As we headed around the motu talking to people working in the health sector, we got a good feel for the key areas of interest around the reform. We were asked a large number of questions. We addressed as many as we could on the spot, and are continuing to provide follow-up detail on some of the themes that emerged from the roadshow sessions.
We will be updating this page regularly with information about the key areas of interest.
The current health system has two related, but distinct, areas to consider in terms of disabled people and disability. Support services which are designed specifically for disabled people – called Disability Support Services (DSS) – and providing health services to people with disabilities.
Our health and disability system has not performed consistently in providing either Disability Support Services or equitable health outcomes for the disabled community – this was evidenced further in the Health and Disability System Review.
Following this review, the Government commissioned further work around how best to ensure the aspirations of the disabled community are met.
The Government has announced that a new Ministry for Disabled People will be established. This will ensure joined-up supports and services are available to disabled people and drive improved overall outcomes for disabled people. The new Ministry will also lead and coordinate cross-government disability policy, deliver and transform disability support services and progress work on broader disability system transformation.
This work complements the work under way within the health reform programme to ensure all New Zealanders have equitable access to the care they need, regardless of who they are or where they live.
The outcome we want is one where people and their clinicians can access patient information through the equivalent of a single patient record. It’s possible to achieve this without needing to roll the same platform out to everyone. Modern approaches can deliver secure information sharing between different care providers and systems much more quickly and affordably than through a single platform roll out.
With varying levels of digital maturity and different legacy systems among DHBs, we’re looking for innovative solutions that allow us to use our resources most effectively. Some of this work is underway, including the Hira programme being delivered by the Ministry of Health. This is focussed on enabling a virtual health record by securely drawing information about a person from different systems. The Hira programme will continue under the new system.
In the short term, PHOs will continue to operate as they are. In the medium term with the introduction of localities and network support functions, some of the functions currently done by PHOs may be done elsewhere. Regional commissioners (Health New Zealand and the Maori Health Authority) will make these decisions once the operating model for primary and community care is developed and finalised. Work is underway on the interim New Zealand Health Plan, which will signal the future direction for PHOs.
Part of the vision for our future health system is to deliver a people- and whānau-centred system. This will be based on the voices of Māori, Pacific, disabled and all other consumers, whether or not they are active users of health services today. To deliver on this vision, it’s vital to embed consumer, community and whānau voices in the design, delivery, evaluation and governance of health services.
In our future system, it will be the responsibility of the health sector to engage with consumers and whānau at national, regional, and local levels. This means, for example, that it will be the job of the regional commissioner for Heath New Zealand to make sure that their commissioning framework includes the diverse voices in their region.
There is no one way to engage consumers. Engagement needs to be designed to meet the needs of the specific consumer being approached. However, there is a need for the health sector to have more support to engage and embed consumer voices consistently, deliberately and meaningfully across the country.
To do this, we are building a national consumer/whānau voice framework as part of a joint work programme with the Health Quality & Safety Commission. This framework includes a code of expectations for consumer engagement, a centre of excellence with resources and training on best practice and a consumer health forum that will give more visibility of consumers and consumer groups to the health sector.
The current thinking is that contracts with kaupapa Māori providers will largely shift to the Māori Health Authority (MHA) and services will continue to be funded by them.
Over time, the MHA will work with providers to review these contracts as we know many are overly prescriptive, fragmented and do not include adequate reflection of Te Ao Māori, tikanga and kaupapa Māori perspectives that they have always wanted to include within their services.
There will also be some other contracts that the Ministry funds that are likely to shift to MHA as well, like Māori provider development scheme funds, targeted mental health funding and early years funding.
There will be a large number of core primary care contracts that shift to Health New Zealand or that are co-commissioned with the Māori Health Authority.
The intention is to enhance access to specialist care in the regions. We know that in the current system, services and staff working in rural locations have been isolated. The plan is to make sure that specialists in the regions are part of a wider and supportive network with opportunities to train and link into metropolitan centres as needed.
Under the new structure, there will be a much more joined-up approach to workforce planning. Health New Zealand will provide a single, national view of the staffing needs making it easier to make sure we have the right people with the right skills in the right place.
We will be also be able to take a system-wide approach to growing our Māori, Pacific and disability workforce, including recruitment, training, career and leadership pathways.