I’m not sure which of these clichés better describes how one should assess the Government’s health reforms announced this past week … ‘the devil is in the details’ or ‘déjà vu’ all over again’. The National Party reduces it to one word, ‘reckless’.

Firstly, regarding the ‘details’, there are very few. Minister Little swept in at 50,000 feet and announced some high level structural changes and shifts of responsibility without any ground-level specificity to speak of.

Terminating 20 District Health Boards and replacing them with a single Health NZ to run hospitals and dole out funds for all other care was the big bombshell. Reduction in number had been indicated, but not total elimination. 

The ‘déjà vu’ irony of this is that a Clark Labour Government created the local DHBs in 2000 to the consternation of the National Party which had abolished their predecessor elected boards in the 1990s. Now a new Labour Government is killing its offspring to the shrieks of the Nats, staunch defenders now of local prerogatives … hence ‘reckless’!

Two other structural changes had been already floated and promised – a separate Māori Health Authority and a National Public Health Authority (replacing 12 public health units around the country). So no surprises there, although clearly the creation of a separate Māori entity is controversial.

Unwell citizens probably don’t give a hoot about how the deck chairs are placed, as long as they get care that is equally prompt, responsive and competent wherever they happen to live – no more health care by ‘postcode lottery’.

This isn’t to say that structure isn’t important to outcomes. At the very least they communicate how priorities have been weighed and addressed, and here are the three priorities as I see them:

Efficiency – in planning, capital investment, procurement, innovation and technology adoption, cost containment – getting rid of 20 DHBs each struggling with all these things on their own is a no-brainer. We must spend better the 20 cents of every Government dollar currently devoted to health … setting aside for the moment the sufficiency of that allocation.

Equity – absolutely no one can dispute that our Māori health situation is a national disgrace. Creating a separate Māori Authority is meant to put an exclamation point on fixing that … the strongest possible statement of intent. Whether it will produce any better health outcomes is a matter of speculation. Any improvement in health will be a result of accessible, sensitive programme delivery on the ground by clinicians and health educators, not bureaucrats.

Prevention – for years now, health planners have talked about giving far more priority to preventive health care. It’s the biggest ‘Duh!’ around. So now we get a Public Health Authority aiming to keep people – especially young children – healthy in the first place, which means tackling smoking, poor nutrition, alcoholism so these lifestyle realities don’t simply guarantee shorter lives and greater demand for expensive treatment down the road, swamping both primary care providers and hospitals.

These structure changes do reflect such priorities, and who can argue with efficiency, equity and prevention? 

But at the end of the day doesn’t it still come down to: 

  1. The dollars actually spent at the coalface (e.g., how many headlines and complaints still over the vaunted $1.9  billion in mental health funding in 2019 ‘well-being’ budget, yet to be seen on the ground?); and tied to that, 
  2. A health care labour force sufficient in numbers and not incapacitated by stress;
  3. A healthy ‘ecosystem’ (meaning conditions like healthy homes, liveable incomes, safe water, etc); and,
  4. The biggest of all – taking personal responsibility for our lifestyles.

Structure change by itself will have minimal impact on these factors. The cliché I’m fondest of is, ‘Follow the money’! And BayBuzz will stay tuned on that.

Meantime, if you’re the impatient sort, focus on #4!

You can read the Government white paper explaining these plans here.

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  1. You can reform all you like, but unless there is more cash, no difference will occur. Saving a few CEO salaries is not going to fix health funding. Centralised decision making is not going to make better decisions (just ask why we have not got a COVID vaccination rollout going … Central government decision makers forgot to order the needles)

    1. Hi Phil, I try to get to these comments as quickly as possible. Short of legal defamation, I don’t delete any. Editor Tom

  2. Hi Tom,
    Gosh! I am now up to the third wave of Centralise; Devolve; Centralise! Your comment around delivery on the ground by “clinicians and health educators, not bureaucrats” is spot on! The system we currently have is seriously broken – DHBs drive to ‘balance the budget’ has had a huge cost in terms of peoples’ wellness and ability to contribute productively.
    Alas! one huge, centralised health agency will be, by its very nature, managed by bureaucrats managing a budget!
    As a ‘slight’ aside: as we see the rise in costly, entirely preventable child diseases, we must tackle child poverty as a priority! Recently talked to a desperate and tearful mother, living in a damp and mouldy home, paying top dollar rental and bringing her young asthmatic daughter home from hospital for the third time in a year…. We’ve got that one sorted – but how many others??? And, will a new, beaut, machine help this Mum?? Let’s hope the clinicians and health educators have a very big say on how it might work!

  3. Will the new system be any better, or will be like road funding, all go to the bigger areas like Auckland. I am in my senior years and actively work driving a school bus, which I enjoy immensely. However I have micro cataracts but don’t qualify for surgery under the public system. It will get done, but only when I’m almost blind and unable to work anyway. If it were done now at no cost to me, the Government would get work, and therefore taxes, out of me for longer. So changing the way we run our hospitals will not change the chronic underfunding of the health system

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