“An abomination’’ is how Andrew Little describes one part of the country’s health system. Political editor Jo Moir spoke to him about how things will be different when the biggest reforms in 20 years kick in on July 1.
The Health Minister can’t say how much money will be dedicated to the new way of doing things, and he says some of the details of what it will look like are still being worked out.
That’s because the legislation to enact the changes has only passed its first reading in Parliament and has been going through the select committee process.
A report is due back at the end of April and Little hopes to have the bill passed by early June at the latest.
“It’s inevitable that there will be changes from the select committee,’’ Little told Newsroom.
He’s read a lot of the submissions made to the committee and expects “practical changes’’ will come out of the report.
How much the Government will invest in the changes comes down to the Finance Minister Grant Robertson and announcements on Budget Day in May.
The reforms will officially end decades of district health boards, all 20 of them, and create a new entity to replace them, Health NZ.
Alongside Health NZ will be another entity, the Māori Health Authority, which will be empowered to commission services specifically for Māori and develop Māori health policy.
Funding budgets for the two entities have never been revealed and ministers have been careful not to hint or over-egg the sort of increases that might be considered.
“The thing to note with the way the two entities get their funding is that it’s not one bundle for one and one for the other. It’s activities that will be funded – some will be the responsibility of the Māori Health Authority, some will be shared, and some will be the responsibility of Health NZ,’’ Little told Newsroom.
Just how that split happens is still a couple of months away, but Robertson has previously indicated the sector has been “underinvested” and health is a big priority in the 2022 Budget.
“There is a cost to change. There’s putting in place the new entities, the new accountability documents and all the rest of it. There’s no such thing as costless change,’’ Little says.
“Part of the change is to recognise not only what hasn’t worked, but what has been not the best use of resources and what might need to change.’’
Pushing for change
The reforms go further than what was recommended by a landmark review of the health and disability system led by Heather Simpson.
It recommended reducing DHBs to between eight and 12 and while only three of the five members of the review panel agreed that the Māori Health Authority should have commissioning powers, the Government decided to do it anyway.
Little says Covid was well underway when the Government was elected in 2020 and his job as the newly appointed Health Minister was to review the Simpson report and assess what implementation should look like.
“It was clear to me even then, the feedback I was getting was the Heather Simpson report was really good but actually there was more that we could do,’’ Little said.
“And, actually it was time for health reasons as well as our obligations under the Treaty of Waitangi to give Māori a real leadership role in the health treatment for Māori.’’
Little told Newsroom there was a deep desire within the health workforce to do things differently this time.
“They don’t want more of the same – just to replicate what we’re doing now with different entities – they want things and the way we do things to be different,’’ he said.
“People recognise the level of inequity in service delivery as being pretty poor.
“People see the level of variability or inconsistency with health services in different parts of the country – we just can’t carry on doing that,’’ Little says.
As the country has grappled with the pandemic over the past two years Little is realistic that aspects of the way the health system has responded have not been perfect.
He points to the vaccination programme as an obvious area where things would have been done differently, and better, if the reforms had been implemented before Covid struck.
“The vaccination programme would have engaged the Māori Health Authority right from the outset.
“It would have been well connected to Māori health providers and Whanau Ora providers, and we would have seen better traction, I think much earlier than we saw.’’
The IT platforms are another disappointing feature of the country’s health system, Little admits.
“The health sector has been calling out for years for a decent platform, so wherever you are in the country and dealing with a patient, you can get their medical records regardless.
“We’ve started building those platforms – one at the moment is being built for care in the community – that should have been available before now and if we had the new health structure in place it would have been’’
“The IT structure of the health system at the moment is just an abomination, that’s why in the last budget we committed to $350 million to lifting our game in that respect.
“That’s something we should have done years ago,’’ Little says.
DHBs across the country will wind up their two-decade existence on June 30, except for a handful of staff who will be kept on for a couple of months to see through reporting requirements before also finishing up.
“We’ve got to close out the old and retain enough institutional knowledge to see things through, and then enough new talent and innovative talent to carve a new path,’’ Little told Newsroom.
The same public scrutiny won’t exist with the two new boards of Heath NZ and the Māori Health Authority, given meetings won’t be open to the media in the way DHB meetings currently are.
Little says both entities will be subject to the Official Information Act, and he expects any decisions to be made available in a transparent and timely manner.
“When you’ve got everything consolidated into one organisation responsible for everything you’re not going to have all of New Zealand being able to turn up to a meeting, but you can find other ways to make sure it’s transparent
“There will be ways to make sure decisions being made by the board are available if not at the time they’re made, certainly on the day they’re made, with appropriate transparency and making them available online as things routinely are at the moment.
“I don’t think that’s going to be difficult,’’ Little said.
As to whether the boards' meetings could be open to media in the future, Little didn’t rule it out, saying he hadn’t raised it with the boards and didn’t know what their position on it was.
Confidence in the Ministry of Health
Little says the Ministry of Health and its boss, Dr Ashley Bloomfield, have gone through a number of reviews during the pandemic, which is warranted given the role the ministry has played.
Most recently Bloomfield had to apologise for an overestimation in testing capacity after mounting questions from Newsroom about the discrepancy between the numbers officials said could be tested and how many actually were being done.
Other reviews by the technical advisory group and the Covid real-time group led by Sir Brian Roche have identified areas where the ministry didn’t respond fast enough or adapt its processes despite warnings and requests to do so.
“We put a lot on the ministry and it doesn’t surprise me as they come under good quality review that those things are being highlighted,’’ Little told Newsroom.
“It’s not what the ministry was originally set up for. It was that anything that had to be operationalised was done through the DHBs.’’
Little said it would have been impossible to carry out a major operation like the Covid response through 20 DHBs, which is why the ministry got given such an “extraordinary range of things’’ to do.
“It’s had to not only be the policy centre and public sector lead for the health system, but has had to have commission functions and carry out major operations.’’
Under the new health structure that work will go to the two new entities, and Little says the ministry will once again be concentrated on policy and providing advice to ministers.
“We’ve had to negotiate our Covid response through a system that was never really geared up to assemble a nationwide response to a single nationwide challenge.
“They’ve done it and it hasn’t been perfect, it was never going to be and there have been stumbles along the way.
“But it’s illustrated why we should change if we want to deliver good quality healthcare in the future,’’ Little says.
