20 different DHBs created a “postcode lottery”, where the healthcare a person could access depended on where a person lived.

….centralising the health system was about improving access to healthcare on the basis of need, regardless of ethnicity, location or gender.

Little also talked about the inefficiencies of DHBs operating in their own manner.

"A population of five million, it does not make sense broken into 20 different parts plus a ministry plus a few add-ons as well.”

"I took the view we could get a lot more out of a single, unified structure that could streamline decision-making, get greater consistency and offer better career structures for the workforce."

Little discussed how there won’t be immediate changes for those using the health system.

They'll still go to their nearest hospital, still go to their same GP, although in a few years Little said there could be more "health hubs" across the country, centralising different services.

National's health spokesman Dr Shane Reti has three main concerns with the health reforms.

the scale of centralisation; the timing, in the middle of a pandemic; and what he says are a "lack of measurable outcomes".

An opinion piece by John Roughan questions the lack of information on the strategy behind the public health system changes.

This is merely a restructure, not a reform. There is a big difference. As the chairman of Southern Cross Health, Greg Gent, put it this week, "Structure follows strategy and I can't clearly see yet what the strategy is."

Nor can professionals in the public sector, from what I hear. They are going to work for a nominally different organisation on Monday but they don't know the point of it all. They don't know what, if anything, they are supposed to do differently.

The Nurses Organisation has concerns about how a struggling health system can undergo major reform.

“If they [Health New Zealand leadership] have allowed a culture to exist and perpetuate, the risk is they know nothing different and we might still be creating those problems,” Kerri Nuku, Kaiwhakahaere at the Nurses Organisation, said.

The problems have been seen around the country: dangerously under-staffed maternity wards, overcrowded emergency departments, a nation-wide shortage of GPs, and inequitable care where those who can afford private treatment are seen much faster than those in the public system.

Nuku fears the new system could just be more of the same.

Other members of the medical community have also voiced concerns.

Christchurch GP Dermot Coffey, who sits on the New Zealand Medical Association board, which will be liquidated, said primary care had also been left out in the changes despite being the bedrock of the health system, where 90% of health interactions take place.

“The success and failure of the reforms is down to the people working in the health system,” he said.

“There is an absolute lack of communication with people on the front line - particularly people working in primary care. It’s been really, really disappointing.”

Sarah Dalton, executive director of the Association of Salaried Medical Specialists speaks about how little funding has been promised to the specialist medical workforce.

“….the promised workforce taskforce being set up under Health NZ has yet to announce its scope, timeframe, or budget.”

“Covid has exposed years of underinvestment in our medical workforce, both at hospital and community level.”

“But the problems run deeper. Already, we have regions without any specialist cover for rheumatology, dermatology, haematology, radiation oncology, child and adolescent mental health…”

“And there are parts of the country where you cannot see a GP or dentist because there simply aren’t any.”

Health NZ - Te Whatu Ora chair Rob Campbell said that staffing was a priority.

"That is not just the numbers, it's the way the staff are organised, it's the way the staff are rewarded and valued, it's the way the staff are involved in making decisions about how their area of work is done.”

"Restoring confidence of staff is not going to happen in a week or a month, it will take time. We have to make the practical steps that people can see are going to make a difference."

Dalton also spoke about the need for more public discussion about the affordability of the health system.

“If we are going to share in a public health system that provides decent, timely, equitable, preventive, community-based, early-intervention, acute and planned hospital care, we have to share the real cost. This is more than a few one-off Budget bounces. It means taxes.”

More daily news:

RBNZ welcomes commencement of RBNZ Act 2021

Flu and RSV cases are increasing across the country

Government announces new measures to help manage COVID-19

Evan Cavanaugh to join Wealthpoint as Head of Insurance and Lending

Louise Nicholson leaves role at FMA

Graeme Edwards takes on new leadership roles at Resolution Life Australasia

Cigna New Zealand appoints Stephen Moir to board

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