District health boards will be slashed and new government health agencies created in a massive overhaul of the health system.
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The government has released its final Health and Disability System Review which aims to bring the biggest change to the health system since DHBs were created nearly 20 years ago.
It proposes a series of changes to reform a system which it describes as complicated and often failing Māori, disabled people and rural communities.
The key changes are:
- Slashing DHBs from 20 to between 8 and 12
- No longer having elected DHBs, they will be appointed instead
- Creating Health NZ - a new crown entity that will oversee services and finances and report to the minister
- Create a new Māori Health Authority
- Have greater sharing of services between DHBs
"The review is very clear, we can do better," Health Minister David Clark told media this afternoon.
"Our system is complex and fragmented," he said.
"Local planning must drive decisions, our health and disability system needs to better understand the real needs of the community and when and where services should be available."
The government is committing to an ongoing programme of reform to build a stronger health and disability system, he said.
"This will take time, you can't make changes to a system as large and complex as our health and disability system overnight."
The report recommended cutting the number of DHBs in the next five years, with the democratic voice on them gone. At the moment there is a mix of elected and appointed members on most boards.
It wanted them to work together better to end the lottery of post code care.
With a country of just five million people, highly specialised services could not be in every area and they should be shared and integrated across the country, the report said.
The new Health NZ crown entity would focus on finances and operational work.
It would have eight board members and a chair, with an equal number of Māori and Crown representatives.
The Ministry of Health would still focus on health policy.
The new Māori Health Authority would sit alongside the Ministry of Health to focus on Māori outcomes.
It would work to build kaupapa Māori health systems and a greater Māori workforce.
It would not be possible to improve Māori health, which is worse as a population than the rest of the country, without making the system more suited to Māori values, the report said.
The report's lead author, Heather Simpson, said there was not yet a consensus among the panel that created the report about whether that authority should control the funding and commissioning of services for Māori health.
The health system had to shift focus in all areas from treatment to wellbeing, the report said.
District health boards should clearly and transparently set money aside for primary health care - that's GP level care, it said.
And it wants the disability system simplified, saying it did not serve disabled communities well.
Rural communities were also disadvantaged and DHBs needed to work out how to serve them better, it said.
There should also be a focus on recruiting and retaining staff, simplifying IT systems and planning better for building work.
The government says the Cabinet has accepted the direction of the review and the need for reform.
However, decisions on the individual recommendations would be made in the coming months.
The decisions on individual changes will be mostly made under a new government, Clark said.
He said it is essentially a three to five year plan.
"I would be expecting a new government would want to progress this as quickly as possible, the direction of travel is very clear and the opportunity is huge."
It's a once in a generation opportunity, he said. "I'm quite excited by the opportunity."
Clark said there isn't much in the report he would disagree with.
'The devil is in the detail'
Hāpai Te Hauora chief executive Selah Hart said the proposed Māori Health Authority would need be given the mandate to ensure it could effect real change.
"I think that we need to be really cautious that this isn't just another level or layer of bureaucracy that again forgets that the people and our communities and our whānau should be at the centre of everything that they do," she said.
Hart said while she was hopeful, it would come down to the implementation and execution of the authority.
"Is this Māori Authority given the same and equal rights to decision making as opposed to just acting as an advisory? That's where we feel the devil is in the detail.
"We need to see more and be provided with the proof that this separate authority will be given the mandate to actually make the systemic changes that we need for our Māori population to achieve health equity," Hart said.
The National Party accused the government of delaying the release of the report so that it could "kick the can down the road".
The party's health spokesperson, Michael Woodhouse, said the report was completed by its 30 March deadline, but Clark refused to address it for months.
"I'm just really disappointed it's taken three months since the report was finalised for the government to release it. I find that extraordinary because now the public are not going to have a clear sense where the government is going to go on this prior to September 19th. That's extremely disappointing," he said.
Woodhouse said Clark's statement that Cabinet accepted the "direction of travel" was extremely "vague".
"I mean it's a several hundred page long report. To the degree that the direction of travel is 'there needs to be some change', that's hardly a revelation. They should be much more specific about what they do agree with and they have to do that much sooner," he said.
It would take the National Party some time to form its response to the report and its recommendations, he said.