Explainer: The new health reforms

Massive changes to our health system are under way. Here’s an overview.

In 2021, Health Minister Andrew Little announced that the Government was working towards an overhaul of Aotearoa New Zealand’s health system. On 1 July 2022, the new health system was launched.

It came into effect through new legislation: the Pae Ora (Healthy Futures) Act 2022.

THE OLD SYSTEM

Over the past two decades, New Zealand has had an increasingly complicated and inconsistent health system, where 20 district health boards (DHBs) planned and funded local services and owned public hospitals. At the same time, 30 primary health organisations (PHOs) coordinated GP services and other primary health care services – those are your first port of call.

The DHB system has long been a problem for people with diabetes and other conditions, leading to what’s sometimes been called ‘the postcode lottery’. That is, the health care we receive has depended on what DHB area we live in.

On top of this, there have been issues with patient/client information not being shared between DHBs, meaning that people travelling between areas haven’t always been able to access healthcare from providers who

know their medical histories. It’s also recognised that the New Zealand health system has led to widespread inequity. It has under-served Māori, Pacific people, disabled people, those living on low incomes, and those living in rural areas.

So how does the new system aim to address these and other issues?

AIMS OF THE NEW SYSTEM

The inconsistent regional DHB system has now been replaced by one national health system. The Government says that the new system will be ‘nationally planned, regionally delivered and locally tailored’.

Some of the key goals and principles that the new system is based on are that:

• Centralising the system will make it more efficient, meaning more money can be spent on actual healthcare rather than administration.

• Māori will have a greater role in designing health services that better meet the needs of Māori.

• Health services will better reflect community needs and preferences, as well as have a focus on prevention, rather than being ‘the ambulance at the bottom of the cliff’. The aim is to improve wellness for everyone, while reducing the pressure on specialist and hospital care.

• Digital technology such as video conferencing will be used more and in better ways to provide people with better services closer to home, as well as when they are away from home.

HOW THE NEW SYSTEM WORKS

The new system involves three national bodies working together to plan and deliver health services:

• Te Whatu Ora – Health New Zealand

• Te Aka Whai Ora – the Māori Health Authority

• The Ministry of Health, which now has a new unit – the Public Health Agency.

Te Whatu Ora – Health New Zealand

This new central health agency absorbs and replaces local DHBs to co-ordinate hospital and other health services nationally.

Fepulea‘i Margie Apa has been appointed as Chief Executive.

Te Aka Whai Ora – the Māori Health Authority

This is an entirely new entity that will work on behalf of Māori, planning and funding services, and managing Māori health policies, services, and outcomes. Riana Manuel (Ngāti Pukenga, Ngāti Maru, and Ngāti Kahungunu) has been appointed as Chief Executive.

The Public Health Agency The Public Health Agency is a new unit established within the Ministry of Health to lead and strengthen public health strategy, policy, and monitoring and to advise the Director-General and the Minister of Health on public health matters.

Dr Andrew Old has been appointed as the Public Health Agency’s Deputy Director-General.

The Public Health Agency is also referred to as the PHA. It's not to be confused with the Public Health Association of NZ, also often called the PHA.

IWI-MĀORI PARTNERSHIP BOARDS

Iwi-Māori partnership boards are a vital part of the health reforms. These boards represent the local voices of Māori. They were already part of the health system, but the new legislation formally recognises them for the first time.

Among their jobs are to engage with whānau and hapū about local health knowledge and needs, and to communicate these to Health New Zealand and the Māori Health Authority, ensuring they are taken into account.

LOCALITY NETWORKS

‘Locality networks’ are a key part of the new health system. They are local advisory networks made up of health professionals and consumers. They will help prioritise and plan health services so they meet the needs of local communities within the broader health system.

Minister of Health Andrew Little has said, ‘A locality for the purposes of the reformed health system has to be a meaningful size – not so large it is impossible to coordinate services and not so small that it would mean an unwieldy number of localities which would fail to provide the cohesion we are seeking.

‘The first part of the challenge with localities is to identify areas around New Zealand to constitute each locality, and that will then be the basis of health networks and funding.’

The ‘locality approach’ has begun to be rolled out in nine areas for a start: Ōtara/Papatoetoe, Hauraki, Eastern Bay of Plenty, Taupō/ Tūrangi, Wairoa, Whanganui, Horowhenua, Porirua, and West Coast.

Andrew Little says, ‘At this stage, we anticipate there will be between 60 and 80 localities once they are all up and running by July 2024.’

WHAIKAHA – MINISTRY OF DISABLED PEOPLE

This is a brand new Ministry. It isn’t part of the health reforms that have been brought into force through the Pae Ora (Healthy Futures) Act 2022. But it is an important new part of the health landscape in Aotearoa New Zealand and, like the health reforms, was launched on 1 July this year.

The new Ministry’s role is to lead and coordinate cross-government strategic policy. It will ensure that, whenever any government agency is writing policy that affects all New Zealanders, the rights and needs of disabled people are taken into account.

Whaikaha will also centralise disability supports and be a single point of contact for all disabled people using Disability Support Services.

The Minister for Disabled People is Poto Williams.

At the time of writing, the interim Chief Executive of Whaikaha is Geraldine Woods.

The goal, however, is for the Ministry to be led by someone who is from the disabled community.

WHAT WILL CHANGE AND WHEN?

At first, the healthcare services you receive will look and feel the same, although they will now have a different name. But behind the scenes, changes are being made. This massive overhaul to our health system will take time. In future issues, Diabetes Wellness will further explore what these changes mean for our communities.

MORE INFORMATION

Te Whatu Ora – Health New Zealand – www.tewhatuora.govt.nz

Te Aka Whai Ora – the Māori Health Authority – www.teakawhaiora.nz

The Public Health Agency – www.health.govt.nz/our-work/ public-health-agency

Whaikaha – Ministry of Disabled People – www.whaikaha.govt.nz

The Pae Ora (Healthy Futures) Act 2022 – www.legislation.govt.nz/act/ public/2022/0030/latest/versions. aspx