The Health and Disability System Review (known as the Simpson Report after the chair, Heather Simpson) was recently published. It draws substantially on submissions from the sector and has been a couple of the years in the making. It is the most substantial review of the sector for about 30 years.
The report presents an opportunity for Auckland. Firstly, the pandemic has forced health services in the region to operate in novel and more co-ordinated ways. There is an openness to change. Secondly, the region has flourished as a single "Super City" for a decade. There could be synergies with this structure. Thirdly, primary and community health services are stretched for Auckland's lower socio-economic and ethnic minority communities. Health risks — obesity, poor housing, insecure employment and so on — plus inadequate health infrastructure and the incursion of barebones and semi-predatory practice operators means the most disadvantaged are at risk of getting sub-optimal care in the community with the hospital sector picking up the pieces. On these three grounds Auckland is the one major area that could make the most of the "window of opportunity" the report offers.
The report's major recommendations that are likely to be implemented in one form or another are:
• A new Crown entity, Health New Zealand, for central co-ordinating, initiating and planning
• A Maori Health Authority that has an advisory, planning and advocacy function associated with the Ministry of Health, but without a separate health system budget
• Fewer DHBs, without elected members
• Networks: local primary and community health organisations, hospitals and specialist services
• A recognition of the need for monitoring and enforcing efficiency and effectiveness in the performance of hospital and related services
• An encouragement to workforce development and training to move towards a competency-based approach to regulation rather than profession-based
• A data-driven, digitally-enabled ecosystem
• Improved management of asset and capital expenditure and planning.
It is hard to disagree with any of these, and the pandemic has brought their necessity into sharp relief. But how will they affect Auckland? What potential is there in the report to enable Auckland to try something more tailored to its requirements as a regional health system?
Firstly, there is the impact of the pandemic that has forged the makings of a regional system.
Second, the 10-year existence of a single city, Auckland Council which has within it 21 ready-made communities of interest of 85,000 each that could provide the basis for primary and social care practice networks and community input.
As with the council, these could provide the "step down" from a single regional health authority. There is also the potential for the council's regulatory functions in health-related areas to find synergies with the Auckland Regional Public Health Service. Finally, the region's primary care system is on a cusp, with the middle class enjoying high-quality services, but low-income and other disadvantaged populations increasingly dealing with barebones corporate and other practices that are struggling financially and professionally to provide adequate care for these groups.
The report is best seen as a starting point for what could be long-term reform with bipartisan and stakeholder support. It is a window of opportunity Auckland should use to the full.
Peter Davis is Emeritus Professor of Population Health and Social Science at the University of Auckland and an elected member of Auckland District Health Board.