The Government's newly announced health plan heralds a massive change in the system. But commentators say its success depends on what's in the detail.
Work is starting immediately to overhaul the health service in the first stage of three-year reforms aimed at dealing with a system under stress.
Health Minister Andrew Little is billing it as a truly national public health service that means health workers "can concentrate on patients instead of battling bureaucracy". He says the current system is under so much stress and the level of inequity is so great that we can't afford to wait.
But ask the experts what the health system will look like in July next year and the answer is the same: the devil is in the detail, and we don't have the detail.
Today on The Detail podcast Sharon Brettkelly looks at the political and practical reaction to what has been announced.
“I was expecting something completely different,” admits Dr Richard Edlin, health economist in the School of Population Health at the University of Auckland.
He says it’s likely many of the same people currently running health services will still be involved in the new system – after all, they are the ones who know what’s going on.
“You don’t want to entirely blow up the system,” he says. “We’ve been down that road before and it didn’t end particularly well.”
And he says doctors, nurses and medical specialists will dig their heels in if they see something coming that won’t work.
Unveiled on Wednesday was a radical plan to create national organisation, Health New Zealand - replacing all 20 DHBs; forming a Māori Health Authority; and a Public Health Agency.
The reforms aim to put greater emphasis on primary healthcare - the GP and other services offered at a local clinic - and ensuring fairer access for everyone.
Health New Zealand will have four regional divisions and will be in charge of running hospitals and commissioning primary and community health services. The Public Health Authority will be responsible for public health issues, and the Māori Health Authority will watch over the state of Māori health and also commission services directly.
Little has talked about ending the ‘post code lottery’ of health care but Edlin warns that while things like different criteria for cataract operations and cancer treatment need to be ironed out, sometimes post code healthcare is needed, with different regions having different priorities.
He does believe this new system will see some people travelling further for specialist care.
“This will be about doing more for the budget that we’ve got,” he says.
Some in the health service say the plan is bold and optimistic, others say the surprise move to scrap DHBs removes the local community voice from running hospitals, and one leader describes it as dropping an atomic bomb on the sector.
“If these changes can fundamentally shift what have been massive, massive problems in quite a disjointed system that’s been operating, then that will be huge,” says Jo Moir, Newsroom’s political editor.
She says there were two arguments going on from the Opposition, the first that we would lose that regional community voice with the health boards all being scrapped; the second that the Māori Health Authority would introduce a two-tiered, race-based system.
“But the Opposition has the ability to make the Government explain why what they’re putting forward is the best model, and they’re saying ‘We’re not convinced that what you’re doing here is actually going to solve it’. It’s actually on the Government to .. prove that wrong.”
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