22 Apr 2021

Health system reform: What the experts are saying

3:52 pm on 22 April 2021

Major changes planned for the health system have resulted in a broad range of views - some for, some against, and some more nuanced. This is what the experts have to say on the matter.

A document setting out the government's restructure of New Zealand's health system.

Minister of Health Andrew Little announced the sweeping changes on Wednesday (file image). Photo: RNZ / Samuel Rillstone

The 20 district health boards will be replaced with a single national agency called Health New Zealand, a Māori Health Authority will be established, and the government is promising better access to care no matter where you live.

Health expert and former West Coast DHB chairperson Dr Gregor Coster told Morning Report he didn't have any concerns about the changes.

"The things I am concerned about is we certainly need to see funding for healthcare addressed. We need to see the shortage of doctors, nurses, midwives, health psychologists, mental health workers and other critical workers addressed and above all we need to improve access to healthcare for Māori, Pacific and others with health disparities."

While he did not think the postcode lottery would end, he did think there would be a significant improvement in the way people get to access services. That means, unfortunately, people will need to travel".

"I think the other thing that people are going to notice is the way primary care works.

"You notice in the government statement is that they will no longer fund primary care through primary health organisations which are GP owned and controlled, largely.

"Their proposed model is through locality networks, which is about groups of [healthcare workers] working together in teams. I think that's a very good thing and a change we need to see."

They would need proper resourcing but were an opportunity to improve healthcare access for the country.

Māori health researcher at the University of Auckland, Dr Jacquie Kidd, said there were some risks in the plans.

Jacquie Kidd

Dr Jacquie Kidd. Photo: Supplied

"If we go down the track of having a Māori Health Authority that is established in the same western model as for example the new national health organisation then it's kind of doomed to fail to start with, because we need Māori processes."

It would have to be set up with a Māori world view and with Māori leaders, she said.

"I am incredibly hopeful about this ... if it is set up using te ao Māori, then whānau and hapū will be empowered to have a say in how things go and develop local solutions, because local solutions are what works."

She was concerned that the new national organisation would still be a Crown organisation.

There should still be substantial Māori leadership within that, under Te Tiriti O Waitangi, she said.

"It's not enough to take the Māori bit and slice it off and then say this is somebody else's problem."

Bowel Cancer NZ patient advocate Sarah Derrett said it was critical the rollout of the bowel screening programme went ahead despite the restructure.

"We have four DHB regions that need to enter the screening programme by the end of this year. That absolutely needs to stay on track."

The change should be done carefully and be properly resourced, and it was encouraging the government was signalling an intention to have Māori leadership embedded throughout, Derrett said.

A major concern was the "gross inequity" of access to screening for Māori and brave decisions were needed on lowering the screening age for Māori.

Association of Salaried Medical Specialists (ASMS) former executive director Ian Powell told Morning Report patients were likely to be big losers in newly announced health reforms.

"The first thing that stands out to me is there is a lack of empirical evidence to actually justify the decision to abolish [DHBs]. The argument about postcodes, for example, or access to ... health services on the basis on where you live - this is not going to change that," Powell said.

The change would not strip away bureaucracy but reposition it, he said.

Association of Salaried Medical Specialists Executive Director Ian Powell.

Ian Powell. Photo: Supplied

"DHBs are actually being scapegoated for the pressures on the system that are causing difficulties such as underfunding, such as the social determinants of health such as poverty ... such as workforces shortages."

The change would take away a strength the health system which was DHBs being responsible for a defined geographic region.

"A branch office of a new health service set in Christchurch is not going to have a proper understanding of the wider health needs of the whole South Island...

"The closer you are to your population, the better you will have an understanding of health needs."

Powell's former organisation said the overhaul was a "massive and necessary change".

He thought many of the positive comments about the changes came from people "who actually are political appointments such as board chairs and others".

"But there is a problem in our health system and it is not cohesive enough.

"When you centralise decision making as much as they are looking to centralise, then ... you are going to make it actually more restrictive."

Canterbury DHB former acting chairperson Tā Mark Solomon told Morning Report the news of the reform was "like an atomic bomb being dropped with no warning".

Dion Tuuta, left, and Mark Solomon.

Tā Mark Solomon. Photo: RNZ / Aaron Smale

He was sceptical of the planned changes.

While it was true there were issues with the delivery of health services to isolated regions, he said: "But extending the size of each of the health areas won't reduce that, it'll increase it. Because you are having bigger areas coming together".

The Ministry of Health had been the "biggest impediment to health delivery in this country, because of the way they have acted", he claimed.

The ministry had "done a good hatchet job to date to get rid of an innovative, integrated health delivery system. They have destroyed that and are now proposing to try to set it up. I find it just a little bit ridiculous".

The best part of the proposal was the Ministry of Health "minimising their input into health", Solomon said.

It was too early to say if the new Māori Health Authority was a breakthrough and it would depend on the "teeth" it had, he said.

Deputy prime minister weighs in

The National Party has called the reform 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.

Party leader Judith Collins took to Twitter to claim National would "reverse the restructuring of public health announced by Labour... Replacement of DHBs by a Wellington bureaucracy will not work; and we remove the Maori [sic] Health Authority. Public health provision must be based on individual need, not race".

Deputy Prime Minister Grant Robertson said it was "hugely disappointing" National was not on board with the planned new Māori Health Authority.

National has said it would repeal such an authority as it risked created a fragmented, two-tiered system.

Robertson disputes this, saying the current system is not delivering and government has listened to Māori and health professionals.

"Anybody can look at health outcomes for Māori and see that the health system has let them down and we need to do so much better than that."

"The Māori Health Authority is going to work in partnership with Health New Zealand, there's no sense of the two systems being in different tiers, they are going to make sure that Māori get access to high quality services," he said.

"This is about need, it's about addressing an obvious inequality, and I think its time has come."

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