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"If you go back to the code black event that happened at Dunedin Hospital, what was that a consequence of?
"I would tell you: very poor management, very poor patient planning."
At a breakfast launch, the Health Minister set out proposals for a sweeping change of the entire health system, far greater than envisaged by the Simpson review of health that Dunedin MP David Clark commissioned when he was health minister.
All 20 DHBs, as well as primary health organisations and public health units, will be swept aside as health planning and commissioning is centralised in one organisation, Health New Zealand.
It will sit alongside a separate Maori health agency, and both will be answerable to the health ministry and minister.
Local interests will be considered through four regional divisions and a range of district offices; locations of these are undecided.
WellSouth PHO chief executive Andrew Swanson Dobbs welcomed the reforms, and volunteered his organisation as a pilot site to test how localised health planning would work.
"There is clear evidence in Andrew Little’s statements today that PHOs have a future and that PHOs which are connected and have the capacity and capability to work with communities will be the locality networks of the future.
"WellSouth is excited about the possibilities for primary health and the community to be better connected to the decisions on funding and service delivery for patients."
University of Otago dean of management Robin Gauld, who has long called for the DHB system to be scrapped, said Mr Little had taken some bold and much-needed steps.
"He is tackling some longstanding issues, and taking the DHBs away is a good move.
"There may not be any job losses — they may just be required to work differently.
"There are quite a few people between PHOs and DHBs who already work together in some sort of administrative arrangement and it will be quite important to get those groups to continue to work together rather than work separately."
Long-serving Otago health academic Prof Peter Crampton called the reforms the most dramatic set of changes to the health system since the 1990s.
"The case for change, I think, is pretty widely accepted and that was not the case for some earlier sets of reforms," Prof Crampton said.
"That makes this a very different prospect ... so I’m not surprised that the minister has felt able to make some fairly substantial changes."
Pasifika health and the disability system also had to be addressed, and there needed to be a greater strategic focus on workforce planning.
"The health system is the people who work in it," Prof Crampton said.
"Therefore, we need to produce the right people. It is utterly fundamental.
"Some broad-sweep architectural announcements were made today. There will be a huge amount of further detail which will need to come out to explain the specifics of all these changes."
SDHB chief executive Chris Fleming said while it meant the end of the organisation he led, , people in the South would continue to receive care.
"The new entities will be formally established from July 2022.
"Our focus now is on preparing for our important work for the transition phase ahead ..."
Yesterday, First Union called for ambulance services to be part of the new health system.
Mr Little said there were no plans to change arrangements with ambulance services.
"However, oversight and monitoring of ambulance services will be a function transferred to Health NZ.”