DHB shake-up: Officials, experts, GPs and MPs divided on decision

The establishment of a national Māori Health Authority could be a "game-changer" for the Bay of Plenty region, a leading health official says.

Health Minister Andrew Little yesterday announced New Zealand's 20 District Health Boards would be replaced by a central national body from July 2022.

A Māori Health Authority would be set up to monitor the state of Māori health and commission services directly.

Bay of Plenty DHB board chairwoman Sharon Shea said the changes had the potential to change the landscape and impact of the health system.

"I think that is an absolute game-changer for New Zealand as a whole if we get that right."

Shea believed the system overhaul was about placing people's health at the centre.

"Sometimes structures need to change to achieve the ultimate goal which is better health and wellbeing for, in this case, the Bay of Plenty community."

Bay of Plenty DHB board chairwoman Sharon Shea. Photo / Supplied

She said as the changes went ahead, it would be important to create opportunities to strengthen the local voice.

"The minister was clear that this is about decision making closer to home, and using local expertise. The way I see it is like creating opportunities that are locally-led, regionally and nationally aligned."

The major announcements from yesterday were:

• All DHBs would be replaced by one national health body, Health New Zealand to fund and run the health system;
• A new Māori health authority would be created, with power to commission health services;
• The Ministry of Health would become an advisory and policy agency only;
• A new Public Health agency would be created within the Ministry of Health.

Bay of Plenty DHB chief executive Pete Chandler described the changes as "bold and ambitious", but said the system needed to change.

"It is absolutely time for change in a health system that was designed for a very different context. The minister's announcements today are bold and ambitious, with structural changes paving the way for a more streamlined system across Aotearoa," Chandler said yesterday.

At this stage, he said it wasn't clear how exactly the changes would impact the Bay of Plenty.

"It will take some time for the full detail of today's announcements to gain shape and form in how it will pan out for the Bay of Plenty and this means a time of uncertainty.

"However we'll walk this journey of change together because the current DHB and PHO teams, along with our rūnanga partners, share a vision of a fairer, more equitable and accessible model of care for our communities."

He said the announcement aligned with the DHBs current development priorities, which included a connected locality-based system, commitment to equity and providing safe, compassionate care.

Mount Maunganui general practitioner Tony Farrell agreed, saying the establishment of a separate health authority was "great news", particularly for Māori.

"Anything that helps the standardisation and efficiency of the system is positive. I think this is great news for Māori health."

Mount Maunganui GP Dr Tony Farrell. Photo / Andrew Warner

He believed that the new system would allow for more collaboration between primary health care providers.

"There are a whole range of people in the community sector that contribute to wellbeing – and a lot of the problem we have is getting people access to those things so they can stay well.

"I am hoping that maybe we can see some better cohesion in there. We will need to work more in line with what our patients need."

Farrell, who is also the Alcohol Action NZ chairman, said the changes would improve alcohol-related health outcomes for Māori.

"Māori are overrepresented in poorer areas, and poorer areas have a high density of liquor outlets.

"There are estimates of up to 11 per cent of health inequity in NZ is based on alcohol.

"So the new structure looks like public health has a lot more of a central role in determining policy and Māori Health Authority will have sign off on those health policies.

"It looks like instead of trying to lobby a government against the industry, the new institutions will have a lot more power and a lot more ability to bring in evidence-based policy that is good for everyone."

Health Minister Andrew Little. Photo / Mark Mitchell

However, Bay of Plenty National MP Todd Muller said he struggled to see how the changes outlined by the Government would help the region.

"I have no confidence that a bureaucracy in Wellington is going to have any ability to support our community," he said.

"I think local DHBs have the ability to understand and fund local services. Losing that connection will reduce health outcomes for my community."

Lakes District Health Board member Merepeka Raukawa-Tait, who is also the Whānau Ora Commissioning Agency chairwoman said the move was a "significant shake-up" and an attempt to fix a health system that had not served New Zealanders well - in particular Māori.

"This is a courageous move by the government," she said.

"I have watched in despair the lack of improvement in Māori health outcomes for the last 20 years irrespective of how much funding was provided to DHBs. Reports of systemic racism within the health system have hindered progress."

Bay of Plenty National MP Todd Muller. Photo / George Novak

She said the proposed independent Māori Health Authority would have a major role in monitoring the performance of the overhauled, redesigned system.

"I am not sorry to see the DHBs go, they have proved to be costly, with the inability to provide consistent high-quality services across the country.

"There is a lot of detail to be worked through but I applaud the government and Health Minister Little who know we can do better and are prepared to do something no about it now".

Māori Party co-leaders Rawiri Waititi and Debbie Ngarewa-Packer also welcomed the health reform announcement.

Waititi described it as a "courageous move" in the right direction.

"We applaud the admission that the current system no longer serves our needs and we also applaud the intention to address inequities and living up to the vision of Te Tiriti o Waitangi.

Ngarewa-Packer said they would over the next two and half years they would "keep the government accountable" to its commitments.

Little said: "The reforms will mean that, for the first time, we will have a truly national health system."

"We are going to put the emphasis squarely on primary and community healthcare and will do away with duplication and unnecessary bureaucracy between regions."