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Aotearoa New Zealand
Aotearoa New Zealand restructures its health services
to communities and more nationally connected. What will the reform look like? The Ministry of Health will refocus to become the lead advisor to government on matters of health. A new organisation will be created, Health NZ, to take responsibility for the day-to-day running of health services, meaning the 21 District Health Boards (DHBs) will become obsolete. A new Māori Health Authority will be created with the aim of improving outcomes for Māori, and to provide tailored health services for Māori where Māori models of care can flourish. It will work in partnership with Health NZ to commission care across the country. Finally, it will establish a new Public Health Agency within the Ministry of Health to respond to threats to public health, such as pandemics. For a number of years, the health sector and the public have been concerned about the apparent inadequacies and shortcomings of some of the services provided by Aotearoa New Zealand’s health services, including ongoing inequities of access and quality that particularly affect disadvantaged and vulnerable groups. This concern led to the instigation of a Health and Disability Review, commissioned by the government in 2018. In April 2021, the government released its response to the review with its plan to strengthen the health system to ensure every Aotearoa New Zealander can access the right care at the right time. It observed that the health system is supported by a dedicated workforce, but that the system has become overly complex and fragmented. It committed to a single nationwide health service with structures that ensure government is both closer
What does it mean for hospital and specialist care? The review identified a need for greater consistency of care across the country. Care should be offered where it is accessible and practical, and the costs need to be better managed. The review proposed wider regional networks, coordinated services, and improved access for those in rural areas. The new service aims to provide greater certainty where more specialist or complex care is required, less fragmentation of services, and less competition between districts for staff and resources. What will these reforms mean for surgeons? At present there is little detail of how the plan will be implemented, but there are some likely consequences for surgical services. Firstly, the impediments caused by the current DHB structure for those surgical
specialties providing a regional service (i.e. across DHB boundaries) should be diminished, allowing for the creation of better national and integrated specialty networks. This will particularly affect the smaller specialties such as Neurosurgery, Cardiothoracic, Vascular and Paediatric Surgery. Currently, service development is very ad hoc, often done in isolation, and is typically short-term. Hopefully, having a single Health NZ will enable improved long-term planning. Secondly, our College has already applauded the recognition of inequalities in the system and has indicated it will do everything it can to support the initiatives to correct these. Exactly how the commissioning of Māori services will affect surgery is not yet known, but RACS will be actively working to ensure it succeeds. Thirdly, the plan makes no mention of significant increases in funding, so it is likely that there will be ongoing pressure around resourcing of services, especially surgical services. It behoves us to continue to use our limited resources wisely without compromising the quality of care we provide. Spencer Beasley and Sarah Rennie Aotearoa New Zealand Surgical Advisors
For more information see: https:// dpmc.govt.nz/our-business-units/ transition-unit/response-health-anddisability-system-review/information
