Health professionals in the Whanganui region are still in the dark about critical aspects of the health system overhaul but are optimistic the reforms could bring real change for Māori and the community.
While health service providers await detail on how the new system will work, the Whanganui District Health Board chief has made a personal commitment to stick by the community. In major Government reforms announced this week, the board will be scrapped by June 30 next year along with the country's other 19 DHBs.
Health board chief executive Russell Simpson says he will work to ensure the community is in a position of strength when changes happen.
"My commitment is to our 69,000 people in our community. In terms of me personally I want to make sure I do everything I can for our people to ensure that heading into any change we're in a position of strength, and we go together as a community with health and social services."
The health reforms will usher in a shift to greater focus on preventative healthcare. Hospitals, primary and community health services will be run through four regional divisions of a new national health service. The four regions and their boundaries have yet to be announced.
One of the "real positives" of the reforms was giving effect to tino rangatiratanga in health, through the establishment of an independent Māori Health Authority, Simpson said.
"It's a big change for the health sector; it's a big change for all of us as members of a health organisation but it will lead to better and more equitable access for our community.
"The health system with district health boards is almost 20 years old and change is needed."
Simpson is awaiting more information after attending Parliament on Wednesday along with board chair Ken Whelan and Māori Health & Equity general manager Rowena Kui to hear the Health Minister announce the reforms.
"At this stage, I'm still working through all of the documents I uplifted from Parliament and am reading quite a lot of material," Simpson said. "When we're in a position to have a kōrero around what that means for our community, I would be very keen to have that discussion with a whole range of stakeholders but at this stage it's too early to provide detail.
"The transition unit through the department of the Prime Minister and Cabinet will be offering us advice in the coming days and weeks."
Mary Bennett, chair of the DHB's iwi relationship board Hauora a Iwi, said more time was needed to consider the implications of the reforms locally. In the meantime, iwi expected the DHB to continue to provide quality services.
"It's a short time to implement such significant change but we are up for the challenge," Bennett said. "I see this as a real opportunity, a time for us to be able to do things differently, to redesign systems and processes, to implement solutions that are going to make a big difference to our people. Achieving equity especially in the health space is really key to our future and our babies."
Wheturangi Walsh-Tapiata, chief executive of Whanganui Māori health provider Te Oranganui, said the construction of the new Māori Health Authority would be "interesting" but Māori kaupapa must be addressed across all the changes announced this week, not just within the new authority.
She urged Māori to make their voices heard locally in the design of the new system.
"I think there's going to be some opportunity at a local level for us to say what we might want. But watch this space and let's see what this looks like.
"It's going to be very, very critical moving forward that community have a voice in terms of what this might look like for our region. I actively encourage people to become informed about this and to find ways they can contribute."
Walsh-Tapiata said addressing health inequity is key.
"Health inequity is when Māori win the gold medals for all of the significant long-term conditions around health. We have higher rates than any other population group of diabetes, cardiovascular disease, cancer … and what tends to happen is that we, for one reason or another, don't seek medical help or don't receive appropriate medical help until it's almost too late."
In Taihape, general manager of Mōkai Pātea Services Tracey Hiroa said a greater accent on preventative healthcare and getting away from 'a sickness model' would be positive for Māori communities.
"The reforms in theory should bring equity and more of a focus for Māori. When it's good for our people it is actually good for everybody. If you keep doing the same things, you're going to get the same results, so let's try something new. It can work.
"It's going to be how it's interpreted, how it's rolled out. You don't want things to get too top heavy and bureaucratic. Ultimately, it has to be a good thing for Māori and actually for our country."
Hiroa says rural providers and their communities will make themselves heard loud and clear if issues arise from centralising health services.
"Quite frankly, rural people are certainly not inclined to be mice, letting things run over the top of us without being heard. When we need to be heard we will certainly be heard. Mōkai Pātea Services and the rohe and the whānau that we work with are certainly in that space, and every rural provider connected into our DHB will be in exactly the same space."