The Government will abolish all 20 District Health Boards and create a single health organisation, in a sweeping plan to centralise New Zealand’s fragmented healthcare system and end the “postcode lottery” of care.
Health Minister Andrew Little on Wednesday announced the Government will create a national health organisation, akin to the United Kingdom’s NHS, and also a Māori Health Authority with spending power, and a new Public Health Authority to centralise public health work.
The radical shake-up, which goes beyond the recommendations from the Government-appointed Health and Disability Systems Review, could fundamentally change how New Zealanders receive healthcare.
“The reforms will mean that for the first time, we will have a truly national health system, and the kind of treatment people get will no longer be determined by where they live,” Little said, at an announcement in Parliament on Wednesday.
The replacement of the country’s health boards appeared not to be anticipated within the health sector in the lead up to Wednesday’s announcement, and it was not a recommendation of the review.
The Government intends for the “first truly national public health service”, called Health New Zealand, to be responsible for hospitals across the country. It would have four regional divisions.
“Our system has become overly complex. It is far too complicated for a small nation. We simply do not need 20 different sets of decision-makers,” Little said in a speech.
Little, speaking to reporters afterward, said he briefed health board chairs and chief executives on Tuesday of impending announcement.
"There was a willing acceptance of the need for change, I'm confident they will do their bit in managed the transition responsibly," he said.
The reforms were expected to take three years to complete. The Government intends to make appointments for positions in the new agency from the beginning of 2022, and if needed will legislate for the changes by April 2022.
The cost of the reforms was not discussed on Wednesday. Little said the funding decisions were yet to be made, and health boards would be expected to continue to appropriately manage their deficits until they are abolished.
The Government will also make an announcement on health targets and how the new health system would be expected to perform in the near future, Little said.
A major reform will see Health NZ commission primary and community health services, which Little hoped would “do away with duplication and unnecessary bureaucracy between regions”.
The focus on primary care was hoped to take pressure off the nation’s hospitals, which are working through a rising tide of illness.
“We will treat people before they get sick so they don’t need to go to hospital, thereby taking the pressure off hospitals,” Little said.
There is a GP shortage across the country that was expected to worsen. On average, GPs are 53 years old and nearly half are due to retire over the next decade. High patient numbers in Counties Manukau’s emergency department led the district health board to pay help pay for GP appointments to ease pressure on the hospital last month.
“We are going to put the emphasis squarely on primary and community healthcare and will do away with duplication and unnecessary bureaucracy between regions, so that our health workers can do what they do best - keep people well,” Little said.
Alongside Health NZ will be the Māori Health Authority. The Government has decided this authority should be independent and have “joint decision-making rights” for healthcare strategies and policies which affect Māori – who are currently chronically underserved by the healthcare system.
The authority's mandate will be set out in legisaltion, it will have some independent commissioning power, and it will work with Health NZ to decide where health dollars are spent for services for Māori.
“It will be able to directly commission services where needed, and to grow kaupapa Māori services and innovation,” Associate Minister of Health Peeni Henare said on Wednesday.
Henare would not be drawn on how much funding the authority would receive, however he said resources would be needed for it to tackle the health inequity.
He said there would “most definitely” be Māori-specific health targets.
A Public Health Agency will replace the country’s 30 public health organisations, a network of agencies which have come under strain during the Covid-19 pandemic response.
The Ministry of Health will remain in overarching control of the health system, and the director-general of health, currently Dr Ashley Bloomfield, will continue to lead the health sector.
The ministry will not be responsible for running hospitals or commissioning healthcare spending, instead focusing explicitly on providing policy advice to the Government.
Credit: Stuff.co.nz
