Te Whatu Ora Whanganui interim district director Andrew McKinnon. Photo / Supplied
Outside of a rebrand, it's been "pretty much business as usual" for most people under Te Whatu Ora Whanganui (Health New Zealand), interim district director Andrew McKinnon says.
It's been almost four months since the country's district health boards were abolished in favour of a centralised national health system.
McKinnon said work was under way on operating models, particularly around enabling services.
"That's the way finance, digital services and people in culture, communications and supplies will work going forward.
"They will be the first people to see some changes."
His secondment to the role of interim district director would end on December 31, McKinnon said.
A review of the structure of hospital specialist services was under way and a new role would come out of that.
"What that actually looks like, I don't know," McKinnon said.
"I'm happy to be here for as long as they want me and as long as they need me."
Te Whatu Ora employed 93,000 people across the country, with about 1200 in the Whanganui district, McKinnon said.
It remained the largest employer in the district.
In order to have a healthy and well population, things needed to start with primary care, McKinnon said.
He said the focus for Te Whatu Ora was largely aligned with Whanganui DHB's strategy that was implemented about a year ago, which was about keeping people well at home and treating the person rather than the symptom.
"There is no point investing in hospitals if everyone is sick because you just keep building bigger hospitals.
"I think people really like that sentiment in our new approach to developing our healthcare system."
Chief executive Judith MacDonald said as a primary care provider, Whanganui Regional Health Network was at the forefront of the changes.
"Our locality plan is about relationships, partnerships, early intervention and preparedness to have the primary sector ready to take on what they choose to unbundle from hospitals."
The network owns and operates subsidiary companies such as Whanganui Accident and Medical (WAM), Taihape Health and Gonville Health.
All were areas at the cutting face of change, MacDonald said.
"That's either in the relationships we are building with our iwi partners and community or the fact that we are critically looking at the model of care to try to move general practice and primary care into a more comprehensive team approach.
"At the same time, our general practices are showing high utilisation rates.
"We are pretty much under the pump out here. Demand is high and there's a lot happening."
McKinnon said collaboration was the key when it came to the relationship between Health New Zealand and the Māori Health Authority Te Aka Whai Ora.
It was still "early days".
"Te Aka Whai Ora is mainly focusing on commissioning services to provide healthcare to Māori, they are not a service delivery organisation.
"People shouldn't get confused whether they go to one or the other. They go to the same front door that they've always gone to.
"It's still one health system."
Health was "a huge beast" and change would take time, McKinnon said.
"It will be gradual change rather than revolutionary change.
"I think people's concerns are really around access and equity, that's equity for Māori and Pacific and for [people with] disabilities.
"There's also the postcode equity to make sure everybody gets access to services they need when they need it."
Te Whatu Ora states that primary healthcare relates to services directly in touch with the community, including general practitioners (GPs), community nurses, physiotherapists, dentists and pharmacists.
Secondary health services are provided by medical specialists such as cardiologists, radiologists, urologists, dermatologists, speech therapists and psychiatrists.
MacDonald said so far she hadn't seen a great deal of transfer of funding from central government to primary care providers.
"To be fair to them, they [Te Whatu Ora] have signalled they are going to have a hospital network, and by having that there will be efficiency.
"I suspect that's the funding they are looking at to support primary care."
Like McKinnon, MacDonald said things wouldn't happen immediately.
"We still have all the backlog of demand for specialist services that were not able to be delivered over Covid.
"Yes, New Zealand is a small country but we're talking about 20 different hospitals that have done their own thing for many years. Now they all have to come into line."
Public Service Association (PSA) union organiser for Manawatū and Whanganui, Kevin Bunker, said the jury was still out on the health reforms.
There are about 500 allied health union members between Whanganui Hospital and Palmerston North Hospital.
"I've just come back from a three-day national meeting with some of the top people in various health positions, who talked to us about their vision," Bunker said.
"The vision has a very nice ring to it but the practicality of it that is yet to be evident."
Clinicians across the central region, which takes in the former Capital and Coast, Hutt Valley, Wairarapa, Hawke's Bay, MidCentral and Whanganui DHBs, were working together to provide the best resources for planned care waiting lists and to implement regional cardiac service, McKinnon said.
"We are working far more closely as a region than we ever have before, which is a good thing for Whanganui because we don't have all the resources here."
Bunker said one question that came up in the meeting was the practicality of the regional layer of Te Whatu Ora's operations.
"Are they going to be a layer of bureaucracy between the district entities and a national office somewhere, or are they going to facilitate the reintegration of health welfare and education?"
For health workers, things were still very much the same as under DHBs, Bunker said.
"There does seem to be a lot of false rumours going around.
"Our members hear of things that are said to have been dictated from Te Whatu Ora and we try to source that and discover it's not true.
"I always say to members we know what we know, and let's not worry about things we don't know yet.
"We are a small enough country to be able to have a fully integrated national health service, and one that links up medical, mental and social needs."
MacDonald said Whanganui was in a fortunate position because relationships were already strong and she was feeling positive about what came next.
"We are not new to each other and that creates the impetus to move together. You need trust and confidence in each other to drive change."
Retention of the workforce as people chose to retire was also difficult and fraught at the moment.
"I've been around long enough to know that despite best plans, we move at glacial speed in health. That's the reality and it creates quite a lot of frustration when you're in the system," MacDonald said.
"We are all working on the bits we can make happen."
