DHBs to be replaced by one national body

Health Minister Andrew Little has announced the changes. Image: RNZ.

District health boards are being scrapped in a radical shake-up of the health system.

Health Minister Andrew Little has announced details to health leaders at Parliament this morning.

Watch the announcement here:

The 20 district health boards which run services for individual areas around the country will be replaced by one new body, Health NZ, which will instead plan services for the whole population.

Health NZ will have four regional divisions but also district offices.

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

"The system must work in true partnership with Maori... Maori still suffer, on average, worse health than others."

There will also be a new Maori Health Authority, sitting alongside that, to both set policies for Maori health and to decide and fund those who will deliver services.

The new Maori Health Authority will "have the power to directly commission health services for Maori".

The country's 30 primary health organisations - large regional networks of GPs and primary care - will also be ditched.

And, on the back of Covid 19, there will be a new Public Health Agency which will target widespread health problems - like smoking - and try to prepare for pandemics and epidemics.

Little says today's announcement is a plan to create a "truly national health service" that "draws on the best that we have now" but reduces pressure on healthcare workers and hospitals and specialist services.

"By making the changes I am announcing today, we will have the chance to put the focus on primary health care.

"We can start giving true effect to tino rangatiratanga and our obligations under Te Tiriti O Waitangi."

"It's a system under stress. Our health and care workers strive every day ... but demand is growing ... and the job is getting harder."

The changes being announced go further than the Health and Disability System Review, the basis for today's plan.

That recommended halving the DHBs, and having a Maori health authority but with fewer powers and less autonomy that the one announced today.

The changes have been made to try to stop what's called the post code lottery of care, where people get different care - or have different changes of survival - depending on which DHB area they live in.

The report released today says a lot of those problems are caused by the fact that hospitals and specialist care are often managed in isolation from each other, not in a coherent network.

Instead of district health boards, the new Health NZ, will oversee the health needs of four regions.

And there is an increased focused on primary - or GP-level community care.

The report says at the moment specialist or hospital care draws away a lot of primary care funding and it wants that to stop.

It also wants those community services - including GPs, midwives and pharmacists, to work more together

And the Maori Health Authority is aimed at overcoming the huge health disparities for Maori as a whole, with lower life expectancy and higher rates of disease in many areas.

Associate Health Minister (Maori Health) Peeni Henare says many Maori don't like going to the doctor because their experiences of the health system is negative.

"This authority will drive hauroa Maori and make real change."

It will represent Maori from all iwi, Henare says.

"This is where we make a start."

Regional public health units, long underfunded, will stay but under the new Health NZ entity.

Little says he's 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 means making the most of the money and resources available, says Little.

He's not underestimating the challenges faced, he says.

"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."

The Ministry of Health will be strengthened, says Little.

But it will no longer directly fund and commission health services.

Health New Zealand - a new Crown entity - will run hospitals and commission primary health care.

It will replace the existing 20 health boards, says Little.

"DHBs have served their communities well."

But they have their failings, he says.

"I want to stress this reform is about doing better with what we have. It is not about cutting services," says Little.

Little says the fourth element of the announcement is about public health.

"There are other equity challenges as well ... the system must listen to the voice of Pacific people, disable people, rainbow ... and all other people."

"We can and must do better.

"Disability issues span the full range of issues any community faces. That's why I have more work being done in this area."

Little says technology will play a part in the new system.

That will include improving access to things like virtual diagnostic tools.

"Health NZ will work with communities ... to develop the priorities for their areas, making sure people have a say in the services they get.

"You should be able to turn up anywhere in the health service and know the health professional has access to information relevant to you."

There will also be a new health charter.

"We will start work on this soon."

Some aspects of change will take years, not months, says Little.

He acknowledged the challenge of making change during a global pandemic.

He was confident they could safely take place at the same time.

"Covid-19 is not a reason to preserve a system that is not fit for purpose.

"I am mindful we need to proceed carefully and not disrupt day-to-day services.

"I expect the new system to come into effect in July 2022."

In coming weeks, work will begin on establishing interim versions of Health NZ and the Maori Health Authority.

New legislation for them will be worked on and Little expects that legislation to be passed by April 2022.

"Together we have an opportunity to make a once in a lifetime change, to put in a new system and improve the health of this, and future, generations."

DHBs will continue in their roles for now.

"I want to reassure new Zealanders that the care they rely upon will still be available."

The changes are overdue, and "this time, it must be different," says Little.

During the process of the reform plan, Little says he has been thinking of those working in the system, and those who need healthcare.

"We are a small nation, and we can make this change working together, and we can make this change in the spirit of Te Tiriti (O Waitangi)."

Rowan Quinn/RNZ.

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@Slim Shady

Posted on 24-04-2021 12:58 | By morepork

It has caused me much sadness to see the things you noted coming to fruition in a country I really thought was wiser than that. I believe there is a lot of misguided effort to "care for" Maori (who, overall, are doing fine, thanks very much...) and it is leading to the dismantling of democracy, and the descendance into Apartheid. I totally agree with you about Nanny, Freedom of Speech, etc. I think most of us can see what is happening, but we can’t do anything about it. Not until the next elections, at least...


Posted on 22-04-2021 00:09 | By morepork

Does Mr. Little think that Maori are the only people who are intimidated or uncomfortable about going to the Doctor? It is nonsense to say this meets a Treaty Requirement when there is no such requirement. Nevertheless, if Maori are statistically worse off than everybody else, I’d agree that needs investigation and correction. The decision to centralize administration or to distribute it out to Districts is older than the pyramids and can be argued both ways. I hope there are checks in place to monitor performance of the new systems and stop if they perform no better than the current one. Health is a Black Hole that will absorb as much money as you can throw at it; it is really about priorities and channeling what is available. We have seen brave new announcements about cutting queues for Health services before... we’ll have to wait and see.

Labour has to go

Posted on 21-04-2021 15:08 | By bruce.b

What the hell next, (new Maori Health Authority)this has got to stop we are or should be one not this segregation that Labour are setting up we have had enough of it.

More division

Posted on 21-04-2021 11:42 | By Johnney

Maori are not predisposed to bad health, just bad choices that results in bad health. Hopefully the government will park the education ambulance at the top of the cliff to improve outcomes for Maori. There has to be a willingness on Maori to change lifestyle choices and not keep blaming successive governments on their plight. They do have social structures from Whanau, hapu and iwi. Maybe some of these organisations can lead the way.


Posted on 21-04-2021 10:10 | By The Professor

In the interests of equality, which seems to be the hit word at the moment, is the Government going to create a non Maori Health Authority.....just to keep people happy?

Red Army

Posted on 21-04-2021 08:51 | By Slim Shady

Dismantling democracy step by step. Nanny knows best and no need for community representation anymore. Councils, DHBs, new freedom of speech laws, restricting freedom of movement. Can people not see what is going on here?

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