KEY POINTS:
Health Minister David Cunliffe wants to give doctors a greater role in planning hospital and health services.
He wants to cut waste through the rationalisation of services offered by some district health boards, for example smaller hospitals working more closely with bigger ones, and greater control nationally of
some aspects of the 21 district health boards.
Mr Cunliffe made his comments on TVNZ's Agenda show yesterday.
He ruled out major restructuring of the health sector but said there was room for improvement.
He described the move as putting the icing on the cake of a system that was fundamentally sound.
Association of Medical Specialists executive director Ian Powell said last night the move was a significant shift in emphasis.
Mr Cunliffe's comments were consistent with what the association had been advocating for years and with what it had been discussing with DHBs.
"We have been advocating for a real shift towards real substantial health professional leadership in services, and more than just senior doctors."
Their contribution would involve providing leadership in planning how services were organised and resourced and would include DHBs collaborating regionally and nationally.
"We got nowhere with [former minister] Pete Hodgson on that. It was like beating our head against a brick wall," Mr Powell said.
"When David Cunliffe came along, it felt as though there had been a change of Government.
"There is a certain 'boy wonder' to him. He sees his role is to fix things and he is quite operationally focused."
Separate from the recent pay negotiations which Mr Cunliffe facilitated between senior doctors and DHBs, he also got the two parties before Christmas to "go away , lock ourselves in a room and come up with something".
The result was an agreement called Time for Quality, which acknowledged that health professionals need to be given time to provide leadership. The parties have agreed to come up with more-detailed plans by June 30 on how to achieve that.
The agreement in principle recognised that the role of management was to support health professionals to provide leadership, not to lead," Mr Powell said.
Mr Cunliffe said on Agenda that he was not proposing to cut the number of DHBs but said there were opportunities for "shared services". That was already happening between Otago and Southland, West Coast and Canterbury, and Whanganui and Mid-Central.
He said that as medicine became more specialised and "sub-specialised", small DHBs in rural areas could not offer everything, and regional hospitals could not offer tertiary services.
"What that tells us is that increasingly we are going to need to build clinical networks, regional shared services and to ensure that DHBs are co-operating with [each] other so they manage across the specialties."
He reiterated his view that there needed to be greater central leadership on matters such as workforce issues, information technology and some financial planning.
But he said he wanted to take out "'unnecessary management" rather than add new layers.
WHAT'S BEEN AGREED SO FAR
* Health professional-management partnerships are founded on teamwork and respect.
* Managers will support health professionals to provide leadership in service design, configuration and best practice service delivery.
* Managers will support health professionals to ensure recognised competency and credential standards are met.
* Managers and health professionals affirm that quality care drives the system to optimise patient outcomes.
* Managers and health professionals will collaborate to meet both the patient test and the whanau test, which means the patient experience is optimised for the patient and in a culturally appropriate way.
* Managers and health professionals explicitly agree that decision-making and responsibility will be devolved to the appropriate level.
* Managers and health professionals accept that there will be some services that can more appropriately be delivered regionally or nationally to effectively meet the needs of patients.
* Health professionals will support managers to operate services within the resources available.
