Health sector reforms: Experts and providers react to the biggest shake-up in 20 years

Health organisations and academics are welcoming the health sector reforms, though some want to see more of the detail before giving their full support.

Health Minister Andrew Little on Wednesday announced big changes were ahead, most notably the scrapping of the 20 regional district health boards, which will be replaced by single entity Health NZ, and the creation of a Māori Health Authority, which will have commissioning powers.

"In the few months that I've been Health Minister as I get around and talk to health professionals... everybody is saying we've got to make change," he told The AM Show on Thursday.

Here's how different groups around the country reacted. 


Plunket chief executive Amanda Malu called it a "pretty courageous step in the right direction".

"The devil is always going to be in the detail, but I'm encouraged by the creation of the Māori Health Authority and particularly to hear that it will have commissioning powers," she told Newshub.

"We think that's a really positive step in the right direction... It's absolutely essential that iwi/Māori are at the table and able to have a say in where resources go." 

Malu said Plunket has been doing its own work to reduce inequities in access to health services.

"We're looking forward to working alongside iwi/Māori, the Māori Health Authority and Health NZ to support in whichever way is most appropriate... We've got nurses on the ground who see the impact every day of health inequity and we're ready to step up - or step back - to ensure the best outcomes can be delivered for whanau Māori and Pasifika whanau who been so far have unserved by the system." 

While the National Party has said it would reverse the changes, both Little and Malu said there is widespread support on the ground.

"These are big, once-in-a-lifetime changes, but I don't think you'll find anyone who would say that change wasn't required," said Malu. "I think everyone was expecting there to be significant change and that's certainly been delivered."

Aged Care Association

Simon Wallace, chief executive of the Aged Care Association - which represents about 600 rest homes around the country - said he's been concerned about inequities, but is holding back judgement on the reforms for now.

"If these reforms address that, that's a really good thing. But there are still some things that we haven't seen in the announcements that were flagged in the health and disability system review last year - one of those is primarily around pay parity for our nurses.

"So parity for our nurses with their equivalents in public hospitals. Our nurses earn on average $10,000 a year less than a nurse in a public hospital... that hasn't been acknowledged in what we've seen today."

The New Zealand Health and Disability System Review last year "identified that workforces like aged care nurses should be paid at parity with a nurse in a public hospital" he said. The Aged Care Association's calculations put the cost at $84 million a year

"The proposals today while new and interesting, there is more detail we need to get our heads around. Until we see that, I think that we need to just tread with a little bit of caution... We're really glad the role of aged care services have been acknowledged in the reforms and we will work with the Government over the next few months on the detail." 

Andrew Little.
Andrew Little. Photo credit: The AM Show

Council of Trade Unions

CTU president Richard Wagstaff told Newshub the current system of DHBs "had some benefits, but it's outlived its usefulness and it's time to do things differently".

"In broad terms we support these reforms. What we are concerned about is that it ends up that there are more people working in health at the coalface, and we need to make sure there's a proper transition to ensure that that happens." 

Little has said back office jobs such as IT and human resources would be lost, as they wouldn't need to be duplicated across several DHBs. But he acknowledged there is a shortage of healthcare workers, so "they will stay". 

Wagstaff said the CTU backed the creation of the Māori Health Authority, saying having more Māori input into their own health "can only be good". 

Michael Baker

Epidemiologist Michael Baker, who has become a household name in the past year thanks to his expert knowledge of infectious disease, said New Zealand was "poorly prepared" for COVID-19 and DHBs have struggled with big events such as the 2016 Havelock North waterborne campylobacteriosis outbreak and the 2019 measles epidemic.

He said the reforms "go a long way" to fixing that, but much would depend on how the reforms are implemented and whether they're properly funded. 

"These new public health structures will also need sufficient critical mass and mandate to influence key health determinants such as housing, social welfare, and tax policy. They will need to be able to affect actions by other organisations such as the Ministry of Primary Industries to improve problems like campylobacter contamination of fresh chicken, which is causing an unacceptably high burden of illness and deaths in New Zealand."

Michael Baker.
Michael Baker. Photo credit: RNZ

Arindam Basu

Arindam Basu of the University of Canterbury's School of Health Sciences, Education, Health & Human Development said it was perhaps too early to comment on "an overhaul of this magnitude", but said it was likely to be an improvement on the status quo.

"Centralisation... carries with it the potential to become a complex monolith, and risks losing the efficiency that each individual unit might provide in a federated system," he said, but expects "access to care will be significantly improved for everyone" overall.

"The establishment of the Māori Health Authority is definitely a welcome move as such a structure will help to mitigate the existing inequitable access to care for Māori."

Taupua Waiora Centre for Māori Health Research

Spokesperson associate professor Jacquie Kidd of the AUT School of Nursing said the creation of the Māori Health Authority "with teeth... embodies Te Tiriti o Waitangi in terms of tino rangatiratanga and ōritetanga".

"Overall the announcement is very welcome and, if fully realised, will address the pervasive health disparities experienced by Māori."

She said many Māori distrust the present system.

"This new structure must fully engage with whānau to ensure that trust is carefully established and nurtured, and that national health agendas do not overtake those of hapū and whānau."

Kate Waterworth

Kate Waterworth, a post-graduate lecturer in Critical Disability Studies at AUT University, said there were a number of "pleasing" aspects to the reforms, but was disappointed decisions on disability issues had been delayed until September.

"Disabled people have traditionally been neglected as a focus of political attention. Minister Little refers to an outcome of this neglect - that there is poor data held nationally about disabled people's experiences and outcomes of healthcare service use. 

"This lack of visibility appears to have delayed important decision-making in this space."

She's holding out hope September's announcement will "address issues of access and quality of health service delivery, of health outcomes (including life expectancy) and of the complex interactions between the experience of disability and broader social and political systems".