Health shakeup: DHBs scrapped for one national provider


• All DHBs will be replaced by one national health body, Health New Zealand
• A new Māori health authority will be created, with power to commission health services
• A new Public Health agency will be created
• The Ministry of Health will be bolstered and will monitor performance, and advise the Government

New Zealand's 20 District Health Boards will be replaced by one, single national health body responsible for the running of all hospitals, the Government has revealed.

The national body will be called Health New Zealand and is part of the biggest changes to the country's health care system in history.

It will have four regional divisions. Each division will work with a range of district offices which will develop and implement local health plans. 

It will delegate authority to local levels so regional services have a say in what they need and how they work, Health Minister Andrew Little says.

On the rural front, a fact sheet supplied says rural communities will still be served by a workforce of professionals.  These professionals will be better supported to deliver more care in the community.

There will be a greater focus on the use of technology to deliver more care digitally where appropriate. 

Community are would also be delivered in a more "integrated" way, so information is shared between services better.

A new Māori Health authority will also be set up, with the power to commission health services and monitor Māori health, as well as developing policy.

This will be overseen by the Ministry of Health, which will be "strengthened" by the review.

The New Zealand Medical Association welcomed the health reforms.  Chair Dr Kate Baddock said: “The announcements are what we have been asking for.”

Little unveiled the major changes this morning  - "the reforms will mean that, for the first time, we will have a truly national health system".

The changes will begin to come into effect in July next year.

The minister said he has heard calls for change, quickly.

"The current system no longer serves our needs well. Our goal is a health system that helps all New Zealanders to live longer in good health.

"We need a system that is not only fairer, but also smarter."

Smarter meant making the most of the money and resources available, the minister said, and he was not underestimating the challenges.

"Our system has become overly complex. It is too complicated for a small nation. We need to operate as one system. Organisations working together should be the norm, not the exception."

New legislation for Health NZ and the  Māori Health Authority will be worked on and Little expects that legislation to be passed by April 2022.

Today's announcement is not the full extent of the Government's major healthcare shake-up and there will be further announcements on the disability sector.

"We are going to put the emphasis squarely on primary and community healthcare and will do away with duplication and unnecessary bureaucracy between regions," Little said.

He added that the reforms "herald a change in focus for the health system".

Changes recommended by Heather Simpson, who spearheaded the report, included slashing the number...
Changes recommended by Heather Simpson, who spearheaded the report, included slashing the number of DHBs and dropping the election of its officials. Photo: NZ Herald
When it comes to the DHBs, today's announcement goes a lot further than the recommendations in last year's Heather Simpson health report.That advised the Government to slash the number of DHB's in New Zealand from 20 down to between eight and 10.

Today's announcement means that the 20 -year-old system, whereby the public vote for DHB board members, will be scrapped.

Although Little said DHBs have serves their communities well for 20 years, having separate organisations and competing priorities has led to "unacceptable variability in health services".

"That is the type of treatment you get can come down to where in the country you live. That's why it's become known as the postcode lottery - in a country as small as New Zealand, we just don't need it."

He stressed that the reforms will not mean funding to hospitals will get cut.

Health New Zealand will comprise the 12 public health services across the country.

The new Māori Health authority will be an "independent voice," which will aim to change Māori health outcomes in New Zealand, according to Associate Health Minister Peeni Henare.

"It will have joint decision-making rights to agree national strategies, policies and plans that affect Māori at all levels of the system," he said, adding that it will work alongside Health New Zealand.

The Covid-19 pandemic was one of the reasons for the new Public Health Agency, Little said.

"Population and public health present some of the largest opportunities to address inequality, tackle the causes of health need and manage future demand."

Its main role will be to lead New Zealand's overall health strategy, policy, analysis and monitoring of the entire health system.

"It will monitor threats to our health and ensure we are ready to deal with them,"  the minister said.

In other words, there will be a shift in the Government's health priorities towards prevention.

"The reforms will ensure the system is able to cope with the effects of an ageing population and respond more quickly to public health crises like the Covid-19 pandemic," Little said.

Medical Association welcomes reforms

The New Zealand Medical Association has welcomed the health reforms and the bold systemic and legislative changes they involve.

NZMA chair Dr Kate Baddock said: “The announcements are what we have been asking for.”

“We are pleased to be at the end of a three-year decision-making process and have a clear timeline for implementation of these system-wide changes.”

Included in the announcement is the establishment of a new Crown Entity called Health New Zealand, a Māori Health Authority, and the establishment of a national public health agency, which will sit within the Ministry of Health.

“NZMA has been advocating strongly for the establishment of the Māori Health Authority, and we are delighted to see this being actioned. Dr Baddock said.

"Giving the Authority autonomy, commissioning powers, and the ability to work in partnership with the Ministry of Health and Health New Zealand is a key step toward achieving equitable health outcomes for Māori."

While the disestablishment of the 20 DHBs is a big change, Dr Baddock believed the creation of Health New Zealand as a centralised health agency is the right move.

“It is clear the Government has recognised the value of an integrated single entity, promoting consistency in health through a truly national system. This is a culture shift that the system has desperately needed, and we welcome this new approach.

“The NZMA will be working with the government on the design and implementation of these changes, and ensuring they are actioned in a way that is equitable and successful for both the workforce and New Zealanders.”





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Goody. Instead of spending money on healthcare, they're now spending it on restructuring. Sigh.

And yet one of the many major criticisms of the current structure is that not enough money is used on health spending as opposed to multiple bureaucracies.

I guess you can't win either way.

Less regional bureaucracy will mean quicker access to out of town care.

The issue is that individual hospitals will still need a local management structure, it's just that decision making will now be based in Wellington. While decreasing bureaucratic costs is desirable, this won't reduce them to nothing, and the overall cost of hospital administration is a drop in the bucket compared with NZ's annual health budget. What we need is a genuine increase in resource, plus reasonable discussions about how we manage expensive care in an ageing / comorbid population with high expectations. The latter discussion is political suicide so will never be touched by government directly.

True, but for once this makes sense. The health postcode lottery with regards to which Board you live under is an anachronism ready for the dustbin of history.

All true. But Kiwis are dying because regardless of where you live you can't access many modern medicines. Regardless of where you live, the wait for cancer diagnosis and treatment in NZ is unsafe. Regardless of where you live, you will wait horribly long for hip or cataract surgery, and post surgery your follow up will be minimised because there is not enough money spent on health. Compared to Australia, our health outcomes are poor on every single measure except wrt our indigenous population where Oz does even worse than we do. So sure, fix the problem of having too many DHBs, but accept the fact that the problem of decades of underfunding is not going to be remedied by playing with the bureaucracy.

Should have happened years ago.

Certainly 20 DHBs was wasteful. Centralising on Wellington - the jury is out. The MoH has proved itself inept at so many levels it is a real worry that a centralised service will work. Is funding going to follow the workload? MoH policy has been to dump on primary care without the necessary support.
Do we need a separate Maori health authority? How will it integrate with the rest? This seems a political move rather than a health care one.

Doesn’t government love to take the complex route? Large chunks of health inequity (and it’s everywhere, not just a Maori problem) stem from the fact that there’s no consistency to funding, and DHBs have to rob Peter to pay Paul. Want to do more elective surgery? That’ll mean less mental health beds... Reviews such as these could have set a bar for minimum standards for the number of operating theatres, inpatient beds, CT / MRI scanners, nurse to patient ratios, ICU / HDU / beds per region based on population with a weighting for care needs, and protected their funding so a minimum standard of care exists everywhere. Centralisation of decision making will not make your healthcare more accessible. A committee of anonymous, unquestionable bureaucrats will end up making decisions about regions they have no interest or understanding of. It’ll be an organisation with the compassion of Immigration New Zealand, only your life maybe at stake.

This is an idea that makes sense , however in comparing it to the NHS one thing that is ignored is population density of roughly the same land mass. It is concerning because with our small population spread out it is likely major services will be centralized resulting in more of a postcode lottery. An example of this is the struggle to keep neurological services in the south with the last few years seeing a constant push to centralize in Chch and the lack of support for Southern DHB services as agreed. This is important because services like this have better results the fastér you can get patients to hospital and as it is getting people to hospital in Dunedin in a timely matter is already borderline in a region almost the size of Ireland. If this goes ahead it has to ensure that critical services like these are spread around so that they are accessible within the 'golden' time-frames for each otherwise it will simply have the perverse effect of making outcomes worse.

This is very relevant for trauma services. You may need to tolerate services that could be offered in a more cost efficient way centrally, in order to provide adequate emergency care when people have to travel long distances to tertiary hospitals. In the case of head injury and some cardiac disease, the price of a trip from Invercargill to CHCH, vs Invercargill to Dunedin will be preventable death.

The District Health Boards were only fake and token ‘democracy’ anyway, accountable to the Minister of Health, not the voters, and with the Chair appointed by the Minister of Health. Their brief was to carry out government policy within budget, act as a ‘wailing wall’ and take the blame for stuff ups and unpopular policies. At least there will be no confusion about who to blame in future - central government. But this is yet another local issue totally decided from Wellington. Since there will always be greater demand for health ( sickness, injury and disability) care than public money available, let’s hope communication between Wellington and the regions is top-rate. A lot of it is going to involve saying no to people in need, also their families.

The devil will be in the detail. They appear to have missed an opportunity to bring the ambulance service on board, it needs to be integral not a 3rd world voluntary service (no disrespect to the staff at the coal face).
Underlying issue is funding. The way it is done has always been secret, much would improve if it was transparent, then we could see why there is a post code difference.
A separate Maori entity will have no impact without getting Maori to actually take advantage of what is already on offer.

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