On April 21 the government released its plans for a new health system for New Zealand. The key announcements were centred around the disestablishment of our 20 regional DHBs in favour of one new national entity, Health NZ, and the establishment of a new Māori Health Authority to ensure our health system delivers improved outcomes for Māori.
The new structure and what the changes mean
1. The removal of the health budget from the Ministry, while still holding it accountable for health outcomes.
The Ministry of Health will no longer commission health care services in New Zealand. It will be confined to stewardship, policy and strategy. It will monitor and report on the outcomes achieved by the system as a whole, together with the Māori Health Authority.
2. The disestablishment of the locally elected DHB boards, and the establishment of a new entity as the 'public face' of health care commissioning.
- A new national entity, Health NZ, will be established in place of the DHBs. It will commission health care in New Zealand.
- All DHB staff will be moved to Health NZ under their current contracts, so for those working in health services in DHBs, not too much will change in the short-term. Health NZ’s regional divisions and district offices will ensure continuity of services in the health system.
- The current DHB Māori/Iwi Partnership Boards will stay on to agree local priorities with Health NZ regarding Māori health.
One could assume if all DHB staff and the Māori/Iwi Partnership Boards are to stay on not too much will change at the coalface, and it will effectively be business as usual, but under a new brand.
N.B. In a previous Cabinet Paper, it was recommended that the board of Health NZ have 50% Māori representation. There has been no comment yet on the Government's response to this recommendation. This is not covered in the official release of Cabinet papers, but this does not mean it has been ruled out. In addition, there has been little word on whether legislation will be amended to incorporate Te Tiriti o Waitangi principles across the system.
3. A new Māori Health Authority will be established to specifically focus on Māori health. This authority will have direct relationships at all levels of the new health structure.
- The Māori Health Authority will have significant authority to work alongside the Ministry of Health on strategy and policy.
- The Māori Health Authority will work in partnership with Health NZ to commission care across New Zealand, ensuring that the needs and expectations of Māori communities are also addressed in design and delivery. When new services are commissioned or existing services are reviewed, the Māori Health Authority will work with Health NZ to make sure service design and priorities reflect diverse needs. When services are not performing for Māori, the Māori Health Authority will intervene to build provider capability and make services more inclusive.
- The Māori Health Authority will directly fund and commission more kaupapa Māori and te ao Māori-grounded services. A previous Cabinet paper mentioned it would “commission Māori provider and workforce development.”
- The Māori Health Authority is expected to have a co-lead role in relation to national planning and in designing the key operating mechanisms that the system will use. This would require the Māori Health Authority to jointly agree national plans and operational frameworks (e.g. the commissioning framework), with clear approval rights including an ability to exercise a veto in sign-off. (Clause 52 - The Health and Disability System Review: Proposals for Reform)
Although Health NZ would be the ‘public face’, it appears that the Māori Health Authority would have the right to exercise veto power over decisions made by the Government relating to general health care. As Judith Collins points out in her recent speech to 2021 Northern Regional Convention:
“That is a veto power over $20 billion worth of Government health spending. That is not something that is designed to address inequities”.
4. The Minister of Health will have a direct relationship with all three entities - the Ministry of Health, Health NZ and the Māori Health Authority.
It is obvious that this shake up of our health system is being used as a vehicle to usher in another one of the recommendations of ‘Vision 2040’ (He Puapua): to develop with Māori partnership/joint governance bodies across government agencies. If the Government is no longer the one in control of the healthcare system, what does this mean for the country?