DHBs are no more with today marking the start of the biggest reforms the health sector has seen in 20 years. Emma Hatton speaks to the co-chair of the Māori Health Authority and member of the Health NZ board about what day one brings.
To the untrained eye, it’s just like any other day.
“You're not going to see a big rah rah sort of thing because we have to maintain a sense of stability.”
“But ... I’ll tell you what, we're not going to leave any stone unturned that’s for sure.”
Sharon Shea (Ngāti Ranginui, Ngāti Hauā, Ngāti Hine, Ngāti Hako) is the Māori Health Authority co-chair and also sits on the board of Health NZ. Work has been underway for months to get the new entities to this point - fully fledged, funded and ready to reform.
The training wheels are coming off, with Shea stressing the next two years are critical.
“I give the 24 months timeframe to you because that is the length of the interim New Zealand Health Plan and we're all about action in that period of time.”
The entities are still waiting on the government policy statement, expected to land any day now, which sets the high-level direction for the new system.
The Māori Health Authority and Health NZ are also forming the country’s first national health plan, the release of which Shea said was “imminent”.
“In that plan the sector will be able to see the direction of travel and that will be in a greater level of detail than in the government policy statement.”
She said it would have six priorities, including climate change, support for long-term conditions, the first five years of a child’s life and mental health and addiction.
“We’re certainly ready. We've worked really hard to create the guard rails, the hand rails, clarity about the next 24 months to give people confidence that not only will they know what's happening, but they've got a clear view of also about how success will be measured.”
She says tangible outcomes such as workforce development and clinical measures would be short-term indicators the entities would track to make sure they were on the right path, indicating specifics would be unveiled within the national health plan.
“You're not going to see a big rah rah sort of thing because we have to maintain a sense of stability.” - Sharon Shea, co-chair Māori Health Authority
Less visible and measurable though would be work to address long-term problems.
“You can't turn the waka with the deepest hull... there are some things like intergenerational inequity that we can't change the direction of in the two years, however, it's incumbent that we are responsible for laying the tracks to make that happen.”
But what about day one?
“Basically it all happened at 1201. All of the contracts and all the staff transfer to Health NZ and we’ve got the finance system set up so people get paid and all that sort of stuff… the branding will change.”
“All the [DHB] boards from midnight no longer exist… the DHB CEOs, they are around and this is part of the stability, until at least September 30, they will certainly be a part of the team.”
It's straight to business as well with meetings already in the calendar.
"We've got joint board meetings in the afternoon and then separate board meetings. So we've got to sign off some establishment stuff to formalise everything... and then we're off.
"We've got a new pair of runners on, and we're going to start sprinting."
Health Minister Andrew Little said to the naked eye, today would look the same.
“It's about structural change. It's about the change of decision makers and how decision making gets made.
“Somebody who finished their shift on Thursday, and then starts [today], they won't notice any difference. For a patient who was in hospital on Thursday, and is still there [today], they won't notice a great deal of difference.”
“My expectation is that we will see some reduction around back office staff and equally my expectation is that whatever we free up there goes into supporting frontline health care.” - Andrew Little
He said patients would start to notice change as the new system bedded in, with greater communication between previously siloed entities and greater efficiency.
“I think particularly of recruiting to fill the nurse vacancies, with 20 different organisations all competing in the same labour market or advertising and trying to get nurses to work for them… Now we've got one big health provider who can do a recruitment campaign that deals with the system as a whole - that'll make a big difference.
“And I think we will start to see the ability to draw on resources wherever they are in the system, so if your nearest hospital can't accommodate you for the procedure, but a hospital in the next town can it'll be much easier for you to go and get your treatment there and you'll get treated much earlier.”
He said streamlining services would result in job losses for back office staff, but resourcing would be worked through as the four new entities consolidated.
“My expectation is that the same number of people you have running 20 different health providers, each with their own HR department, IT department, finance department, corporate services, all the rest of it, won't necessarily be required when you've got one entity.
“So my expectation is that we will see some reduction around back office staff and equally my expectation is that whatever we free up there goes into supporting frontline health care.”
Little expected to see change in the early stages, saying the new entities are expected to get on with things “pretty smartly”.
“They're going to have a couple of years to get things moving, get a good rhythm going. But equally in that same two years, there's got to be ... change that has to be evident ..."
Despite the reins formally handed over today to the new entities, Little said it was by no means “hands-off” for the Government.
“Definitely not. There's always going to be making sure that it's operating as we expect. I've got my first round of meetings all set up with the chairs and the chief executives of the new entities.
“The work will change its nature ... but it definitely won’t reduce.”
