spinofflive
Margie Apa and Riana Manuel – the women in charge of rebuilding New Zealand’s health system (Photos: supplied, Brett Phibbs/RNZ)
Margie Apa and Riana Manuel – the women in charge of rebuilding New Zealand’s health system (Photos: supplied, Brett Phibbs/RNZ)

The BulletinJuly 1, 2022

A new era for the health system

Margie Apa and Riana Manuel – the women in charge of rebuilding New Zealand’s health system (Photos: supplied, Brett Phibbs/RNZ)
Margie Apa and Riana Manuel – the women in charge of rebuilding New Zealand’s health system (Photos: supplied, Brett Phibbs/RNZ)

July 1 is D-Day for the health reforms. While practitioners are hopeful, the day dawns on a health system under very real pressure, writes Anna Rawhiti-Connell in The Bulletin.

 

What’s changing and what will it mean for you?

Introduced in 2001, district health boards (DHBs) represented the fourth iteration of health system transformations in New Zealand since the beginning of the 1980s. From today DHBs are no more. For a good quick overview of what this means I recommend this from 1 News’ Nicole Bremner and this cheat sheet from Stuff’s Hannah Martin. If you prefer rugby analogies, Stuff’s Chris Hyde has an explainer comparing the old system to the NPC and the new one to super rugby. Essentially it’s highly unlikely patients will notice much difference to start with. There has been a lot of reassurance from health care providers that for their communities and patients, very little will change.

When was reform put on the agenda?

This reform programme was first signalled in the 2020 Health and disability system review. The review recommended that 20 DHBs be reduced to between eight and 12 within five years. In 2021, the government announced that all 20 DHBs would be replaced by one national organisation, Health NZ, and that a Māori Health Authority would be created. Today, the Pae Ora bill comes into force and those entities begin steering the health system through the transition. Heading the two new agencies are Margie Apa (Health NZ) and Riana Manuel (Māori Health Authority – MHA). Toby Manhire spoke with both of them at length in March.

Hypothetical future arrives as present day problems mount 

This change is happening against a backdrop of a health system that’s had its faults, failings, pressure points and capacity constraints magnified over the last two years. Reading through coverage in the lead up to today, health practitioners seem to be hopeful about the future but are incredibly weary. They’re desperate for some alleviation of the very present day issues they are confronting, some of which have been flagged for some time. The Royal College of GPs has indicated that meeting the expectations of the reforms is contingent on  “frontline issues” being urgently addressed. Listening to Today FM this morning, Tova O’Brien asked Margie Apa about getting nurses onto the residency fast track. Apa said Health NZ were pushing to get nurses added.  Health minister Andrew Little repsonded by repeatedly saying it’s never been easier for a nurse to cross the border and come and work here.

The hope for the Māori Health Authority

The vaccination rollout highlighted long-standing health inequities for Māori and Pacific people. Much of the hope about what happens from today is based on anticipation of what Riana Manuel says is a Treaty partnership turned into a functional and operating reality. As Stuff’s Ripu Bhatia reports, practitioners are excited but realistic.  Asked about whether the MHA was another layer of bureaucracy or an unnecessary separate system, Manuel points to the Covid response from ​​kaupapa Māori providers as an example of the nimble and action-focused approach the MHA can take and says it wasn’t just Māori who benefitted from what those providers stood up.

Keep going!
Illustration showing roading around the Basin Reserve, no longer to be the Southern Hemisphere’s largest roundabout. (Photo: Supplied / LGWM)
Illustration showing roading around the Basin Reserve, no longer to be the Southern Hemisphere’s largest roundabout. (Photo: Supplied / LGWM)

The BulletinJune 30, 2022

Getting Wellington moving

Illustration showing roading around the Basin Reserve, no longer to be the Southern Hemisphere’s largest roundabout. (Photo: Supplied / LGWM)
Illustration showing roading around the Basin Reserve, no longer to be the Southern Hemisphere’s largest roundabout. (Photo: Supplied / LGWM)

Announced as a once-in-generation opportunity, the long-awaited Let’s get Wellington moving plan prompts a range of reactions, writes Anna Rawhiti-Connell in The Bulletin.

 

“Once-in-a-generation opportunity”

I am in the capital this fine morning so thought I would take a look at the plan to get Wellington moving. I absolutely will not gripe about the airport bus situation which I believe is due to be rectified from tomorrow. Yesterday the government announced its preferred plan for the overhaul of how Wellingtonians get around. It was billed as a once-in-a-generation opportunity to shape Wellington’s future by finance and infrastructure minister, Grant Robertson. The government has backed light rail from the city to Island Bay and a new tunnel through Mt Victoria. Overall, the plan is estimated to cost $7.6b and slated for completion in the 2030s. Wellington city council and Greater Wellington regional council now have to choose their preferred option before more detailed planning can begin.

Mode shift

Wellingtonians have waited a long time for this. Let’s get Wellington moving is a joint initiative created in 2015 involving Wellington city council, Greater Wellington regional council and Waka Kotahi NZ transport agency. It hit problems along the way, with the project deemed at risk of failure in March last year. Stuff’s Kate Green has written this very good overview of the initiative. The project’s main aim is mode shift – getting people cycling, walking and taking public transport. The Dominion Post has been championing and explaining the concept with a regular series. You can read editor Anna Fifield’s introduction here.

So what’s been the reaction?

So far, from local and central government figures, I’d go with unsurprisingly “mixed”. Stuff’s Luke Malpass describes the arguments for and against as a retreat into various ideological silos. Mayor Andy Foster applauded the announcement as a “massive” day for the capital. The Dominion Post is running that line on the front page of the paper this morning. The Green party welcomed portions of it but transport spokesperson Julie Anne Genter said the government’s preferred option is “not the best for the climate overall” citing the tunnels as “high-carbon and high-cost”. As RNZ’s Kirsty Frame reports, the government is yet to complete an assessment of the climate implications of the policy. National MP Nicola Willis criticised the announcement for being just that, an announcement, saying it was hard to get excited because as yet there was no business case, no funding agreement and no plan to start construction until 2028.

New contender for largest roundabout in Southern hemisphere?

Naturally the first question we had in the Spinoff office was “will people still toot in the new tunnel?” The old Mt Victoria tunnel would be converted into a walking and cycling-only route according to the plan. I recently drove to Wellington airport in torrential rain and observed the bottleneck the current Mt Victoria tunnel creates, barely squeaking onto the plane in time. The proposed second tunnel will have four lanes – one lane each way for public transport and one for private vehicles. There are also proposed changes to roading around the Basin Reserve, meaning there will be a new contender for the title of largest roundabout in the Southern hemisphere. Bit of a throwback but in 2013, the roundabout caught the eye of the United Kingdom roundabout appreciation society and it featured the Basin Reserve in a roundabouts of the world calendar. The National library has a copy.