Health review: Reform will be 'like trying to move the titanic'

District health boards such as Whanganui could be cut from 20 to between eight and 12. Photo / File

Whanganui District Health Board says its board and management need time to "digest" a major report into New Zealand's health sector.

The "once-in-a-generation" report has recommended a significant overhaul of the country's district health board system and the creation of new health agencies.

It calls on the Government to scrap the democratic process of the public voting for DHB representatives and shift to a system where board members are appointed by the Minister of Health, based on merit.

The report, spearheaded by former Prime Minister Helen Clark's chief-of-staff Heather Simpson, also called for New Zealand's 20 DHBs to be slash to between eight and 12 within five years.

The report recommends the creation of a new entity, Health NZ, which would focus on the operational and financial side of the health and disability sector.

The Government is also being asked to consider setting up a Māori Health Authority, which would advise on Māori Health and report on the performance of the system.

Yesterday the 'Chronicle' contacted a number of Whanganui District Health Board elected and appointed members who said they were unable to comment. Comment was also sought from WDHB chief executive Russell Simpson.

A DHB spokesman said board members and management received the Health & Disability System Review at the same time as its public release at 10.30am on Tuesday.

"It is a lengthy, detailed and significant report and they need time to read it and digest it.

"All we [management] can say at this time is that the Government is responsible for the review and decisions about the recommendations and how these might be implemented.

"The review concludes we have a very good health and disability system that we can be proud of, and the review is a significant step in informing decisions about how to ensure our health and disability system is sustainable and achieves better and more equitable outcomes for all New Zealanders."

Simpson's report labelled New Zealand's health care system "complex" and "fragmented," and in need of major reform.

Māori already have a voice in the health system, but it isn't listened to, Tupoho kaumātua John Maihi said.

John Whaanga was appointed Deputy Director-General Māori Health in January 2019, and has talked about removing bias from the system.

"They don't listen to him, and so we are wasting our time," Maihi said.

Dr Alan Mangan

If a Māori Health Authority is established, Māori will try to get some advantage from it, but he didn't think that was likely.

"They started all that with Helen Clark, and look where we are today. They know we are there, and that's about all. We will not be listened to."

Whanganui GP Alan Mangan said he hoped that the primary care strategy, which came out in 2001 under then Health Minister Annette King's jurisdiction, gets "some serious recognition".

"To be fair, not a lot of what was said hasn't been put in place," Mangan said.

"Because hospitals are such a huge focus of our health system, primary care has got lost in the flotsam and jetsam of health reform.

"Primary care is where a huge amount of prevention works takes place, so hopefully there'll be a redress of that."

Mangan said achieving full-scale health reforms was like "trying to move the Titanic".

"It is incredibly hard, with the bureaucracy and vested interests that go on to protect the status quo. That's not a criticism, that's just a fact."

Mangan said the proposed five-year span for reforms would cover at least two terms of government.

"There could be a change of government and strategy and this could all be wasted. We need someone to implement any changes in 12 months.:

Mangan said he couldn't understand why there was a proposal of eight to 12 DHBs.

"Eight would be far more preferable to 12, and they're already sitting on the fence with that.

"Eight to 12, what does that mean? That's allowing for a two-year debate."

Mangan said he "didn't have a problem" with a merit-based system for MOH appointed officials.

"Health is such an important industry that you need to have experts running it, and that doesn't always happen with a community-based vote.

A Māori Health Authority was "an extremely good idea", Mangan said.

"We still have disparity between the Māori and Pacific Island health statistics and others.

"We have an obligation under the Treaty of Waitangi to meet the full needs of Māori health, so that would be part of that implementation."