Whanganui leaders have reacted to the government's move to centralise the country's District Health Board system, with mixed views on what the decision means for the district.
On Wednesday Health Minister Andrew Little revealed plans to replace New Zealand's 20 District Health Boards with a single national health body responsible for the running of all hospitals.
A new Māori Health authority will also be established, which will have the power to commission health services and monitor Māori health as well as develop policy.
The announcement means that the 20-year-old system, whereby the public elect DHB board members, will be scrapped.
Josh Chandulal-McKay, serving his first and now likely last term on the Whanganui DHB, said in his short time on the board he had found that his role didn't carry much influence.
"I've been on the board for a year and a half and my experience has actually been inconsequential in terms of impacting the Whanganui healthcare system," he said.
Chandulal-McKay said while it's important there was accountability to the public, local representation on the health board doesn't achieve much as the public seemed to think it did.
"There's an argument that people make that local representation is important, and I accept that to an extent, but as soon as you're elected you become accountable to the Minister," he said.
"Getting rid of the boards is actually the right move. I don't think we're consequential at all really."
Philippa Baker-Hogan, now serving her sixth term on the board, said in an emailed statement that she supported the Government's move but believes the answers to key questions would lie in the detail.
"I've always said retaining our autonomy is not about 11-13 individual DHB members around the table having all the answers," Baker-Hogan said.
"Whanganui is well placed to help lead and drive these key NZ Health changes for the benefit of our communities. I don't need to be at the table to monitor that, as I have strong confidence in my primary health colleagues and DHB leadership to help drive that."
WDHB member Judith McDonald said the new proposal appeared to be loosely based on the UK's NHS system and hoped the move provided more equitable healthcare services across the country.
"I think that there are efficiencies to be made by working together nationally, which hopefully will result in more investment for frontline services," McDonald said.
On the idea of losing her role as a community representative on the DHB, McDonald said she had faith the government wouldn't simply ignore the views of local communities.
"I would expect that there is something that will be put in place for the community to have a voice. I'm still hopeful that there will be active engagement in local planning."
Questions surround Māori Health Authority plan - Iwi healthcare provider
Included in Wednesday's announcement was a move to establish a new Māori Health Authority, tasked with ensuring better outcomes for Māori patients.
Wheturangi Walsh-Tapiata, the Mātaiwhetū/CEO of iwi health provider Te Oranganui said that on the surface the move was positive but there was further detail required to back up some of the big promises.
"When I heard the announcement from Minister Little, it looked to be some really significant changes, however, I have been in the game long enough to realise that [the success of the plan] will be in the detail of what comes out in the coming weeks and months," she said.
"Ultimately, I need to be absolutely assured that [the changes] will benefit our community. What does that look like?"
According to Walsh-Tapiata, the announcement for a dedicated Māori health body is something she could see benefiting vulnerable Māori, but said it couldn't be the only mechanism.
"Across all of the changes, there is still a responsibility from a pro-equity position that Māori be considered in the four areas the Minister was talking about. I wouldn't want to think that the only place that we'd be considered is in that Māori authority space."
Mixed views from local MPs
The concept of a Māori-specific authority didn't fill Rangitīkei MP Ian McKelvie with overwhelming confidence, saying overlapping responsibilities could result in confusion.
"It'll be very interesting to see what form the Māori Health Authority takes, because I don't think it's in our interests to have dual systems operating side by side.
On the proposal to slim down the current DHB system as a whole, McKelvie said it's nothing that hasn't been tried before.
"We've had regional health authorities before in my lifetime, and they didn't work at the time. I think some of the proposals leave a little bit to be desired."
Whanganui MP Steph Lewis said while she believed the move was the right one, there was still uncertainty around the full plan.
"It doesn't mean we're going to lose services or our hospital, but I think it's too early to say what it's going to mean long term," Lewis said.
"There's still some more detail to come out, and I think we do just need to be given the chance to go through the detail that has been released already and be patient a bit longer."
Lewis said there would still be some form of community input, but there would also be a much more streamlined system to get people the care they need.
"It's important communities have a voice in what they need, but I've spoken with health professionals who themselves have told me there is room for improvement and efficiencies," she said.
In a statement to the Chronicle, Te Tai Hauaūru-based Māori Party List MP Debbie Ngarewa-Packer praised the move to establish a Māori Health Authority, a move her party campaigned for at the last election.
"Our job over the next two and half years will be to keep the government accountable to their commitments, particularly as they relate to the legislative powers of the Māori Health Authority and their commitment to reinforcing the principles of Te Tiriti o Waitangi," Ngarewa-Packer said.
"We want to acknowledge the blood, sweat, and tears of our many whānau, Iwi and Māori organisations who advocated fiercely for this model. Today is their day."
Whanganui District Health Board chief executive Russell Simpson was contacted for comment.