In Thursday’s Budget 2022, a whopping $11.1 Billion dollars was tagged for the reform of our health system over the next four years.
Called the “biggest investment in our health system ever”, the reforms nationalise health under two entities: Health New Zealand and the Māori Health Authority. For some this is being heralded as a giant step towards health equity in New Zealand, ‘an atomic bomb’ or ‘tectonic shift’ in the way we do health, or conversely, at the other extreme, the beginnings of ‘apartheid’ in New Zealand.
For Hawkes’s Bay DHB head, Keriana Brooking of Ngāti Pāhauwera and Ngāti Kahungunu ki Wairoa descent, the reforms will put a Māori voice into all health decisions going forward whether on a national, regional or local level. “Just as there’ll be a clinical voice,” she says, “and a consumer voice and a business voice….”
Come June 30th, the 20 District Health Boards across New Zealand will be legally disbanded and Keriana and her 3,800 staff in Hawke’s Bay will lose their jobs, only to pick them up again the next day.
“I’ve been asked to stay on and I will be supporting the change ,” she says. “I will be called an Acting Chief Executive [with Health New Zealand].”
Health NZ (HNZ) is a service delivery arm while the Māori Health Authority (MHA) is a planning, funding and monitoring arm. Keriana expects that current DHB staff will either work for one or the other. “We have a number of staff working in the DHB Māori health team now who will move over to the MHA.”
She says the transition team are still working through what things are going to look like at a national, regional and local level. “And if we are still working through this on 1 July, then we will,” she adds. “Working with national colleagues there is a real desire not to spend taxpayer money on re-branding when it could be spent on services. So we are doing a very careful transition.”
One of the changes we will see quickly in Hawke’s Bay is the formal establishment of an Iwi-Māori Partnership Boardthat will work with Health NZ commissioners and the wider community to ensure Māori voices are heard, and that health equity for Māori is non-negotiable.
“The parameters of the board have been set,” says Keriana “and its members cover iwi across HB, that’s more than Ngāti Kahungunu, and includes post-Treaty Settlement groups.
“It is my understanding an advertisement for people to sit on the board has gone out and there will be a board in place before 30th June.”
‘Localities’ mirroring our traditional Hawke’s Bay localities – Wairoa northern HB, Ahuriri Napier, Heretaunga, Hastings, Waipawa, Waipukurau and Central Hawke’s Bay – will be set up with consultation with Māori “strenghthened” .
Wairoa is currently part of a pilot study looking at how a ‘locality’ prototype might work. Wairoa CEO and a member of the community consultation group, Kitea Tipuna told BayBuzz recently that “access to health services” was a key focus for them. “We will be asking how do our communities access services and be self-determining? What does that look like? And what might this look like for our different groups such as kaumātua, tamariki; those with long term health conditions; our rural communities and our Online services.”
There are three tiers to the new reforms that come from a community perspective, says Keriana Brooking. “This is the establishment of localities and how they work, the introduction of the Iwi-Māori Partnership Board and how it contributes around decision making to what is purchased, planned and delivered, and then the role of the consumer voice in this.
Another change we will see quickly in Hawke’s Bay is opportunities for health consumers that will come with disbandment of DHB boundaries.
“If I was in Northern HB,” suggest Keriana, “and couldn’t get my cancer treatment done in Wairoa, I could go to Palmerston North as has traditionally happened or, now there is no reason why I couldn’t go to Gisborne, where I might have good whanau support. Or if Gisborne people usually go to Waikato for hospital services, they might choose to come here to Hawke’s Bay instead. So some of the boundaries constructed through the DHB legislation get removed.”
Keriana is used to change. Before she came to Hawke’s Bay she was the Ministry of Health’s Deputy Director General Health System Improvement and Innovation and was already working in the health reform space.
For her the Healthy Futures (Pae Ora) Bill which will legalise the reforms is a chance to close the gap on health equity in NZ and the “unexplained variability” in health outcomes across different populations.
“For most people, most of the time, they get the health service that they need,” she says.
“You can’t deny though that across New Zealand how people access health and how they experience health and the outcomes they have after receiving health services are different? Why is life expectancy so different? Why is life expectancy so different between people who live in northern HB and North Shore Auckland, for example?
“People who have better incomes, better education, more stable jobs, better health, greater social support tend to have better life expectancy, better healthy life expectancy. And they are treated differently by the health system.
“There’s is lots of literature about unconscious bias. For example, from an access to cancer treatment perspective, the research will show that the time you interact with primary health care and discover you need access to cancer services for some populations is very early in the cancer journey; for others they may arrive in the emergency department unwell and discover they have cancer – and at a degree where the treatment they need is more intense, larger.
“What research shows is that over each phase of cancer treatment, Māori are more likely to arrive into cancer treatment later than other populations. And over each phase of treatment, Māori are more likely to drop off. It may be because they do not think anything is going on; they may put other whanau ahead of themselves; they may not go and see the doctor. They may not have financial means to put petrol in the car to go to doctor; or there could be literacy problems – they don’t understand the doctor.
“We could debate a for a long time about colonisation and its impact,” says Keriana
“But it is true that there is variability across NZ that is unexplained about how some people will get a good health service and others won’t. That some people live longer and others don’t.
“We need to remove this unexplained variability.”
This interview is part of a larger feature on the health reforms that will appear in the July/August BayBuzz.