New Zealand doctors are waiting to see the impact of the DHB changes. Photo / NZME
New Zealand doctors are waiting to see the impact of the DHB changes. Photo / NZME
This Friday marks a watershed moment in New Zealand healthcare as all 20 DHBs are abolished and replaced by a new nationwide entity called Health NZ.
Samantha Murton, the President of the Royal New Zealand College of General Practitioners, tells the Front Page podcast that health professionals around the country are waiting with "bated breath to see what happens."
"When you restructure something like the health service, which is a massive entity in this way, it's hard to imagine that it will reform progressively enough that we see the change that we want, but we live in hope," she says.
"This whole reform is about patients getting the right care, close to their home and in the right place – so that should be the main focus."
Patients aren't likely to see any immediate changes, according to Murton. This is a longer-term strategic shift that will change the structures existing within the health sector.
The shorter-term changes will involve the management structure associated with each DHB.
"In the past, each DHB had a board, but that board is now gone. The hospitals in those districts will still have their own CEOs and people managing them, but the board-level healthcare for the district will go straight to the Health NZ team. They will make sure that the care for that district is being dealt with appropriately."
The explanation used throughout this process is that it will end the postcode lottery which meant some areas were getting better treatment than others.
If the changes work as intended, this will allow for more consistency across the country while simultaneously removing unnecessary management layers.
However, there is some concern in the rural community that the centralised system of management might be too far removed from the day-to-day concerns of doctors and patients in the regions – particularly those living more rurally.
"Semi-rural towns, where some of the most disadvantaged people live are the areas where we need to know that we're making a change," says Murton.
"There is a risk that being more centralised will mean they're not seeing what's happening on the ground. And that's where we need really good feedback and mechanisms from people able to view what's happening on the ground – and that applies to patients as much as doctors.
Hearing those concerns will only be part of the job. These communities will also have to be assured of the necessary resources to improve health outcomes no matter where they are.
"There are a lot of keen, creative people who to see this change be successful. They want to be able to do innovative and new things, but it's about giving them permission to do that. Often if something becomes centralised, then that permissiveness goes away. So we need to be able to keep that option open for innovation."
Another key change will come in the shape of the Māori Health Board, which will be committed to working with Health NZ to improve health outcomes for New Zealand's Māori population.
"In New Zealand, Māori people have worse health outcomes than non-Māori people," says Murton.
"And so, any reform of our health system has to make sure that Māori people have exactly the same outcome as non-Māori."
Murton explains that this shouldn't be viewed as a separate health entity, but rather a concerted effort to ensure healthcare is equitable across the country.
"That means we need to focus way more on the people who aren't getting the service everyone else is getting. And if that means we need to put more effort and work in, then that's what we should do. It's not about dividing services. It's about providing the right services to everybody."
