The Government is to scrap District Health Boards as part of its response to Heather Simpson’s “Health and Disability System Review”.
In other key moves, it will:
- Establish a new Maori Health Authority
- A new Crown entity, Health New Zealand, will replace the DHBs and will run hospitals and commission primary and community health services.
- “Locality networks” including GPs, maternity carers, district nurses, pharmacies and providers like optometrists could replace the current Primary Healthcare Organisations.
- The Ministry of Health will be restructured as a policy advisory Ministry but will also house a new Public Health Agency.
“The reforms will be phased in over three years to make sure existing services — including the rollout of the Covid-19 vaccination programme are not disrupted,” said Health Minister Andrew Little.
The decision to scrap the DHBs has obviously been debated since Simpson recommended that they be reduced from 20 to between eight and 12.
POLITIK understands that there were views among members of her review team favouring a more dramatic reduction, but she believed that it would be politically difficult to force too many amalgamations.
National Health spokesperson Shane Reti is likely to try and ride the coat-tails of parochial opposition to the move to scrap them and oppose the move.
Little said the current system forced too many artificial barriers between regions, professionals and populations.
“What it doesn’t do is allow us to focus on the needs of the New Zealand population and the system as a whole or to identify and spread good ideas,” he said.
“Covid-19 has seen the system forge a spirit of collaboration, but this is seldom how we operate in normal times.”
He said to change this required a fundamental shift in ethos and culture in the way health services were organised.
“We need to operate as one system,” he said.
Health New Zealand will have four regional divisions, which will be responsible for overseeing and managing a network of hospitals and commissioning primary and community care services in their region.
Those regions are not finally confirmed, but POLITIK understands they would be like to be Northland-Auckland; Central North Island; Southern North Island, and all South Island hospitals would report to one regional body.
The Ministry of Health will undergo what is likely to be a radical restructuring.
There is little doubt that it is not regarded highly by either the Government or the public sector more widely.
It will now be a policy advisory Ministry, perhaps like the Ministry of Transport, and will set strategic direction and develop national policy, and it will be responsible for the regulation and ensuring financial stability.
It will continue to be headed by the Director-General.
But it will no longer directly fund and commission health services.
“Instead, it will be leaner, sharper, more agile and focussed o its core role,” said Little.
There will be a new Public Health Agency housed within the Ministry which will lead public health strategy, policy analysis and monitoring.
But that is all it will do.
There will also be a new national public health service within Health NZ comprising the 12 public health services across the country, which will provide the “on the ground” services.
This separation may reflect lessons learned during the management of the Covid pandemic.
The scrapping of the District Health Boards is the end of a long which began in 1983 with the advent of area health boards which then in 1993 saw the establishment of 23 Crown Health Enterprises and four regional health authorities.
In 1997, those authorities became the Health Funding Authority which was abolished by the Clark Labour Government in 2000 and 21 DHBs were established.
The decision to establish a Maori Health Authority was described today by Associate Health Minister Peeni Henare as “transformational”.
It will have joint decision-making rights to agree on national strategies, policies and plans that affect Maori.
It will work in partnership with Health NZ to ensure service plans and commissioning drives improvement in equity, he said.
“It will be able to directly commission services where needed and to grow Kaupapa Maori services and innovation.”
Little said some aspects of the plans announced today might take years, not months, to implement.
However, he said he expects the new system to come into effect in July 2022.
In the coming weeks, work will start on establishing interim versions of Health NZ and the Maori Health Agency as temporary agencies.
They will be headed by acting chief executives, and independent committees and permanent appointments will be made in the early part of next year.
Little said he expected the necessary legislation to be passed by April next year.