Health experts on health sector overhaul: 'Devil in the detail but everybody is feeling positive'

1:27 pm on 21 April 2021

Health experts are optimistic the government's shake-up of the health system will create much needed substantial change.

Announced today, the government plans to scrap all 20 district health boards in favour of a single entity, Health NZ, that will take over the "day-to-day" running of the health system.

A new Māori Health Authority will sit alongside Health NZ and have joint decision-making rights strategy and policy at all levels.

Māori Health Authority

The new Māori Health Authority will have the power to choose what services it funds.

Sitting alongside Health NZ, it will also have joint decision-making rights on strategy and policy at all levels.

Māori GP and professor of hauora Māori Sue Crengle was a member of an advisory group involved in last year's Simpson review of the health and disability system.

"I'm really optimistic and hopeful that the announcements today are going to bring about substantial [change], the changes we need to see in terms of Māori health equity."

She said Māori will now have greater say in how services are delivered in their area.

"The use of localities provides us with an opportunity of primary care to become truly multi-disciplinary and to be well coordinated across a whole lot of different groups and services that deliver inter-primary care. I think that kind of coordination is going to be very essential to achieve the things we need to do in relation to primary care.

"I also think that Māori communities will have the opportunity at that locality level and the regional level, with regional commissioners, to influence the range of services and the direction of services and how those services are delivered in their localities and I think that's really important as well."

Senior lecturer at the University of Auckland's medical school and GP at Papakura marae, Dr Matire Harwood, said it was great to hear the ministers acknowledge the research showing the inequities between Māori and non-Māori health outcomes.

Dr Matire Harwood

Dr Matire Harwood. Photo: supplied

Dr Harwood said the biggest change will be around the authority's commissioning function.

"Devil in the detail ... but everybody is feeling positive."

Māori health leader Dr Rawiri Jansen says he has great hope for the planned health reforms.

Dr Jansen told Nine to Noon that there is twenty years of experience of having Māori working within the bureaucratic system.

He said currently Māori are working on DHB boards and within the health system but it hasn't got the job done.

"Māori health bureaucrats working in the ministry or DHBs are still required to serve the structures that they're in and the imperatives that boards make as autonomous Crown entities."

The Māori Health Authority will bring something very new and influential to the space, he said.

"We've got to get to a place ... where there is real partnership and there is real influence and a Māori Health Authority has that set of permissions and those powers to be influential to get better outcomes for Māori .

"I think that is a good future to describe and I think the announcements today are really interesting."

'This is a big de-clutter of health'

The senior doctors' union says greater national oversight of the health system is desperately needed.

Association of Salaried Medical Specialists executive director Sarah Dalton said the overhaul announced today represents a massive and necessary change.

"We have been asking for a joined up system for some time and so now this is a big declutter of health."

She said it's a fear of her members that it may be impossible for voices to be heard with a more centralised bureaucracy.

"Some national oversight of a whole bunch of things is going to be a really welcome development but also there have been some undertakings around managing the workforce nationally, investing more in the workforce, ensuring that they are valued and trained."

She said there's infrastructure, staffing and access issues in the system at the moment.

The things that get measured in health get funded and responded to, she said.

"The model of healthcare is wrong" and needs to change, she said.

Rural GPs

Rural General Practice Network chief executive Dr Grant Davidson said rural areas had been underfunded and ignored for too long, and while the announcement was encouraging, it did not completely deliver.

"I guess our biggest disappointment was the minister went through a list of priority populations and, despite the Simpson report indicating that rural were completely disadvantaged in the system, rural wasn't mentioned at all in his speech.

"So concern that rural populations, those 700,000 people throughout New Zealand, might get missed out again - so the devil's going to be in the implementation detail."

Davidson says it's vital rural health practitioners are involved in decision making for the new entity.

Opposition reaction

The National Party has decried the shake-up of the health system as reckless, saying small communities will be stripped of their voice.

The party's health spokesperson, Shane Reti, said the proposed Health NZ regime will likely end up another sprawling bureaucracy.

Act is more supportive of the plan to merge all DHBs, but said it is undermined by the proposed separate Māori Health Authority.

Health spokesperson Brooke van Velden said all races should be catered for by one system.