DHBs are replaced with one big national health authority today, but patients and suppliers are yet to discover where they will fit on NZ's new health map | Content partnership
Pay close attention. That's the timely advice to doctors, health workers and contractors with the advent of Health NZ irreversibly changing the health landscape today.
Bell Gully litigation partner Kirsty Dobbs is well placed to offer counsel on this – not only does she have a background in genetics, and she has been talking to health service organisations in order to co-write the law firm's advice on the health reforms, but she's also married to a doctor.
"My husband is a doctor, working in both public and private practice. He is aware of some of the changes. I did say to him, 'You do know that your employment contract with the DHB won't be with the DHB on Friday?'"
She laughs. "He just shrugged his shoulders."
If one was to sum up the message of Bell Gully's new report, The Big Picture – a Prescription for Change, it might be just that. These reforms will require care and change and adaptation from all those who work in and around the health sector. Don't shrug your shoulders.
One of the most key changes will be the eventual introduction of locality plans, Dobbs says. "Suppliers will want to keep a close eye on developments in their local area."
Of course, there are thousands of suppliers across New Zealand’s health sector: scanning services, radiology services, kaupapa Māori services, product suppliers and many more.
At present, there are 20 democratically elected DHBs, tasked with ensuring the distinct needs of local communities are understood and accounted for. The new centralised Health NZ model will attempt to provide for those needs through locality plans.
These 60 to 80 localities will be geographically defined areas, established by Health NZ in agreement with Te Mana Hauora Māori, the Māori Health Authority, for the purpose of commissioning primary and community health services.
They will be identified by July 2024, though already the Minister of Health has started with nine “prototype” localities: Ōtara/Papatoetoe, Hauraki, Eastern Bay of Plenty, Taupō/Tūrangi, Wairoa, Whanganui, Horowhenua, Porirua and West Coast.
These prototypes are intended to consider areas with high Māori and Pacific populations, high levels of deprivation and rural areas.
“Health NZ and the Māori Health Authority will be driving change from the top down. But what is very clear from this reform is that there will also be very clear messages coming from the bottom up.” – Kirsty Dobbs, Bell Gully
Health NZ will work with the Māori Health Authority, Iwi Māori Partnership Boards, local consumers and communities, local authorities and social sector agencies to develop boundaries and plans for each locality. That plan must set out the locality’s priority outcomes and services, and give effect to the NZ Health Plan.
According to the Bell Gully report, the localities could vary quite significantly in size. "Defining precise geographic scopes, consulting with local communities and developing plans will represent a significant undertaking over the coming years."
The report suggests that organisations operating in the health sector will wish to carefully review any locality plans published, and ensure they are across the details of any changes that may impact their operations.
"Change so significant will have implications for many," it says. "They may consider getting involved with the relevant reform and implementation processes to ensure their voices are heard."
Some suppliers and contractors will already be on edge, after a combative speech from Health NZ chair Rob Campbell this week, declaring "war" on those health technology providers and other suppliers who he says are exploiting New Zealand’s hospitals and health system for their own gain.
“While staff on the front line are under real pressure coping with current realities, the corridors of management are cluttered with consultants, contractors and vendors hawking their wares to solve problems which they promote to meet whatever they have for sale,” he said.
Dobbs offers some reassurance, to those worried about whether their services will be retained, they have the benefit of their existing contracts.
"This is a huge change coming," she says. "There will be aspects that are moving, and we're hearing that from the chair of the new entity. It's possibly unnerving for some, but at least he's being upfront.
"You'll have rights under a contract. If you are a supplier in the market, you will be looking at your contract, and weighing it against his comments.
"There needs to be continued supply throughout this transition and implementation. It'll be for a supplier to gauge how nervous those sort of comments make them about their own business, and their knowledge of their role within the market."
The new localities with their as-yet-undetermined boundaries provide further uncertainty. Health consumers and contractors may now find themselves pulled every which way geographically, with different and shifting boundaries for local and regional authorities, iwi, Three Waters incorporations, education regions, and now health localities.
It's a problem that Chris Hipkins, the minister for the public service, has previously acknowledged. He's set up a public service work programme to move to common boundaries based on communities of interest, rather than administrative need. But for now, health organisations will have to be on their toes.
"There is an obligation to consult with local authorities and other entities to determine the boundaries of the localities. Health NZ have to do that in agreement with the Māori Health Authority." – Laura Hardcastle, Bell Gully
Contractors that once supplied a single DHB may now find themselves working across several localities, with different priorities, plans, and commissioning practices for primary and community health services.
"Some in the health sector may feel like they’re being pulled in different directions," Dobbs says. "However, it may well be that as part of the consultation, Health NZ takes into account existing divisions of the country around service providers.
"Health NZ and the Māori Health Authority will be driving change from the top down. But what is very clear from this reform is that there will also be very clear messages coming from the bottom up.
"The focus will be on minimising any disruption to people who receive services on the ground. Disruption would not be a great outcome."
Bell Gully senior associate Laura Hardcastle, who co-authored the report with Dobbs, says it's not clear where the boundaries will be at the moment. "There is an obligation to consult with local authorities and other entities to determine the boundaries of the localities. Health NZ have to do that in agreement with the Māori Health Authority."
The Pae Ora Act provides for any existing contracts or other documents that refer to DHBs to be read as referring to Health NZ. Health NZ will also acquire all rights, liabilities and contracts of DHBs upon the act’s commencement on July 1. "Any reference to a DHB’s geographical area or resident population would, however, be preserved," the report says.
Staff from shared services agencies and DHBs will be transferred to Health NZ upon its establishment, so suppliers will probably continue dealing with the same health personnel initially.
"It will likely take some time for the new arrangements to bed in and locality plans setting new priorities to be issued," the report adds. "The pace of change may not necessarily be consistent nationwide and suppliers may wish to be prepared."
"If suppliers have particular issues with key contracts, they may wish to consider raising them with staff as soon as possible to ensure that they are properly addressed. Presenting Health NZ staff with possible solutions, during this busy period, should also be preferred."
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