Editorial: One health department is not so radical, but overdue

Health Minister Andrew Little, flanked by Associate Health Ministers, from left, Aupito William Sio, Peeni Henare and Dr Ayesha Verrall. Photo / Mark Mitchell

EDITORIAL

Health Minister Andrew Little could be excused some hyperbole after the mostly warm reception to yesterday's shake up of New Zealand's health provision.

"For the first time, we will have a truly national health system," he said, seemingly overlooking the Department of Health which formed in 1903 with the merging of multiple government departments.

This time, our national service will be known as Health NZ. And, although Little may want to highlight the potential gains, there are possible pitfalls too.

Health New Zealand will comprise four regional divisions and 12 public health services across the country. A new Māori Health Authority will be an "independent voice," aiming to change Māori health outcomes.

The Ministry of Health will become an advisory and policy agency only and a new Public Health Agency will be created within the Ministry of Health.

Similarly in the UK, the NHS England is an umbrella body which oversees healthcare. It is an independent body, which means the Department for Health cannot interfere directly with its decisions.

In our case, it has not yet been stated whether that control mechanism will be placed on the relationship between the Ministry of Health, its Public Health Agency and Health NZ.

Associate Health Minister Peeni Henare said merely that the Public Health Agency will be located inside the Ministry of Health and will lead strategy, policy, analysis and monitoring as "the authority on public health knowledge in the system."

Whether that authority reaches to directing Health NZ decisions remains to be seen. Additionally, a Health Promotion Agency will be part of Health NZ and will work closely with what is likely to be a veto-empowered Māori Health Authority. All, it appears, with their own kaupapa, or agenda.

As with any large change, there are many unknowns, such as how or where the funding of general practitioners will slot in and whether Primary Health Organisations still have a role.

It is true that the reform goes further than the recommendations from last year's Heather Simpson health report, which advised the Government to slash the number of district health boards.

The Health and Disability System Review proposed reducing 20 district health boards to between eight and 12 within five years. A reduction in unnecessary duplication and competition is long overdue and this newspaper has repeatedly called for it. However, as we said in June last year, eight would be preferable to 12.

In opting for the four regions and 12 services, the reform doesn't go that far and there is still scope for duplication and inter-service rivalry. Still, the reform is proposed in three years, rather than Simpson's five.

National's Health spokesperson Dr Shane Reti says scrapping elected district health boards across the country means a loss of voice and autonomy. It's a valid point. However, it is sometimes necessary to prevent villages of thought from pulling against each other for society as a whole to make some gains.

The devil may well be in how the ministry, Health NZ, the agencies and the Māori Health Authority can work together for our collective wellbeing.