Experts hold “considerable hope” that the health reforms will be more than just a band-aid for a system buckling under pressure, but have concerns it could struggle to deliver, and that change could take years.
July 1 marked the most sweeping change to the country’s health system in more than two decades. The 20 district health boards were disestablished, and Health New Zealand and the Māori Health Authority forged in their place.
The move came in the thick of the one of the worst winters Aotearoa has seen in years, and amid mounting strain on GPs, primary care, hospitals and planned care – highlighted this week in Stuff’s Life Support investigation into the state of health.
On Wednesday night, a University of Otago panel made calls for a “significant” rethink of how health is funded in New Zealand, and stated the reforms would fail in execution if workforce issues were not tackled.
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Professor of Public Health Peter Crampton led a discussion on the health reforms, as one of four in the university’s annual winter symposium series.
Crampton was joined by Professor Robin Gauld, Pro-Vice Chancellor of the Otago Business School and co-director of the Centre for Health Systems and Technology; GP and Professor Tim Stokes; and public health physician and dean of the Dunedin School of Medicine, Professor Joanne Baxter.
A panel of health experts hold hope for the health reforms, but say greater focus on primary care, how we fund health, and addressing workforce issues are needed.
Workforce issues a ‘crisis’
New Zealand’s health workforce emerged as a critical touchpoint.
Stokes said the reforms offered the opportunity to have more equitable outcomes for patients, enabling more people to receive high quality, accessible and prompt care.
However, he said we cannot implement health system changes without a high functioning workforce.
Healthcare workers have “high intrinsic motivation” to care for their patients. However, we’ve moved from intrinsic motivation to “moral distress”, where clinicians cannot always give timely care to patients in the way they want to, given external pressures: “that needs fixing”.
Gauld said we are “way, way behind where we need to be” in the health workforce, and that it was time the issue was put “front and centre” – particularly increasing the Māori and Pacific health workforces.
However, this would take “many years” to solve, and there was no easy answer.
Baxter said due to the previous DHB set-up, there is “patchy” information about gaps in the health workforce, and differences between regions.
It was difficult, as “this is a crisis right now”, but being able to take a step back and think about these nationally would be really important, and she believed the reforms would offer a “better position” to tackle this from.
‘We need to be patient’
The time it takes to bed-in such changes was also raised as an issue, with the experts saying New Zealanders need to be patient, as many – including on the frontline – won’t see differences for a while.
“It will take time, and people need to understand that,” Stokes said.
Stokes said he believed the reforms were a “road paved with good intentions”.
“This road could, I hope, lead us to a ‘New Jerusalem’ – to be transformative and enable equity.
“But it could take us down to a road to a darker place, where the reforms essentially become structural redisorganisation, where we then allow the current pressures on the New Zealand health system not to be fixed.”
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Dr Robin Gauld suggested Aotearoa open up the debate about a ‘social insurance’ model of healthcare funding, to allow for greater equity.
Funding ‘rethink’ needed
Gauld believed the reforms would struggle without a “fundamental rethink” of how we fund health.
Currently, funding is separated into primary care and the public hospital sector. Private and public hospital sectors operate in parallel, but private “significantly” benefits from public back-up and support.
“The goals of co-ordination and equity [in the reforms] are inherently undermined by those underlying institutional arrangements.”
Gauld also said we need a “serious debate” about a social insurance model of healthcare – a scheme similar to ACC, funded through a mix of payroll and employer contributions, as well as Government funding.
He noted that while there is no perfect model, social insurance has equity at its core, and opens up resources available in the system to all – whether they are public or private.
Stokes also noted that Aotearoa does not spend enough on health, to be able to correct the historical underfunding of primary and community care.
Hope for collaboration, community voices to be heard
The role and scope of the newly-emerged Māori Health Authority was also the topic of much discussion.
The “persistent, pervasive” health inequities Māori face were “unacceptable”, and starkly seen in morbidity and mortality data, Baxter said.
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Professor Joanne Baxter said Māori have been poorly served by the health sector in the past, and was hopeful that the establishment of the Māori Health Authority would enable Māori to be present and engaged with the system, in a way that works for them.
The Māori Health Authority was an important platform to enable greater Māori presence, engagement and representation in the health system – including through the voice provided by iwi partnership boards.
Baxter was “optimistic” this would flow into services really meeting needs of Māori.
But again, this would not happen overnight, and its existence was already being challenged.
“We know, for such big changes to make a difference, we need to give it time, resourcing and support.”
Baxter “very much hopes we are given the scope and time to help the [Māori Health Authority] realise its aspirations.”
If the reforms work, the health system would have both local insight into communities’ needs and national oversight into emerging inequities – balancing these, and ensuring equity is achieved, would be one of the big challenges going forward.
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