21 Apr 2021

Govt health shake-up 'bold, necessary' - veteran DHB chair

From Checkpoint, 5:11 pm on 21 April 2021

The government's health shake-up is 'bold and necessary' systems building, but needs to be implemented right, veteran health expert Dr Lester Levy says.

Levy, who chaired New Zealand's biggest DHBs and headed up a private hospital, told Checkpoint the reform plan announced today was the most transparent and "least compromised" he had read.

Levy is also the chair of the Health Research Council and the Crown Monitor appointed to oversee the troubled Canterbury DHB.

He says if the reforms are implemented properly the new system should be a success, but acknowledges not everyone will like it.

"People feel that it's centralisation. I think that's going to be an issue, and I think that needs to be really reframed, because it's not centralisation, it's system building," he told Checkpoint.

"This has got a regional flavour to it and it's got a locality flavour to it, so it goes down, actually, to districts and locality.

"A lot will rest in the implementation, but there shouldn't be a fear that people will lose their input or influence. I don't believe that elected health boards have actually delivered on that community kind of influence.

"I think there are a lot better ways of actually achieving that. There's a lot of opportunity to streamline, I see this in the work that I've done previously - I was chair of three DHBs - and just to be able to get some kind of standard approach to buying the same equipment.

"There has been a lot of what I call zero-sum competition in the health system as we've had it. It wasn't really a system. I think it will be good to see that gone.

"For example, if you have a certain level of vision loss from a cataract in one DHB, you might be eligible for an operation quite soon. And at another DHB you wouldn't be eligible at all. That's not good.

"We should have equal access. I think that's something that we can really fix."

Overall, Levy said access was good across DHBs.

"But this also gives an opportunity to rationalise resources. There are certain types of services where the expertise is only able to be developed by having a certain number of patients.

"Sometimes people value access over quality. So sometimes local access may not be the best thing for you. This may be an opportunity for us to rationalise all of that and make decisions that are coherent and in the best interests of patients."

He said he was not looking for any particular role.

"I just want to see it work. I've spent decades in this, and this is probably the most transparent set of reform that I've seen, and it is the least compromised. And I think [if] well implemented it is likely to be very successful."

Levy said that some people in the briefing he was part of may have been surprised, as the proposal went much further than the Simpson report recommended.

"And it is difficult for people who are going to be in challenging positions [if they] have their roles changed or put up for competition or however it's going to work.

"But in the end, we keep saying that we patient-centric, we keep saying we want a better health service, we keep saying we want more prevention. Why is it that the most common and costly conditions in our country are the most easily prevented? How has that happened? Now this has got the capacity to start reversing that.

"It will start getting the priorities right… I don't think that we have had the priorities right."