But you realise pretty early on that what Wellington says goes. Meaning the Ministry of Health.
In my opinion, it has been the biggest drawback to New Zealanders receiving the quality healthcare they are entitled to.
Bureaucrats sitting in Wellington are invariably highly skilled and the Ministry has some of the brightest public health advisors on staff too.
But I still feel they fail to realise the true impacts of the decisions they make on the lives of New Zealanders.
And without this awareness, they carry on regardless, irrespective of the feedback they receive from DHBs. Bureaucrats love their plans.
They are necessary, but at some stage they have to be implemented. Without the continuous, informed input of local DHB staff and trusted health providers you end up with services that appear designed for a one-size-fits-all model.
I think this is lazy service design.
It gives the appearance that required services are being provided.
But try and determine what is being achieved and measured, who benefits and more importantly who is missing out, and you start to see your community's needs are not adequately covered. Because communities are different.
Governments always talk about solutions being developed and decided closer to where the problems exist.
I couldn't agree more. Communities do know what's best for them. But with health that appears to be a "no go" area.
Communities are not trusted enough to be given the opportunity to have real input into planning and designing services.
They know the difference between primary and secondary healthcare and they know where they can make a meaningful contribution.
Local community and iwi health providers view health services as an investment.
They know early and targeted investment will, over a number of years, reduce the high cost of secondary healthcare, where people need to go to hospital.
If more health dollars were invested in primary healthcare services and health literacy our communities would be better served.
But health spending is a huge cost to the Government - watch this week's Budget - so it starts from the premise that services must be provided as economically as possible.
In my view, this is a false economy.
DHBs should have been able to set their own health priorities and health targets and to have these adequately funded to achieve successful outcomes.
Plans went to and fro to Wellington.
There must be hundreds of staff at DHBs all over the country who pulled their hair out regularly when they saw their plans returned yet again stamped "Further changes required".
With 20 DHBs being disestablished, many staff are already moving on.
I suspect a great number will decide to move offshore.
Everyone is now waiting to see how Health New Zealand and the Māori Health Authority will fare.
These are the two entities that will replace DHBs from July 1 this year.
It's early days and I am aware that the two boards have been working hard planning what modern future healthcare services will look like for New Zealand.
Services that are fit for purpose. I know people on both boards, know their backgrounds and years of commitment and hard work to ensure all New Zealanders live to their potential.
They know our current services intimately. They have seen the necessity for major change over the last few decades. I trust them with this significant piece of work.
They will take advice from the Ministry of Health, I'm sure, if necessary but I don't believe the Ministry will ever return to an exalted position that bullied and insisted "our way or the highway".
I do hear people complaining that this significant health reform should not have started and be undertaken at this time, with New Zealand battling Covid-19 for the past two years. I don't agree.
Change should happen when it's needed most, and now is that time for New Zealand's health services.
I was part of a DHB that did its utmost to comply with what Wellington asked of us, with the funding provided.
Now, with these two new authorities, local communities can plan and work constructively with them on their local needs.
Thanks must go to the 200 board members around the country who, I believe, always served with their communities' health interests at heart.
- Merepeka Raukawa-Tait is a Rotorua District councillor and member of the Lakes District Health Board. She is also the chairwoman of the Whanau Ora Commissioning Agency.
