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DHBs to go

Written By: - Date published: 8:20 am, April 21st, 2021 - 101 comments
Categories: Andrew Little, health, labour, Social issues - Tags:

Television New Zealand has reported that Andrew Little is to announce that district health boards are to go.  The announcement is being made formally right now in Parliament by Andrew Little but media have had an embargoed opportunity to view the changes.

From TVNZ:

New Zealand’s health system is in for a significant shake up. Changes include an end to district health boards in favour for a national organisation, as well as creating a new Māori Health Authority and a new public health agency.

The announcement by Health Minister Andrew Little comes after a scathing report found New Zealand’s health system was under “serious stress”, lacked leadership and did not serve Māori or people with disabilities well.

Today’s changes go even further than the recommendations in the Health and Disability System Review – instead of reducing the number of DHBs – it scraps the model altogether.

“The reforms will mean that for the first time, we will have a truly national health system, and the kind of treatment people get will no longer be determined by where they live,” Little said.

The national organisation will be named Health New Zealand which will have four regional divisions.

It will run hospitals and commission primary and community health services.

“The reforms herald a change in focus for the health system, we will treat people before they get sick so they don’t need to go to hospital, thereby taking the pressure off hospitals.

There is also to be a new Māori Health Authority which will have powers to commission health services, monitor Māori health and develop policy.

There will be a huge amount of detail behind the announcement.  But the basic rationale, that we had 20 separate organisations delivering health services to our country and that service was expensive and fragmented, is hard to dispute.

101 comments on “DHBs to go ”

  1. tc 1

    A good start. Self serving layers of red tape sucking resources from frontline clinical care.

    Ryall and coleman used that to achieve their goals knowing a well stacked DHB plays the game.

    Game over ! About time.

    • greywarshark 1.1

      That seems unduly optimistic tc. A great mistake on your and Andrew Little's and Labour's part I feel. DHB's and efficiency – in the time of private interests being put ahead of government's responsibilities, we will be more efficient and effective if run like a business – this is part of the NZ Inc. mantra. This may be Labour's death knell. Bong, bong.

      Get ready for call centres, more babies born at the side of the road, less personal interest as I have enjoyed, being run on an insurance company basis, eg being discharged before you are well or stable because your time allocation has run out. The hospitals already do this after young mothers’ give birth. And business getting their sticky fingers in further. CEOs have already been shown to be running their own businesses and supplying to the hospital that they are ‘managing’ – getting your cake and eating it too. Sort of quantum management?

      • Sanctuary 1.1.1

        The CHE/DHB model is a bit like the bastardised Auckland Supercity – a structure put in place to cynically removed democtrratic oversight of a public service and offer a pre-baked option for privatisation for any right wing government with the courage to pull the trigger.

        This is a much more logical administrative system for five million people. The era of the "disinterested" expert technocrat is over, that was only ever class war by stealth anyway. Now let the politics of democracy commence – which is how public money spending decisions should be made.

      • ghostwhowalksnz 1.1.2

        "more babies born at the side of the road,"

        Throwing red meat falsehoods out there , are you?

        Babies can be born with little advance knowledge, I guess you have never had one.

      • tc 1.1.3

        Simple maths.

        A population of under 10 mill doesn't require the plethora of boards, committees etc serving each other.

        Never did

        • greywarshark 1.1.3.1

          Nothing connected with humans, and health services, is simple maths tc. The problem is complex and sweet simplicity has to go home, take a rest and have a cup of tea, even a calming pill and a lie down.

      • KJT 1.1.4

        A bit of cognitive dissonance there. It was the DHB, model that tried to run healthcare, "like a business" including decades of ,"privatisation by stealth" and avoidance of responsibility, it enabled. This is a return to a State run system. Finally an acknowledgement that the Neo-liberal private managerial model, doesn't work.

  2. greywarshark 2

    Watch here – Labour repeating 1984. If you try and fail, don’t give up – try, try, try again. Who would have thunk??

    https://www.rnz.co.nz/news/political/440903/watch-live-health-minister-andrew-little-details-biggest-health-system-restructure-in-decades

    • Marcus Morris 2.1

      Labour repeating 1984??? Were you round then. The policies of Douglas opened the (flood) gate for neo-liberal economics, and, inch by inch, this government is closing it again, to everyone's advantage. The business model has been a disaster for Health and Education. At last we are now seeing what was lauded as "transformational". The nay sayers have been quick "out of the blocks" as to be expected. It is unbelievable to think that have digested the full import of the policy in such a short time. To be expected from JC. She is paid to be negative.

  3. Ovid 3

    This has the potential to be the big, transformational change we’ve been looking for from this government. More details at https://www.beehive.govt.nz/speech/building-new-zealand-health-service-works-all-new-zealanders

  4. Ad 4

    Good work Andrew Little. That took courage.

    Particularly nice to see a structural shift far bolder than the review recommendations. That doesn't happen often.

    • Sanctuary 4.1

      I remember(!) the late MP for Napier Geoff Braybrooke lamenting to my mother something along the lines that the Napier hospital used to be run by the head nurse, the head registrar and someone else and Hawkes Bay was in line for one hospital with less than half the beds run by dozens of well paid health bureaucrats.

      In short, there may be a lot of members of the managerial class worried about their future today.

      • Ad 4.1.1

        All those Board members and interagency shufflers in particular.

        • Sanctuary 4.1.1.1

          Do you think this will have some of the paper shifflers at our Supercity CCO's shifting uneasily in their chairs?

          • Ad 4.1.1.1.1

            I'm thinking it's a big precedent for Mahuta in water governance reforms, and others.

            Its the first full reversal of a 1980s neoliberal structure we've yet had.

            • Sanctuary 4.1.1.1.1.1

              I agree, and it will be perceived as that.

              The neolibs won't go down without a fight I expect a full on counter-attack from the NZ Institute, journalists like Fran O'Sullivan, and all the rest of the apparatus of neoliberal policing in our elites.

              • Anne

                We're going to hear the words "Communism by stealth" – and slightly more obtuse counterpart offerings – reverberating across the land for the next two years.

                The fact we had fully centralised government entities for umpteen decades before the mid 1980s will escape the naysayers of course.

                I can't wait to watch David Seymour's apoplectic fits during his media stand ups. I often wonder if he's got scouts seeking out the whereabouts of the parliamentary media pack so he can 'inadvertently' bump into them on a daily basis.

                • Sanctuary

                  lol Prebble right on cue in the Herald, playing the race card and talking about the Soviet Union and lamenting the failure to implement the (30 year old) Gibbs report written for an entirely different generation that caused a revolt even then but still clung to by fading men of yesterday like the decaying flesh of a long dead sacred cow.

                  Playing the race card straight up is a signal the neoliberals plan fanatical resistance to this thin end of a reforming wedge that they worry will sweep many of them from their well paid sinecures.

                • Anthony

                  We're also going to hear a lot of racist dog whistling against the Maori Health Authority. National and their social media trolls are already hard at work on twitter, Facebook, etc.

      • AJ 4.1.2

        The bit about the Ministry of Health being "beefed up" is a bit of a worry then.

    • Patricia Bremner 4.2

      My immediate thought was "So this is 'The do nothing government"

      That mantra is looking a bit silly now.

      Yes Ad, agree. This goes further and is truly welcome.

  5. Rosemary McDonald 5

    Much too soon to evaluate…but…what I'm not seeing is the use of the word "entitled".

    The most significant difference between Ministry of Health and ACC pertaining to the management of a significant physical impairment is that an ACC client, once their claim is accepted, is entitled to treatment and supports. By law.

    There is no such entitlement under MOH…and no real recourse if harm occurs because treatment and supports are denied.

    No avenue of complaint for non-provision.

    I won't shed too many tears with the demise of the DHBs….but I will be interested to see how services currently funded by the DHBs (such as the NASCs and the supply of ostomy and continence gear) are going to be managed on a national level.

    Currently each DHB has to 'negotiate' individually with the Ministry to get the best deal for patients in the regions….and provision of supplies can vary widely, not only with brands and quality but also quantity.

    My dream would be for all contracts with private providers be abandoned and a return to a central purchasing system with regional points of contacts so patients/clients can access personal services.

    Tbh…the current system is shit. These 'transformational reforms' can't be any worse.

    Surely?

    • Pat 5.1

      "Tbh…the current system is shit. These 'transformational reforms' can't be any worse."

      One would hope….though I suspect bringing services back in house is unlikely, indeed contracting may be expanded. The devil will be in the detail, and 3 years to implement seems ambitious given their record.

      • Sabine 5.1.1

        well selftesting for cervical cancer was to be implemented this year, but alas it got scrapped. 🙂 Three years is a long time for this government, a lot of water down the river and if it goes bad, as chances are it will – see track record – hopefully no one will remember and Mr. Little will not be worse of anyways.

        So lets see if healthcare can get even worse in this country.

        Also the NHS in England is in shambles. Just saying. Some in England are even speculating that it is run down on purpose so as to be sold easier to big private industrial Healthcare.

        • ghostwhowalksnz 5.1.1.1

          It may be called 'self testing' but it still took place at the testing location.

          according to the Australians

          'The cervical self-test is not available to everyone.

          Patients who have declined a screening test by their health professional can be offered the self-collection method. You also need to be over 30 years of age and be overdue for your screening test.'

        • Brigid 5.1.1.2

          This is worth watching Sabine.

          The privatisation by stealth of the NHS

    • Sabine 5.2

      does this address the shortage of GP's, nurses, Midwifes, etc? IF it does not then chances are you will have the same issues today (as a user of the system) in the future.

      One of the reasons regions do badly is the lack of the aforementioned, and that it seems is not addressed in Mr. Little Plans.

      • ghostwhowalksnz 5.2.1

        The answer is in the headlines , its administrative

        Its not a 'workforce' issue they are working in this proposal

        • Sabine 5.2.1.1

          then my comments stands.

          If this is purely administrative as you said, then the misery of trying to find a midwife unless you live in decently served areas are the same.

          Look the hovel got painted red, its the same as it was in blue. Just don't get sick.

          • ghostwhowalksnz 5.2.1.1.1

            Then its the neo liberal model of the self employed midwife thats the problem….and the 24/7 contract for before and after birth thats ignored.

            It seems to be some- but not all- run it like a clinic with set hours and bookings for ante and post natal care and afterhours you contact the any after hours service

      • Rosemary McDonald 5.2.2

        The shortage of doctors, nurses, midwives, physio and occupational therapists, radiologists and the like is worldwide.

        Back in the day these vital health professionals were not having to go into debt in order to be trained. The State funded their training, and the upside of this was that these newly minted professionals worked in the State health system and repaid this investment.

        Another reform would be to return to the days of fully funded training for health professionals.

        • Sabine 5.2.2.1

          The shortage is due to underpayment, student loans, lack of respect by their 'owners' (governments) etc.

          Hence why the idea of this being the Kiwi answer to the NHS is actually frightening, considering what the government in England has done to the NHS.

          As for fully funded training, or as it was done in the old days, training in hospitals with pay, will never come back. Best we can hope is that they bond the poor people that still get into the service via their student loans to a hospital for a few years (and then write of the rest as time served) but even then it might be easier to just go overseas to where the pay goes hand in hand with the workload and skill requirement.

        • Patricia Bremner 5.2.2.2

          agree Rosemary.

        • Pat 5.2.2.3

          Those are all issues but one of the greatest problems is the international mobility of trained workforces….and we are consistently outbid for those skills and that isnt going to change anytime soon, unless the worlds borders remain closed ad infinitum. The sad reality is we will struggle to retain trained staff as we dont have the wherewithal to pay them at comparable levels so the motivation to remain needs to be other than monetary, i.e. lifestyle, workload, autonomy and the feeling of being heeded and making a positive impact.

          • Sabine 5.2.2.3.1

            or unless we raise the wages.

            It is easy to blame others for what ails us, but the pay that we offer these people who are at the forefront of the pandemic world wide beggars believe.

            Here is the NHS with a miserly 1% offer and imagine that that is still better for some that leave to nurse in England.

            https://www.bbc.com/news/56294009

            How has NHS pay changed over time?

            In 2010-11, it was decided that pay would be frozen for all public-sector workers as part of government austerity measures.

            Strict pay freezes or pay caps were implemented until 2018-19, when the government removed these limits and a three-year pay agreement was implemented for NHS staff in England.

            But the impact of inflation means that over the whole period some salaries are worth less than they were a decade ago.

            For example, a newly qualified nurse starting in 2020-21 would be earning about 3% less than one who started in 2010-11, once we account for inflation and the impact of pay freezes and caps.

            Nurses are just one part of the NHS workforce and the pay agreement implemented in 2018-19 affected different staff members in different ways.

            For example, the agreement meant the wages of those in the very lowest pay band, such as housekeeping or security staff, increased by almost 30% over the past three years.

            Staff at the top of their pay bands would have had a smaller pay increase.

            And it's important to point out that the pay of many NHS staff increases as their experience grows and they move up within pay bands.

          • Rosemary McDonald 5.2.2.3.2

            ….we will struggle to retain trained staff as we dont have the wherewithal to pay them at comparable levels so the motivation to remain needs to be other than monetary, i.e. lifestyle, workload, autonomy and the feeling of being heeded and making a positive impact.

            No student loan, tolerant and tolerable working conditions (including basic accommodation and meals) might just put enough butter on the paws of the newly qualified. Also, Te Virus might have lessened the influence of higher pay overseas.

            He tangata, he tangata, he tangata. This may be an opportunity to make that adage real.

  6. greywarshark 6

    It's going to be a revolution – I wonder who will fall through the cracks which always open up? And is it going to be run from Wellington or Auckland? Auckland has the expertise on bringing together disparate outliers and combining them. Perhaps the hospital system will set up free standing agencies as Auckland has that have become little fiefdoms?

    • woodart 6.1

      a revolution is needed to get rid of the senseless competition between dhb for $$$. go look in any operating room, millions of dollars of equipment, which is often duplicated 50 k away. one of the treasury recommendations was to get different hosps to specialise, auck, children, chch, spinal are already done to a degree but many millions can be saved by carrying this further. much cheaper to have one hosp do something very well and have air ambulances move patients around country. the terminally unhappy will cluck about having to travel to visit sick rellies in hosp, but if better patient care is the outcome, its a no-brainer. there will be managers and middle managers who pop up on herald for a whinge, but they can go pick fruit.

      • ghostwhowalksnz 6.1.1

        They dont compete in the way you suggest …its a population formula with loadings that comes out of Wellington.

        The competition came within the DHB for its funding tranche…for primary care, for hospital care , for mental health, public health , for new construction , for maintenance and the elephant in the room- the depreciation funding of assets and the Treasury capital charge sent back to Wellington.

        • woodart 6.1.1.1

          splitting hairs. they do compete for a part of a limited health budget. dressing it up with flash phrases like population formula with loadings, doesnt hide the fact that my dhb doesnt offer particular services that other dhb do. they ALL spend too much on duplicated management, not what you need, when you go to A+E. or when you ask your G.P. to refer you to a specialist, and are told your dhb doenst have one of those on staff , so you then ask to be referred to out of town dhb, but that starts a paper war.

          • greywarshark 6.1.1.1.1

            Some major concerns about the health funding and model mentioned by various commenters which need to be addressed by a new system:

            ghostwhowalksnz – 'the depreciation funding of assets and the Treasury capital charge sent back to Wellington.'

            woodart – 'millions of dollars of equipment, which is often duplicated 50 k away. '

            Pat – 'one of the greatest problems is the international mobility of trained workforces…' (Train nurses in hospitals again with techs providing; block courses. Have bonded trainee nurses and doctors who go where they are directed to various areas where they are needed as they work out their bonds.) See Rosemary McDonald also.

            Forget now – Local input, involvement, submissions, hearings where?

            woodart – Failed IT projects (big biccies there).

            RedBaronCV – Loss of privacy through shared records. (We know that there have been some egregious examples of information release.)

            • Pat 6.1.1.1.1.1

              What you propose dosnt solve the problem GWS, at best it may delay departure, depending on the conditions of bond it may also deter entry into the sector.

              This isnt to say that in house training and bonding cannot be utilised but it dosnt prevent in demand health staff being recruited offshore….as with any industry/organisation a level of staff turnover needs to be allowed for and we need to train at a rate with that in mind WHILE endeavouring to make our employment conditions/satisfaction as appealing as possible to retain those trained here

        • Incognito 6.1.1.2

          You’ll love this one:

          Six weeks after the February 2011 earthquake the Ministry (NHB business unit) met and advised CDHB that it would be facing a $140 million funding reduction due to a claimed population decrease resulting from the earthquakes.

          When CDHB asked how the Ministry had arrived at the $140 million it was told that its Canterbury’s population had dropped by over 70,000. What was the Ministry’s evidence for such a bold claim? Demonstrating a preference for sloppiness’ rather than analytical rigour the answer given was the front page of the Press where Mayor Bob Parker had said that over 70,000 people had left Christchurch.

          https://democracyproject.nz/2021/04/15/ian-powell-a-very-bureaucratic-coup-part-one

  7. Forget now 7

    Budget is in a month's time (20/5). So I imagine there will be a few big announcements in the next few weeks. Unless there is more money in that for more healers, I can't see that this will change much.

    Also, this will get rid of locally elected health board representatives won't it? Which may have been mostly window dressing, but down south we only just got them back; after years of central government appointed commissioners in the SDHB, so it would've have nice to let that continue for a bit.

    How will a member of the public be able to make submissions to their Regional Health boards? Or will they have to have the time and means to travel to Wellington for that? Will this new Health administration system even allow members of the public to attend their meetings?

    • Treetop 7.1

      I call it health politics, public voice into clinical care and redress.

      Are you aware of the Serious Sentinel Events (SSE) which occur with unexpected hospital procedures?

      The DHB is required to notify the SSE. Often the SSE is not notified and the SSE cannot look into an individual case. Basically useless and this is an example of the power imbalance between the health consumer and the clinical care given.

      • tc 7.1.1

        Totally.

        ACC make matters worse by classifying issues the DHB's create or miss as 'pre-existing'.

        Xrays where broken bones get missed end up 'pre-existing' for the poor patient.

        Farcical

        • ghostwhowalksnz 7.1.1.1

          I dont think you are understanding 'pre -existing' . A broken bone is clearly an accident ( even if frail) and covered . What isnt covered is the frailty means you dont recover quickly and become mobile/back to work and ACC ( which funded the medical care for the breakage including the ambulance and hospital treatment and maybe physio) wont fund the extended off work weekly payments.

          Unfortunately there is a fuzzy area where ACC has its experts go looking through case files on those on extended wage payments for signs of pre-existing conditions.

          However even Southern Cross has people checkout those who want to claim on their insurance for an operation at the time of their choosing, and instead SX bumps them on the public hospital waiting list as the operation might not be 'elective' , and thus insured.

          • tc 7.1.1.1.1

            This is a healthy adult under 40 who carried around a broken bone the DHB said was 'badly bruised'.

            Finally once diagnosed correctly ACC went nope 'pre-existing' not our problem.

            • ghostwhowalksnz 7.1.1.1.1.1

              ACC is a funder not a fixer of broken bones. if you had a GP medical certificate saying you are off work for X weeks because of accident then ACC steps in when a claim is made – usually by a GP office

              I had a stress fracture on lower leg bone , was bruised and I hobbled a bit . but often some thing that will heal largely on its own, for younger people which it did. if you arent working then its nothing to fund

              Did you want more than a week off work ( ACC doesnt fund the first week)

  8. Treetop 8

    Covid has shown how important it is to have a single purchaser and how important a nationalised data/register is. Were it left up to a single DHB some would have done better than others.

    Disbanding DHBs is a massive change. When it comes to dealing with a DHB who has not given ACC accurate information on a treatment injury and a person cannot get the deceased person's file from ACC the new system needs to address this as a dead person has no rights unless they have an executor which ACC will give the file to. I do not think the High Court will give a certificate to the ex wife so ACC can give her the file. Sickening as I have the information which differs to what the DHB gave to ACC. So a legal section which a person can go to is what is required at no cost.

  9. AB 9

    Ambitious and necessary – let's hope the implementation is resistant to future National governments' inclination to privatise potentially profitable parts of it, that it doesn't get mired in failed IT projects, and has the courage to tackle the role that private health insurance with the connivance of the medical profession has in perpetuating the current two-tier system.

    I still think it's only half the story though – or less than that. While the economic system still produces such huge inequality, it will continue to throw a massive burden of illness at any health system, no matter how good. They might therefore successfully implement this structural reform – and still not improve outcomes much at all.

    • woodart 9.1

      two things to take to the bank.(1) every dollar saved on offices can be better used on actual health care(2)there will never be enough money in health budget.,,,with the new, very expensive technology in health today, combined with an aging population, and ever increasing pharma costs, no amount of $$$ will pay for everything. good call on failed I.T. projects. more money has been wasted on shonky I.T. systems in the last 25 yrs(by every gov dep, and private enterprise), than is commonly known.

    • RedBaronCV 9.2

      Good points. I too would like to see the health system hardened against creeping privatisation or letting it be run down by a future right wing government. The Maori Health Authority would be a prime candidate for being disbanded under the right wing.

      Plus I can see a huge loss of health privacy for individuals – it's bad enough now – stuff getting hacked etc – and who needs that data collected being made accessible by future RW governments to employers, health insurers, religious fundies so anyone who has had an abortion is punished long after the event, that dreadful social investment data base that the Nacts set up and which still appears to be running.

    • greywarshark 9.3

      The health system seems fairly good, and gummint may have been able to streamline it, make it more efficient where possible, just by encouraging suggestions for change from the staff who notice things and think about them. They could have been anonymous in case someone was afraid of their supervisor. This would reveal gaps. Also good communication between DHBs and some case histories about improvements or changes made that were beneficial would raise all the boats on the same tide. Has that been done?

      There has been time well spent with efficiencies from clinics reminding people of their appointment times to limit the number of no-shows. Fulminating about them is not productive, understanding that it happens and acting to prevent it was a good, practical move.

      I think there is already a nation-wide approach on funding, being a population basis, such as Dunedin complains about. There they have population funding but a large area with low population, needs well-resourced scattered clinics to serve them, staff with a good transport allowance, and include a dedicated helicopter service for all those outlying areas that experience inclement weather often. Then even that may not be enough for good services to the outliers. So will a national approach now take note of the previous anomalies like this in the system?

      Has this change been made necessary because we have been stuck with a system embedded, with highly paid CEOs swanning around like private company heads on similar salaries? Did government have little room to make change in a system that was hammered in tight? Are the positions made available to those in a favoured pool who move from one high-paid position to another, and the ordinary public who have a good background have little chance? Does the generic manager approach push out those with medical backgrounds who have worked in and understand hospitals and have added management training to their skills?

      I have a dread feeling that this is another example of Labour feeling frustrated and going for the putsch as they did in 1984. Perhaps they have no ideas of how to make change as it seemed earlier, and have 'bought' this idea of a revolution, rather than incremental improvements using different approaches than previously. Was it necessary, was it broke and needing to be fixed, or just staggering under the increasing demands on it, many from the large growth in immigration of past decades. Our own fertility figures are below replacement; the population growth is largely from overseas. But also medical services are assisting growing numbers of old people to live longer, who then need more medical assistance to cope with ailments, so that is a compounding problem that no-one seems to want to face.

      Also there are the calls from people with cancer for the latest pharmaceuticals to fend off death, to have more years of life, at great cost which they don't want to bear; death notifications refer to a 'battle' with cancer. Is that a task for a 'health' system. Having a nationally managed health service; what effect will that have on such cases? As Rosemary McDonald says ACC provides entitlement. But everyone clamouring for everything; how can we all be entitled for all we want as things are at present? How can a publicly funded service cope in a small country that has deliberately opened its borders to foreigners, as a way of stimulating the economy. The thoughtful wisdom of anyone in government, or the economic community has been overwhelmed and drowned out by those with enthusiasm for growth and increased wealth for some.

  10. KSaysHi 10

    Excellent news. Too much money going towards overhead, rather than frontline. Well done Andrew Little.

    The health system has been failing too many people especially for routine stuff where delays cause permanent disability, or death.

  11. dv 11

    For those who want the dhbs to stay (Collins) the local dhb should be allowed to raise their cost locally via a DHB tax.

    • McFlock 11.1

      Because areas with high levels of poverty-related diseases are able to afford to pay more to treat them?

  12. Peter 12

    Now we're going to have 'the health system is stuffed, something needs to be done' brigade chanting 'but not that, it won't work.'

  13. Peter Don Wilson 13

    Well done. The next step in creating a truly public health system is to nationalise all private hospitals and shut down all private health insurance. Just think of all that resource and revenue that could then be available for the public health system.

  14. Booker 14

    Fantastic news. For too long successive governments have kicked the can down the road and done little to address the problems with the DHB model of running healthcare. There’s already been back-end changes like having more centralized accounts departments and IT systems anyway.

    The idea that you vote for people to run a healthcare system and that would result in better local healthcare has been a failed experiment. I remember Susan Davoy saying after her stint on a DHB board that she felt she lacked the necessary background knowledge, and I’m sure that most people would.

    The notion that a tiny country of 4-5 million should have so many separate health systems is ridiculous, and has resulted in huge amounts of bloat and middle management duplication. The funding allocations are opaque and too many DHBs have needed emergency interventions to keep them financially solvent.

    I have to say this is unexpected, but enormously welcome and it’s great to finally have some true leadership in charge 🙂

    • ghostwhowalksnz 14.1

      "The notion that a tiny country of 4-5 million should have so many separate health systems is ridiculous.."

      A false narrative. NSW has 7 non metropolitan health districts, 7 disdtricts within Sydney itself plus 3 specialist areas such as Sydney Childrens health, Justice Forensic and Mental health, a one for 3 Catholic hospitals

      https://www.health.nsw.gov.au/lhd/Pages/default.aspx

      The NHS in England has virtually every major hospital as its own self governing trust almost like a DHB..

    • gsays 14.2

      Well said Booker, I fully concur with yr last paragraph.

      When I watched Minister Little on tele this morning I was grateful he is the Health Minister.

      Now, heaven forbid, the IT know-how could be bought in-house. Further undoing the sub contracting of responsibility.

      Start building institutional knowledge.

    • Anne 14.3

      Thank you for that Booker. Excellent summary.

      The ideology behind the DHBs was to allow local people to run their own health institutions they way they believed was best for their communities. That is not what happened of course. All the local sociopaths (Susan Devoy excluded) scrambled to get on their health boards where they thought they could wield power and control over their locals communities largely to satisfy their personal egos.

      The reason we have had to wait so long for these much needed 'reforms' is because Labour was being stymied by NZ First. Now the flood gates are open, so lets hope this is only the start of winding back the failed neoliberal system.

    • Foreign waka 14.4

      I think the elephant in the room is actually the doctor fee that so many cannot afford and opt to go to the hospital instead and thus clogging up the system for patients that are really needing the staff attention for serious conditions and accidents.

      If you really want to make things work, than cancel the doctor fee and selects under a "preferred supplier" model Medical practitioners and put a funding mechanism in place, centered around actual people treated and see how that works. You cannot over stretch a number of doctors x hours in a day / by average time per patient = $ value sub. This would prevent people going to hospital with a headache. This would make better use of resources and the funds go where the "action" is. Just saying.

      • greywarshark 14.4.1

        FW I think we need to be careful about condensing the GP visits and making them cheaper etc. In Britain they give a 5 or 10 minute window and only one ailment can be discussed at a time. That's real wartime rationing I think. The neolibs and wealthy in the UK are at war with the ordinary folks in this and other ways.

        In theory in NZ it would be better to go to a GP or after hours service free than get into the A&E. But distance has to be considered, some people can't get to suburban after-hours places. GPs wouldn't have security officers handy at night which the hosps should, and also regular visits from the police, doing their job.

        • Foreign Waka 14.4.1.1

          gws, this is already happening anyway and has no connection to DHB's. You only get 10 minutes and that is generous. Except you are lucky and the waiting room is almost empty at summer holiday time. If you move to a different area it can be does the local doctor does not accept any new clients.

          Most GPs operate out of a larger Medical center where you have some 4 or so practitioners as well as nurses. It is mainly a cost issue that many people on benefit and lower income visit the hospital. There are only so many resources available and by that I also mean feet on the ground. Having waiting rooms for emergency full of people with runny nose and headache will worsen the outcome of those who seek actual emergency services. Some might even have a very detrimental outcome because of this. Care for patient first and in an appropriate facility. Hence my take on the fee issue. As for at night services, if it is that urgent it would be an emergency. But we see those waiting rooms full all day long with cases that should be going to the medical center. And this is a money issue as hospitals do not charge fees.

          • greywarshark 14.4.1.1.1

            I didn't realise that NZ had got so tight in its GP treatment of their clients – patients.

            Your points are so true Foreign Waka. Thinking about it all I believe we could find that by increased spending going to a different type of service we could be much more helpful to the health status of low income citizens, and perhaps also to those in remote places. And that is with mobile vans with regular rounds, staffed by well-trained mature nurses with both a professional approach also being considerate, friendly and understanding.

            There would be enough time to deal with the immediate problem and to give some consideration and advice to other concerns with the intention of checking outcomes on the next round. There would also be an 0800 number for the round so that needy people could ask for advice or help between visits. There would be a trust relationship between the service and the people in the area of the medical round.

            Getting in early and people not having the stress of having to travel, as well as meet the needs of dependents in their families, finding caregivers to sit with them or having to take the family with them to appointments – would be avoided by such a service which would be cost-effective.

            The value of this would be realised if the top-down health administration of services to the population was reversed, and looking at the needs of the people, particularly poorer families and people with caring responsibilities from their point of view, was paramount.

            This is the approach we need in NZ today, at so many levels, so that we have a society that runs itself effectively, practically, humanely and happily. I believe we could have a happy society that all people would enjoy living and co-operating in. We just have to decide that we want it, and then shape all our behaviours to be effective for that outcome.

            • Foreign waka 14.4.1.1.1.1

              I really hope that some thought is given to the people who actually need healthcare rather than endless bureaucracy. But I am by experience a cynic and in my mind a better bet is that, the managerial snout in trough disease will get absolute priority for the health dollar regardless how many DHB's there are. Meanwhile we all can just dream of better times.

              • greywarshark

                Looking at past history for us and then looking at the UK, which I have attempted to place information on, I fear that will be the case. I think it's say 80/20 against – the bureaucrats are mortared in. Each of us is just another brick in the wall.

  15. greywarshark 15

    edit
    Government has produced an idea for a new system for DHBs which were still holding together under the old one, with difficulty, but actually with working systems that needed rejigging and then more cash.

    What could have been done instead – the DHBs mainly needed to be listened to, including the nurses and all staff who would be encouraged to make suggestions about being more effective and efficient, anonymously if necessary, work out a straight-forward plan of how to get ahead, change the wage structure, and be given their heads to get better health outcomes along monitored lines.

    But now Labour can wave the DHBs restructuring and the addition of proper concern for Maori Health in the air as their second 'nuclear' moment. We can't expect full effectiveness from the health system as it gets changed and for a while they will rely on that response to all criticisms – 'it's being restructured'. And how long will that take? Can we have faith in them getting everything right – more likely to end up with a different set of problems. But they will send out a puff of green smoke so they look trendy and concerned about Te Green Party. I have to look further and find out what input the Green Party has had, and see how practically based that was.

  16. McFlock 16

    Interesting model. I extected maybe half a dozen regional health orgs, didn't think of branches within a national admin body.

    I do worry about the lack of local advocacy that will happen with all the decisions in Wellington, though. But we'll see how it fleshes out – damned straight the current model is inadequate in many ways.

  17. Byd0nz 17

    Let's hope ACC is next on the block for reform. Time to scrap their crap investments and put the money back to caring for the injured who have paid their levies for service not for foreign investment.

  18. Stuart Munro 18

    Cautiously optimistic – there was plenty wrong under the DHB model, and with the added challenges of Covid, what went before really did need some reform. I expect some resistance however.

    While National are sulking in the dustbin of history, it might be a good thing to do rolling reforms of all major sectors every decade or so – things fall apart, and the needs of the community change. Treasury is ripe for one – Brash's little helpers are neither use nor ornament, insisting on changes that never produced the promised benefits. Somehow the axe never fell on that nest of non-performing charlatans.

    • woodart 18.1

      neice of mine is high up in treasury . when I asked why 90% of their staff werent sacked and their work outsourced to far cheaper accountants in delhi , she went very quiet and couldnt give an answer.

  19. Tiger Mountain 19

    A whole layer of health executives and contractors are likely bricking it today across the nation…because at first glance it looks like neolibs first and enduring love–“funder/provider split” is going to be fractured for good.

    Other managerialists deep in the monetarist hegemony may be similarly concerned, so hopefully Ministers such as Little and Mahuta have friends and a strategy to defend this most significant rollback on Rogernomics and Ruthanasia for many years.

    • Rosemary McDonald 19.1

      A whole layer of health executives and contractors are likely bricking it today …

      By the grace of the Goddess, please let it be so.

  20. I don't think he has gone far enough.

    A nuclear moment such as this should not be the reason to create Health NZ, we already have one of those called the Ministry of Health.

    The additional layer just adds extra cost and bureaucracy.

    Lets follow this with a recreation of the Ministry of Works and get rid of Waka Kotahi

  21. Foreign waka 21

    It remains to be seen whether this becomes just a budget exercise. If I am not mistaken, 20 DHB get some 4 bill out of 15 or some 26% of the Health budget. If the money is just allocated to more decentralized operational assistance with compliance and paperwork we wont get more health services we just have other people on the trough.

    • ghostwhowalksnz 21.1

      Its more like just over 70% that goes to DHBs, including Pharma

      Using the Treasury online summary using 2019 figures ( before Covid) of $19 billion

      Its a bit behind but the % are much the same

      $3,221 million (16.2% of the Vote) funds health and disability services and maternity and other ‘national’ services

      $911 million (4.6% of the Vote) for the support, oversight, governance, and development of the health and disability sectors, consisting of:

      • Ministry of Health operating costs ($221 million or 1.1% of the Vote)
      • Supporting Equitable Pay ($414 million or 2.1% of the Vote)
      • Health Workforce Training and Development ($212 million or 1.1% of the Vote

      1,713 million (8.6% of the Vote) for capital investment, consisting of:

      • sector capital investment ($1,548 million or 7.8% of the Vote)
      • Equity Support for DHB deficits ($134 million or 0.7% of the Vote)
      • Residential Care Loans – Payments ($15 million or 0.1% of Vote)
      • Foreign waka 21.1.1

        Hmmm….

        From this web page:

        https://www.health.govt.nz/about-ministry/what-we-do/budget-2020-vote-health

        Vote Health is the main source of funding for New Zealand’s health and disability system and ACC is its other major source of public funding. It’s a significant investment – almost $20.27 billion in 2020/21

        My comment: includes ACC that is funded by user pay taxation.

        DHB funding

        A total $3.92 billion is allocated to district health boards in 2020/21 to provide additional support over the next four years, and another $125.4 million over four years to meet further cost pressures on planned care. DHBs have also had a one-off injection of $232.5 million to help them catch up planned care after COVID-19.

        And then there is this:

        https://www.asms.org.nz/wp-content/uploads/2020/06/Examining-health-funding-in-Budget-2020-final.pdf

        When you read through it, the over run of budgets comprise the debt servicing (buildings/upgrades/equipment) and increase of all wages to living cost, the additional centralisation of some admin functions (i.e. disability) etc. Some might remember the expensive upgrade of the Auckland Hospital.

        I just look at all issues and up till then reserve my judgement. So far I have seen so many stuff ups that at the moment I hope this is not one of them. With the huge amount of tax payer money at stake, a failure could mean full privatization.

        • ghostwhowalksnz 21.1.1.1

          Yes , I saw that too and it didnt make sense. $4 bill over 4 years is what the largest DHBs alone get each

          " 2020/21 to provide additional support over the next four years,"

          Its a Covid related thing , where the amounts available for health were boosted specifically for the epidemic

          My % are the standard ones as any covid money is available over 4 years and not spend in a budget year which is what you were really after

  22. Brendan 22

    Goodbye health boards.

    When Kiwiblog comes in support of the basic gist of this policy, then it looks like this policy could work. Again implementation is another issue.

    All the best for the next few years implementing it

    • Sacha 22.1

      Do you mean this 'could work' as in the Nats will not seek to overturn it when they are next in power?

      • Brendan 22.1.1

        Implementation is everything. Anyway.

        Why did the Act reformers come from the Labour party? Because Labour was the party of the reform, whereas the Nats were the party of the status quo.

        The reforms outlined by Labour are safe and unlikley to be overturned outright.

  23. greywarshark 23

    Looking at the UK and its National Health Service – on google there are a large number of reports, analysis on the NHS. The Nuffield reports are lengthy and thorough.

    The conclusions on the one for 2008-2017 indicates what they were experiencing there in the recent decade both internally and affected by international events: https://www.nuffieldtrust.org.uk/chapter/2008-2017-an-uncertain-path-ahead

    In the Conclusion this statement appeared which had been a tweet:

    Jeremy Hunt, the Secretary of State,* adopting social media, tweeted about the biggest things that he wished he had known when he took up his post. The top issues were:

    a) Importance of detailed workforce planning

    b) Critical link between NHS and social care and

    c) If you want to improve patient safety, ‘there is no change without culture change…’

    d) Reform that moves care models to prevention

    e) Grasping potential of tech to transform health, as it has every other aspect of life..

    (Jeremy Hunt had a long tenure looking after the NHS and other matters. A heavy burden, I think he looks in the Wikipedia image a bit wacky. Some of his pronouncements are ill-thought I consider.) https://en.wikipedia.org/wiki/Jeremy_Hunt%27s_tenure_as_Health_Secretary

  24. greywarshark 24

    edit
    We should look at the UK where the NHS has been tossed around as a political football, underfunded, and then blamed for ineffectiveness.

    It makes an uncomfortable read. I don't have faith that great changes in NZ will help us avoid problems that the UK hasn't been able to cope with. And really the NHS woes were at the back of the Brexit referendum and the ensuing political moves out of Europe and finagling with USA interests to possibly privatise the UK health service as a very lucrative business. The UK public continue on a losing streak. There has to be a limit on what the national health system can fund. See below the list of demands on the health system that have grown and overwhelmed it, prepared by the Royal College of Physicians.

    https://www.theguardian.com/commentisfree/2017/feb/28/labour-nhs-jeremy-corbyn-hospital-theresa-may (by Polly Toynbee)

    Labour’s failure on the NHS is prolonging this health crisis

    [overly long text deleted]

    • weka 24.1

      I deleted that cut and paste. The other comment is too long too. You can quote to offer an idea of what is in the link and/or to connect to your own words, but it needs to be shorter.

      • greywarshark 24.1.1

        Okay it just could be that everyone doesn't have a computer and time to look up the shortened detail that I can lay in front of their eyes so they can be informed but if that is against the rules I understand that you can't allow it.

  25. Herodotus 25

    Changing head office from the DHB to Wellington, how will that allow more to be done when there is pressure on limited facilities and staff numbers. Staff are under pressure and there are questions as to how (in) appropriate pay rates are. We are so fortunate that the workforce (also include ECE, education and aged care) are so committed and skilled.

    "..However, the most glaring shortage is in staff. We don’t have enough doctors, nurses, midwives and other critical care workers in this country…"

    "..What we've been offered is lower than the rate of inflation.."

    The budget will be interesting to see what funds have been provided for the transition from DHB's. We also need to be reminded of current issues that need addressing and the delivery of what was promised with funding provided for the likes of mental health that have not been delivered.

    https://www.stuff.co.nz/national/health/300282654/healthcare-change-needed-but-crucial-staff-shortages-need-to-be-addressed

    https://www.newshub.co.nz/home/new-zealand/2021/04/latest-dhb-pay-offer-felt-like-april-fools-joke-nurses.html

  26. greywarshark 26

    Today, Thursday on Radionz about the health reforms. People who know about health outcomes personally: https://www.rnz.co.nz/news/national/440988/health-system-reform-what-the-experts-are-saying

    Canterbury DHB former acting chairperson Tā Mark Solomon told Morning Report the news of the reform was "like an atomic bomb being dropped with no warning".

    He was sceptical of the planned changes.
    While it was true there were issues with the delivery of health services to isolated regions, he said: "But extending the size of each of the health areas won't reduce that, it'll increase it. Because you are having bigger areas coming together".

    The Ministry of Health had been the "biggest impediment to health delivery in this country, because of the way they have acted", he claimed.
    The ministry had "done a good hatchet job to date to get rid of an innovative, integrated health delivery system. They have destroyed that and are now proposing to try to set it up. I find it just a little bit ridiculous"…'
    .

    Association of Salaried Medical Specialists (ASMS) former executive director Ian Powell told Morning Report patients were likely to be big losers in newly announced health reforms.

    "The first thing that stands out to me is there is a lack of empirical evidence to actually justify the decision to abolish [DHBs]. The argument about postcodes, for example, or access to … health services on the basis on where you live – this is not going to change that," Powell said.
    The change would not strip away bureaucracy but reposition it, he said.

    "DHBs are actually being scapegoated for the pressures on the system that are causing difficulties such as underfunding, such as the social determinants of health such as poverty … such as workforces shortages."

    The change would take away a strength the health system which was DHBs being responsible for a defined geographic region.
    "A branch office of a new health service set in Christchurch is not going to have a proper understanding of the wider health needs of the whole South Island…

    and – https://www.stuff.co.nz/national/health/124901961/health-reform-is-right-move-but-ministry-of-health-must-overhaul-its-own-leadership-charity-hospital-founder-says Apr.21/21

    Canterbury Charity Hospital founder Phil Bagshaw has welcomed the Government’s plan to overhaul the health system as “aspirationally correct” – but warns the Ministry of Health needs reforming too.
    Health Minister Andrew Little took the sector by surprise on Wednesday when he announced all 20 DHBs and 30 public health organisations will be abolished under a health system shake-up…

    Bagshaw, who was both an appointed and elected member of the CDHB from 2000 to 2004, said he thinks of the period as “the wasted years” in an undemocratic bureaucracy…
    Bagshaw, who is also a surgeon, said he had serious concerns about the Ministry of Health’s ability to lead the transformation.

    “I have very little confidence in [its] leadership. Trying to work with them is like trying to run around in a vat of treacle.”

  27. greywarshark 27

    Further – Health Minister Andrew Little took the sector by surprise on Wednesday when he announced all 20 DHBs and 30 public health organisations will be abolished under a health system shake-up…

    GPs comment – https://www.rnz.co.nz/news/national/441029/fund-primary-care-gps-demand-more-from-health-system-reforms

    One reason of the many why people go to hospital A&E:

    "Maybe it should be a means-tested thing – free if you earn under a certain amount," another said.
    "It could be possibly that they have to work more than one job and they're not able to go the GP during normal working hours, and going to [an after-hours medical centre] is going to be two or three times more expensive, so I can understand why they'd go to a hospital."…

    [Dr Api Talemaitoga] Talemaitoga, who is also the chair of the Pasifika GP Network, said doctors needed to think outside the box to increase equity, like being open late or offering live video consultations.

    "It's not just the cost [that's a barrier] – it's the opportunity to visit your GP. That's where virtual platforms are really important, or opening extended hours as people do their double shift at the factory and there's just one car at home," Talemaitoga said.

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