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A Truly Equitable National Health Service

What have Minister Andrew Little’s health reforms and the verdict in the George Floyd case in common? Both herald promise of significant reform, in our country, and America. Both seek significant redress ensuring all people will benefit. Both are historic.

Minister Little has announced sweeping and overdue change in our Health system, determined to bring about equitable access to a national health system, to replace inequitable access, a fragmented system, difficult for professionals to work in and people to navigate.

Much of the focus in public discussion will be on his scrapping the DHB’s (District Health boards). No doubt there will be simplistic cries that the scrapping is undemocratic.

I am a strong advocate and protector of democracy and democratic principles. However, I know, as a Capital and Coast Board member for 15 years, that Health Boards operated in an undemocratic way. Processes meant that they never could properly or readily serve their communities. The only ‘democratic’ aspect was that some Board members were elected. But from then on the normal processes of open democratic decision-making, and dialogue were absent.

Instead, Boards were an uncomfortable messy mix of political appointment (directly accountable to the Minister and government of the day), and elected persons ambiguously accountable to both the Minister, operating under both Crown Entity restraints and also the community introduced in the 2000 Act “to foster community participation” in planning for services and improvements. They never really did.

Freedom of speech and public comment was curtailed and members gagged in various ways. Boards were never accountable for final approval of their budgets (unlike in local government).

Minister Little has taken the essential decision to scrap all DHBs and PHOs (another unnecessary layer). 20 Boards and their bureaucracies, led to serious fragmentation, confusion, duplication of costs and services, and a costly introduction of management layers into the Health system. He replaces them with a “truly national health system” Health New Zealand, and alongside it, with Associate Minister Henare taking the lead, a Maori Health Authority able to commission services, with resources to develop services with local iwi, and to ensure provision. Both aim to bring about equitable access and national coordination.

He has clarified the role of the Ministry of Health as advisory, monitoring, policy development, including that of public health and mental health. We have learnt much as a country from our experience of the Covid pandemic and as a consequence, establishing a national Public Health Agency is clearly appropriate.

I have two areas of concern. One is workforce planning, an area of evident failure over years and today. Urgent action is needed, but it seems that government has kicked for touch here in suggesting instead (or as well?) a new New Zealand Health Charter is to be established. That’s fine, but action is needed.

The other area of concern is disability and an aging population (at present awkwardly and sometimes coupled together in policy and implementation.) It is pleasing for the Minister to announce that the focus for disability is not to be only on health but also on spanning the full range of social issues, that more work has to be done, and that a report is coming out in September.

As a 24/7 carer for years of my young husband with lewy body dementia and as a psychologist and author, my book, ‘Peter and me, when a love story becomes a carer’s anguish’, aimed to give voice to isolated and exploited carers, and to expose “a failing adhoc failing” health system. I called for a Royal Commission and a “bipartisan Parliamentary response to produce viable solutions”. But that was years ago. It would have reported by now. However, the issues remain but more. Urgent work needs to be done. The care of the elderly especially but only in their homes, and their carers needs significant focus, whether part of a disability strategy or in some other way.

This health reform is outstanding work by the minister, his ministerial colleagues and staff who have supported him. They have heralded significant change, to be legislated late April 2022 with the promise (not overnight) of an equitable national health system, and as Minister Little said, “a once in a lifetime change for tomorrow and care for today.”

It is to be welcomed.

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