Health Minister Simeon Brown. Photo: RNZ / Mark Papalii
The health minister says he expects decisions to be made as close to patients as possible, as he directs Health New Zealand to devolve its decision-making.
But whether clinical heads of departments will get to hold their own budgets is still something to be determined by the board.
Simeon Brown appeared before Parliament's Health Committee on Tuesday for Scrutiny Week.
Last week, he released a letter of expectations setting out his stance that too many decisions were made by people removed from the frontline, and has told Health New Zealand to come up with a plan to devolve decision-making to regions and districts.
Labour MP Ingrid Leary asked Brown whether the decision not to fund Wellington mental health recovery centre Whakamātūtū sat with his assessment that too many decisions were made by people far away from the frontline.
Brown said individual funding decisions were not for ministers to make.
"I would just like to remind the member that Health New Zealand was an organisation established by the previous government, which amalgamated decision-making into a centralised bureaucracy, away from local decision-making by local communities," he said.
Brown expected the devolution process he had asked Health New Zealand to go through would fix those frustrations.
Leary's follow-ups were eventually cut off by committee chairperson Sam Uffindell, with New Zealand First MP Jenny Marcroft asking Brown when he expected that devolution process to be completed, and what it would look like, to "give these regional leaders real power".
Brown said he had received positive feedback about devolution.
"There's a real desire from the organisation for decisions to be made closer to those who are providing the care in the districts and in the regions."
Te Pati Māori co-leader Debbie Ngarewa-Packer wanted to know why the government was keen to devolve decision-making, but had centralised Māori health strategy.
Brown said the Iwi-Māori Partnership Boards were providing advice at a local level, and the Hauora Māori Advisory Committee would have a strengthened role at the national level.
Asked by Labour's Dr Ayesha Verrall to commit to clinical heads of department holding their own budgets, Brown expected budgetary decision-making, and decisions like employment, to go to a lower level, but it would be up to the board to approve.
Afterwards, he told media the organisation had to deliver within its budget, but the budgets and decisions needed to be devolved down.
"I'm focused on making sure that frontline doctors and nurses are able to be part of the decision-making process, so that we can provide as much care for patients as possible, reduce wait times, reduce wait lists, and provide that care that patients need and expect."
Despite his criticism of amalgamation, it would not be a return to the district health board model.
"The devolution policy will say, what's Health New Zealand responsible for, nationally? What are the four regions responsible for? What are the districts responsible for? And that's about laying out very clearly to the organisation where accountabilities sit, who's responsible for what, and then what decisions get made within that policy."
In his introductory remarks, Brown said wait times remained the most pressing issue facing the health system, and the primary clinical risk.
The government has set a series of health targets to achieve by 2030, including 95 percent of patients waiting less than four months for a first specialist assessment, and 95 percent of patients waiting less than four months for elective treatment.
The Quarter Four 2024/25 update showed 62 percent of patients were waiting less than four months for their first specialist assessment, and 63.9 percent were waiting less than four months for elective treatment.
Verrall also questioned whether the departing director-general of health being paid $365,000 for 52 days of work was "good value for money", similar to a question on Monday regarding a payout for Pharmac's former chief executive.
Brown said it was a matter for the Public Service Commission, not the Ministry of Health or its minister.
In a separate hearing shortly afterwards, the Public Service Commission told the Governance and Administration Committee it was a contractual payment, not a negotiated settlement, and the PSC had an obligation to pay out notice periods.
After Verrall asked further questions to Brown on the matter, Uffindell cut her off and allowed National's Hamish Campbell to ask a question, which was "who employs the director-general of health?"
As is often the case in Scrutiny Week, government MPs were keen to ask 'patsy' questions, such as "how does the government ensure taxpayer money is used efficiently?" from National's Carlos Cheung, and "this government has reinstated national health targets, can you outline why they're so important?" from Campbell.
Health New Zealand will appear before the committee on Wednesday.
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