In August 2018 then Minister of Health, Dr David Clark, confirmed a review of the national health system – a review that could “chart a course for a fairer, more sustainable health and disability system”. The report, commissioned by the current government, sets out its plans for national healthcare reform.

The final report of the Health and Disability System Review, released in June, lays out specific restructuring and new options for more streamlined decision-making, reduced costs and more sustainable healthcare responsiveness. Clark surmised that the review of New Zealand’s public health system was positive. He claims that although New Zealand’s response to COVID-19 shows many areas of robustness, reforms are essential because the “health services and workforce” are “under considerable stress and our system is complex and fragmented.”

We’ve previously described how the review marks a significant shift away from outdated types of regulation, professional silos, provider focused systems, and treatment focused models.

Yet whether the report’s recommendations will be enacted depends to a large degree on the results of October’s election. With this in mind, here’s a breakdown providing greater detail into what the review could mean for future health service providers.

Key change messages

• The current health and disability sector model is highly distributed, leading to expensive and unsustainable design and delivery of capital projects.
• A long term, nationwide health and disability service plan must be established, with more effective strategic planning across the system.
• Change must be collaborative and cooperative, with clearly defined mandates and accountabilities. This will involve changes in attitude and culture that are led from the centre and applied consistently throughout.
• The focus should be consumer-centric, related to what consumers most value and need, and giving consumers more choice.
• Promotion of well-being will be a bigger focus in order for future demand to be manageable. Progress toward the Primary Health Care Strategy, dating back to 2001, must be accelerated.
• Healthcare must be based on the Treaty/Tiriti, and developed in collaboration with Māori to embrace a Māori world view and improve Māori health outcomes.
• A clearer decision-making framework must be set out to allow for timely, appropriate and enforceable decisions.
• The national network of hospital and specialist services must operate cohesively.
• Funding streams must be simplified with more emphasis on teamwork and prevention in community and primary care, rather than treatment.
• Disability services planning needs to have a more visible presence within the system, and there needs to be more flexibility in how services are funded and delivered.
• Data standards must be implemented, with protocols on stewardship, identity management and interoperability.
• Workforce strategies must be in place to predict and address shortages.

Big picture – primary and community services are to be refocused on preventative, self-care, mental health and general support. Greater digital connectedness is essential to enable information flow and planning, with outreach opportunities to enable whānau to connect with the system, and for virtual and personalised advice to be unified across a network of specialist providers.

The key system enablers will be an appropriately trained workforce, digitised data designed to enhance integration, patient safety, efficiency and effectiveness, and fit for purpose facilities and equipment.

An overview of the proposed accountabilities, structure and functions

What would a clear accountability framework for the health and disability system look like?

The Ministry of Health would continue to play a lead role in strategy, policy and legislation, as well as long-term system outcomes and performance metrics that integrate into planning, accountability and equitable outcomes.

A Māori Health Authority would be set up as an independent department working with, and advising the Ministry of Health on incorporating Māori health into sector policy, inclusivity, workforce and outcomes.

A new crown entity, Health NZ, would be established to ensure consistency of the health system across the country, including being accountable for the systems overall costs and finances, working with the Māori Health Authority to provision for Māori health services.

District Health Boards (DHBs) would become fully accountable for achieving equitable health outcomes per population grouping, and collectively accountable for the efficiency and outcomes of the nationwide system. DHBs will be expected to drive the planning and delivery of  Tier 1 community services. Health NZ would fulfil some of the DHB duties and the report recommends a sharp reduction of DHBs to between 8 and 12 within five years.

Regional boards would be managed directly by Health NZ. They would lead the development of health and disability reform in the regions, providing expertise on population health to DHBs and in wider coordination functions. These should be reduced from four to two or three.

Heather Simpson, review Chair, summarises, “To meet the challenges of the future our population’s health focus has to be stronger, our preparedness for emergencies greater, and our system has to be much better integrated with clear lines of accountability and decision rights.”

As October’s election approaches, and as we cautiously emerge from the grip of COVID-19, the future of public health and these proposed health reforms could be one of the biggest talking points on the political agenda.