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Those who have been waiting for this Government to do something bold will have been buoyed by yesterday’s major announcement of a shake-up to the health system.
District health boards and primary health organisations (PHOs) will be gone and replaced with a new crown entity, Health New Zealand, which will commission and fund hospital services and primary and community services. There will also be a public health service within Health New Zealand to provide long overdue cohesion between the nation’s 12 public health units.
Sitting alongside Health New Zealand will be the Maori Health Authority with the power to commission and fund services for Maori.
The decision to scrap all district health boards rather than just reduce them by about half, as recommended in the Heather Simpson-led review of the health and disability system published last year, will be welcomed by many.
Those who have been agitating for much more to be done to deal with the long-documented inequities in the health outcomes for Maori will also be pleased at the Maori Health Authority proposal which, again, is bolder than that proposed by the Simpson review.
Under the proposals, the Ministry of Health will no longer be responsible for dishing out funds for services, but it will be the primary source of strategy and policy for the system, and it will also secure and monitor health funding.
There will be a new Public Health Agency to lead overall strategy, policy, analysis and monitoring of the health system, a move which signals a shift towards prevention of disease. How much licence it may have to publicly address unpalatable truths about action required on questions which might impact on big business, and provide truly independent advice, as indeed the short-lived Public Health Commission did in the 1990s, is unclear.
Concerns have already been raised about where the community voice will sit in the new system. We tend to agree with health minister Andrew Little that the existing set-up does not work well in this regard, but there is not enough detail yet to know how well this might be improved.
One of our major concerns is around transparency and what timely public reporting there will be to ensure communities are kept in the loop about how the system is operating.
District health boards may not have been bastions of open government, but at least they held public meetings with access to documents regularly produced for board members.
In the Ministry of Health, access to information can be fraught and we would want improved ready access to people in roles which have an impact on our communities, rather than being held at arm’s length by communications staff.
An illustration of the inadequacy of the current set-up is our failed repeated attempts to get comment from the new Dunedin Hospital executive steering group chairman Evan Davies, since his appointment in late December.
It would be unfortunate if, under the reformed system, journalists were reduced to using formal Official Information Act requests, with inevitable delays, to garner basic information.
If the changes herald the introduction of a truly national health system, as Mr Little says, replacing a system which has become known as a postcode lottery for many aspects of care, they will be applauded.
Some may see the move to centralise health again as eerily reminiscent of the much-derided reforms of the 1990s, and there will be much work to be done before the reality of turning around a system which has been fragmented for decades matches the minister’s rhetoric.
The pressure will be on. Mr Little expects the permanent bodies to be in place by July 1 next year and it will be some time before we know what funding will be allocated to support the changes.
Mr Little, and all those desperate for improvements, will be hoping there will be more delight than devil in the detail when it eventually appears.