Health reforms get positive report card
The Government's health reforms have received a tentative "thumbs up" in the first report from a major research project
analysing the implementation of the new system over three years.
The report, by a consortium of researchers led by Victoria University's Health Services Research Centre, covers the
first half of a three-year research period.
Principal Investigator Jackie Cumming said that overall, there was support for the new model but the research has
already highlighted key issues that need to be addressed.
"We have received reports of a number of strengths from the model, including the ability to look locally at the needs of
the population and the ability to involve the community in decision-making and to be more responsive to local needs and
to better plan for them.
"Our interviews with chief executives have found that they see more strengths than weaknesses with the new system and
they believe those weaknesses can be managed and will be overcome with time. Even in this early part of the research, we
have reports of relationships and processes improving with time.
"Our research has not uncovered a call or need for further major change although this may in part be related to 'change
fatigue' and a desire to let the new structure settle in and evolve gradually rather than face further disruption."
The research has highlighted a number of issues relating to how the model is working in practice. For example, many
respondents believed there were too many district health boards and that was leading to higher costs and duplication of
effort.
"Some DHBs expect amalgamations, although no DHBs are yet 'putting up their hands up' to amalgamate. Concerns were also
expressed about the cost of supporting the three statutory committees that each Board is required to have. Some in the
sector are also worried that primary health organisations (PHOs) might also add an extra layer of bureaucracy and
further increase 'management' costs."
Ms Cumming said the research also highlighted a need to develop strategies to ensure adequate, appropriate and effective
Mâori representation on DHBs.
"While the law requires two Mâori to be appointed to each board, there was concern that few Mâori were elected. Although
the appointment of Mâori members was seen as a welcome step, increased participation at a local level may still not
translate into improved health outcomes for Mâori where a DHB does not actively promote Mâori health and because many of
the factors that contribute to poor health lie outside the control of the sector. Pacific peoples also have few
representatives, with no elected board members".
Ms Cumming said the respective roles of the Ministry of Health and the DHBs also needed clarification.
"We found a degree of concern from boards about a lack of autonomy for boards and a sense that the Ministry was too
involved in their work. There was also a strong perception of reluctance by the Ministry to devolve funding and
decision-making and that its performance monitoring was seen as intrusive and demanding."
The research, over three years, is funded by the Health Research Council; and by the Ministry of Health, The Treasury,
and the State Services Commission, through a Ministry of Research, Science and Technology Departmental Contestable
Research Pool, and examines the reforms through interviews with key individuals in the Government, Ministry, district
health boards, national stakeholders and the wider public while five case study DHBs are studied in greater depth.
Interim Report: Now available: http://www.vuw.ac.nz/hsrc (look under publications and then new reports)