- Impact on healthcare today
- How will these changes affect current health services, like my local GP and hospital?
- How will these changes improve priority services like mental health?
- What does this mean for our response to COVID-19 and the COVID-19 vaccination programme?
- Will these reforms affect ACC or ACC entitlements?
- Does this reform affect my private health insurance?
- Organisations and structures
- What's next?
Where have these reforms come from?
In 2018, the Government commissioned an independent review into our health system: the Health and Disability System Review. The Review published its Final Report in mid-2020.
Since the release of the Review's Final Report, the Transition Unit within the Department of the Prime Minister and Cabinet has been providing the Government with advice on their response to the Review and the future of our health system. These reforms represent the first stage in the Government's response.
How does this reform fit with the recommendations of the Health and Disability System Review?
The Health and Disability System Review was the starting point for reform – it found a fragmented health system that does not serve everyone well and produces unequal outcomes, particularly for vulnerable populations. This reform accepted the clear case for change and builds on the future direction set by the Review.
The Government has accepted many of the proposals recommended by the Review, and others will be considered over coming months. In some areas – such as reducing the number of DHBs and the creation of the Māori Health Authority – the Government has determined that to achieve the future direction set by the Review, an even stronger response is required. In these instances, these reforms go further than the recommendations outlined in the Review.
The timelines for implementation of these reforms are also faster than those proposed by the Review. This is to give more certainty to those working in our health sector, and to deliver the value promised by these reforms to New Zealanders as quickly as possible.
Why reform now when the health system is focused on the COVID-19 response?
The case for change is clear and urgent – many New Zealanders experience inequitable health outcomes and poor access to quality healthcare today and cannot afford to wait for change. Additionally, our health workforce is facing unsustainable pressure which has been exacerbated by COVID-19 and requires urgent relief. These problems will only worsen over time, which is why we need to act decisively to start building a health system which will perform better for all of us. Change of this magnitude takes time and if we want to see meaningful improvements by 2022 and 2023, work needs to begin now.
Our approach to implementation is designed to ensure that our health system can continue to deliver usual care during the transition. Importantly, we are confident that the transition will not impact our COVID-19 response; most of the major changes to structures and roles will not occur until next year, by which time we expect our core vaccine rollout to be complete.
Why do these reforms not include decisions about the future of disability support services?
The Health and Disability System Review recommended that responsibility for managing disability support services move to District Health Boards. Feedback from the disabled community highlighted a strong desire for the stewardship of disability support services to instead be determined in consultation with that community.
As a result, decisions about the future of disability support services will follow later in 2021. These decisions will be informed by advice from the Ministries of Health and Social Development provided in consultation with the disabled community. This advice will form part of an existing machinery of government review of disability support services, alongside work on the future of the Enabling Good Lives model.
Impact on healthcare today
How will these changes affect current health services, like my local GP and hospital?
One of the greatest strengths of our health system is our skilled and dedicated workforce; this workforce will continue to care for our communities in our future health system. These reforms will not change who your local GP is, or your ability to go to your local hospital or specialist. Instead, these reforms will improve the support available to our workforce to deliver connected, effective and equitable care, which will reduce pressure on our health system and improve consistency and quality. These changes will occur slowly over time to ensure that care can continue to be delivered effectively.
How will these changes improve priority services like mental health?
Currently, one of the greatest barriers to improving care in priority areas such as mental health is the fragmentation of our health system. New initiatives have to be rolled out across 20 DHBs, ~30 Public Health Organisations, 12 Public Health Units, and a range of supporting organisations. The complexity of this slows down, and complicates, attempts to improve services nationally. In the future system, Health NZ will be able to easily identify areas where new investment or review are needed and move rapidly to improve services, with less complexity in implementation.
Mental health services are delivered by a range of providers who today are not always well connected. The future system will have much stronger links between different providers, especially between those delivering care in the community, which will make it easier to improve care in complex areas such as mental health.
What does this mean for our response to COVID-19 and the COVID-19 vaccination programme?
Our COVID-19 response has succeeded because we have had a unified response across all of our public health units and DHBs. Our system has acted as a nationwide health system which is exactly what these reforms aim to do. As DHBs and Public Health Units move into Health NZ over time, this unified approach will continue to be supported by the new structure.
The implementation of these Reforms has been designed to ensure it will not interfere with the current COVID-19 vaccination programme, an essential priority for the health system. The vaccine programme will ensure getting the vaccine is as easy as possible for every New Zealander with a wide range of providers including Māori and Pacific providers, GPs, pop-up centres, pharmacies, medical and hauora centres, and community clinics. You can find out more here.
Will these reforms affect ACC or ACC entitlements?
These reforms do not directly affect ACC or ACC entitlements.
Does this reform affect my private health insurance?
These reforms are to New Zealand's public health system; no changes are currently being made to change how private healthcare is provided or funded in New Zealand.
Organisations and structures
Why are District Health Boards being disestablished?
Over the course of the last decade, our health system has become increasingly complex with a plethora of organisations and functions now split across national, regional and district entities, including DHBs, Primary Health Organisations, Public Health Units, shared services agencies, and other actors. This growing complexity has driven inefficiencies and has failed to address inequities in care for New Zealanders.
Will there still be elected boards?
DHBs won't exist in the new system, and Health NZ will not have elected boards or officials. However, the locality model will enable much greater community consultation, involvement, and representation in how care is designed and delivered. The health system will also have other mechanisms to ensure wider consumer, whānau, and community voice in the planning and delivery of services at the regional and national levels. Ultimately, these mechanisms will increase the influence New Zealanders have on our health system.
How will the Māori Health Authority work?
The creation of a strong Māori Health Authority recognises that our health system has long underperformed for Māori, and does not consistently embed Te Tiriti o Waitangi and Māori health equity at the heart of how care is designed and delivered.
The Māori Health Authority will work alongside the Ministry of Health to steward the health system, and alongside Health NZ to plan and commission services for all New Zealanders. In some instances, the Māori Health Authority will commission services targeted particularly at Māori, such as kaupapa or rongoa Māori services. But in many cases, the Māori Health Authority will work with Health NZ on making sure that the services we deliver for all New Zealanders are high quality and reflect the needs of New Zealand's diverse communities, including Māori. This will ensure our integrated health system delivers equitably for everyone.
What will happen to Primary Health Organisations in the future health system?
At the moment, DHBs have to commission general practice services through a PHO; this will not be the case in our future health system. However, many of the services provided by PHOs – such as coordinating multidisciplinary teams and supporting clinical improvement – will be all the more important in the future health system. Health NZ will be responsible for determining how best to deliver these services in each locality, including whether there is a role for an organisation to coordinate locality networks.
What impact will changes have on providers who have contracts with the Ministry or DHBs?
Health NZ will become responsible for all DHB contracts in mid-2022, and will take over operational contracts from the Ministry as it takes responsibility for national commissioning functions. In future, the priorities and services that Health NZ are commissioning for will be much more clearly signalled through the New Zealand Health Plan and locality plans, which will improve certainty for health providers.
How will these changes affect frontline health staff and those working in DHB offices?
As our population ages and we become better able to care for people, we will need more – not fewer – people working in our health system. We have also heard clearly that our workforce is under pressure, and these reforms will help to alleviate that strain.
Frontline health staff currently working for DHBs, Public Health Units and shared service agencies will move to work for Health NZ from mid-2022. Health NZ will retain a range of district offices reflecting our current DHB arrangements, so DHB staff will be able to continue working for our health system from where they work today.
These reforms will not directly affect employment relationships for non-government organisations, such as primary health organisations, private care providers or general practices.
Over time, these reforms will improve the experience of our frontline staff by:
- improving our health system infrastructure, meaning less inefficiency and bureaucracy, better planning, and clearer expectations for care
- strengthening our workforce planning, so that we have the right number of people with the right skills in the right place before we need them
- shaping a unified culture across professions with shared expectations, ways of working, and clinical pathways – including through a New Zealand Health Charter.
How long will this change take to implement?
This is a substantial change to the way the health system is structured, and how it operates. There will be an initial period of structural change, which will include the establishment of Health NZ and the Māori Health Authority by July 2022 once enabling legislation is passed.
The Government is still taking advice on the details of the future health system, some of which will be built in partnership with the health sector and other New Zealanders. Further changes to culture and ways of working, training, digital infrastructure, and other improvements to create a single system will happen over a longer period.
How can I be involved in the reform?
There was extensive consultation and engagement as part of the Health and Disability System Review and the Transition Unit has continued to engage with a range of sector leaders in developing the options considered by the Government.
Over the coming months, there will be many opportunities to contribute to the detailed design of our future health system. These opportunities will be announced and communicated to those who may want to be involved in the near future.
How can I stay informed?
Information about the work and progress of the Transition Unit is available on the new Future of health website, futureofhealth.govt.nz. We are committed communicating proactively with the health sector and wider communities about health reform, and will ensure that further announcements are clearly communicated.
If you have specific questions, you can contact the Transition Unit by emailing firstname.lastname@example.org.