No, we’re not talking about the Hastings and Napier Councils.

The first mover on regional amalgamation turns out to be Hawke’s Bay’s now fragmented primary health care system. Specifically, our three primary health organizations (Hawke’s Bay PHO, Wairoa PHO, TuMeke First Choice PHO) are merging into one as of Friday April 1st.

Formerly, your GP has belonged to one of these three PHOs, through which funding for your primary care is channeled. In turn, the separate PHOs interfaced independently with the DHB, complicating the integration of hospital care with primary care.

It sounds like a lot of folks had to ‘let go’ on this reorg. That’s commendable leadership.

The single new Primary Health Organisation is called Health Hawke’s Bay — Te Oranga Hawke’s Bay. Shares in the new organization will be owned by a trust, Te Matau a Maui Health, representing health and community stakeholders. That Trust will be chaired by Tony Edwards, who represents the region’s general practitioners. Two additional trustees have been appointed — DHB Chair Kevin Atkinson and Ngati Kahungunu Chair Ngahiwi Tomoana; seven more will be appointed, representing health practitioners (including nurses), iwi, and territorial authorities.

The Trust will appoint the Board of Health Hawke’s Bay (whose interim Chair is Helen Walker), which will be responsible for $32 million in primary health care funding, and set its strategic direction.

Phew! Now that we’ve gotten the governance arrangements out of the way, how will this reorg matter to you … the patient?

The Promise: Improved health outcomes, especially for those with substantial health care needs.


DHB Chair Atkinson says the new unified structure will reduce administrative duplication and ensure more money is spent actually delivering health services to the community.

Well and good. But there’s more going here, I suspect, than capturing dollars from inefficiencies and duplication. Making the health care dollar go farther also involves better integration between primary and hospital care … and perhaps smarter investment in the former.

As DHB CEO Kevin Snee puts it: “Making it easier for people to access health care so they don’t end up needing hospital care is fundamental to improving health care and ensuring we are looking after our vulnerable communities and reducing disparity.”

If there’s any ‘agenda’ here, it would appear implicitly to be raising the ante for primary care … in the sense of keeping people healthier in the first place and out of the hospital, where care becomes rather more expensive.

The new structure will also involve more of the community in shaping health solutions. Says Mrs Walker: “Te Oranga Hawke’s Bay, means ‘great health’ and this is where we want our region to be. A wider cross-section of our community will have input into health solutions. Trustees will choose and appoint directors with the skills to run an efficient and focused business to deliver extra benefits to our region.”

While patients might care (as enlightened taxpayers) about cost control, business efficiency and participation in shaping health priorities, I’ll bet they’re far more concerned about access to care and not falling between the cracks, especially in situations requiring complex and sustained treatment … in and out of the hospital.

If the amalgamation delivers against that expectation, Health Hawke’s Bay will get deserved applause from the community at large. Patients care most about positive outcomes from the treatment they receive … and considerably less about the seating plan.

Perhaps a message for all amalgamators.

Tom Belford

P.S. And it should go without saying … no one should construe this reorg as taking any responsibility from you, the potential patient. The cheapest health care is no health care, which begins with the lifestyle choices each of us makes every day.

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