A bold and positive health reform from Labour

Andrew Little announced:

  • All 20 district health boards replaced with a new Crown entity, Health New Zealand, which will be responsible for running hospitals and commissioning primary and community health services. It will have four regional divisions.
  • Responsibility for public health issues will rest with a new Public Health Authority, and a new Māori Health Authority will monitor the state of Māori health and have the ability to commission services directly.

Overall this is a very bold (even brave) reform which will significantly improve the status quo, if done well.

My brief take (will do more in depth analysis on Patreon) is:

  • No more DHB elections is excellent. They actually decreased accountability by allowing central Government to blame local DHBS
  • 20 DHBS was far too many. I supported reducing their numbers. I think overall having one entity responsible for running the hospitals is appropriate for a small country. We have only one Police force etc. The proposed Health New Zealand could reduce a huge amount of bureaucracy and provide for better health services around the country. There is a risk smaller areas could be overlooked, and that can be mitigated
  • A dedicated Public Health Agency is probably better than having it in the Ministry of Health. But there is a risk of zealot capture here. A good Public Health Agency should be evidence based.
  • The Maori Health Authority will probably achieve nothing, despite good intentions. I can’t think of any other sector where such an agency has led to improved outcomes for Maori. Improving outcomes requires getting involved at the whanau level, in my view.

So overall I think the reforms look promising, and kudos to Labour for commiting to them. But the big challenge is the quality of leadership in implementing them. Done badly and it could be a disaster. Andrew Little is one of their more capable Ministers but he will be tested by trying to maintain services at the same time as huge structural change. The person picked to head up Health NZ will be critical to its success and possibly have the hardest job in the public sector.

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