Those of us who govern are acutely aware of the problems inherent in the requirement to mind our own patch, not everybody else’s, writes Auckland DHB chair Pat Snedden.
This week’s health announcements signalled a big day in a number of ways. Health minister Andrew Little took time in a thoroughly principled fashion to describe how a country our size has shortchanged ourselves and shortchanged Māori in the provision of health care. His commentary was devoid of usual political rhetoric. He took the time to say in plain language that what we have at the moment simply isn’t working well enough for most of the population.
In particular, he named the elephant in the room. For decades, Māori citizens have got the short end of the stick. The care provided has not been good enough. No excuses, no literary flannel. He simply named it and then explained what this government intended to do to fix this citizen deficit. His analysis was brave but unsentimental.
He was clear that we have failed the citizen test of equal access to care for Māori and we are not going to continue with policy and practice that will maintain the status quo. Nor are we going to try yet another formula to fix it. Rather we are to enfranchise Māori with the resource and the operating authority to address their own needs and reach into the wider system to moderate the practices of their tāngata Tiriti partners.
This is truly transformational in intent. Never have I been in a room where the Māori audience was so in harmony with such a change. I think this has struck a chord of optimism similar to the setting up of the Waitangi Tribunal in 1984. At last the health system has recognised that tāngata whenua are best placed to decide what is right for tāngata whenua and what’s more they are capable of telling the rest of us as Tiriti partners what they want. This shift is monumental.
This is but one of the seismic changes. The initial analysis on the need for system change, ably managed by Heather Simpson over two years and across the whole of the system, told us that care is uneven throughout the country. Postcode health is not an acceptable position to be in where the closer you are to the main centres, the better your chances lie in living longer assisted by higher quality care. This cannot be right and this Minister is determined to change this on behalf of us all.
Where Heather Simpson’s work parted company with the final result is around the new emphasis of tino rangatiratanga in Māori care. Māori being in charge and fully funded for their own health delivery did not find favour initially. But the final result is emphatically in favour of Māori for Māori care and for Māori to influence more directly and more decisively the whole of the health system delivery. This has a genuine chance of providing something approaching equal health outcomes for all New Zealanders. There is now a huge expectation to get on with this.
We have obviously learnt from the Covid pandemic that the power of a public health system that can work together seamlessly across the nation is better than a series of outposts trying to do their best in the local areas. We also have learnt that public policy matters when it comes to the social determinants of health. It counts if we are well fed, live in warm and dry housing and have access to social services where and when we need them. Hence a public health agency in the Ministry of Health for policy, strategy and intelligence with an expert advisory committee about what counts for the health of the population. In addition, a single public health service managed by Health NZ as the operational arm to manage threats to the population such as Covid, wherever they occur in the country.
We have wasted time and money in our current system duplicating technology, having multiple systems that don’t interface each other well, creating bespoke solutions to challenges where a centralised mandate would do better for all of us. Workforce planning is a clear example. It will now be a centrally managed process. This will also apply to capital expenditure that will at last be rationed in an effective, whole-of-country manner.
Those of us who currently govern have seen this problem but our historical requirement is to mind our own patch, not everybody else’s. All this changes as DHBs disappear and four regions take on the job of organising the care equitably. This is much less a centralised model being proposed than it is a distributed model. It will mean simplifying organisations and consolidating roles under common leadership, but that will involve greater investment and more people – not fewer. What gets done centrally, regionally and locally has yet to be described in comprehensive detail but the intentions are now clear. There are some decisions we no longer need to make 20 times.
We now need to give this change the chance to fulfil its promise.