E kore e taea te whenu kotahi ki te raranga i te whāriki
kia mōhio tātou ki ā tātou.
Mā te mahi tahi ō ngā whenu,
mā te mahi tahi ō ngā kairaranga,
ka oti tenei whāriki.
I te otinga
me titiro tātou ki ngā mea pai ka puta mai.
Ā tana wā,
me titiro hoki
ki ngā raranga i makere
nā te mea, he kōrero anō kei reira.

The tapestry of understanding
cannot be woven by one strand alone.
Only by the working together of strands
and the working together of weavers
will such a tapestry be completed.
With its completion
let us look at the good that comes from it
and, in time we should also look
at those stitches which have been dropped,
because they also have a message.

Nā Kūkupa Tirikatene (1934–2018)


Photo of Heather Simpson.

Heather Simpson | Chair

This Review is probably the most comprehensive integrated look at the New Zealand Health and Disability System in a generation.  The terms of reference were wide and challenging and required the Review to confront many of the inequities the system has perpetuated over the years.

This review was essentially completed before Covid-19 hit New Zealand.  Obviously this pandemic has put the system under extreme stress.  While the Review is totally supportive of the leadership and commitment the system is showing to help New Zealanders through, what only a few months ago seemed unimaginable, the experience only reinforces the Review’s conclusions.  To meet the challenges of the future our population health focus has to be stronger, our preparedness for emergencies greater, and our system has to be much better integrated with clear lines of accountability and decision rights.

Putting this report together has involved a huge amount of effort from a wide range of contributors.

From written submissions, through face to face meetings, expert analysis, and the dedication of a secretariat who have worked tirelessly to pull it all together.

The Panel has had many lively discussions as we debated the merits of alternative proposals, but throughout, all Panel members have been driven by a strong commitment to providing a set of recommendations which we believe have the best chance of ensuring the Health and Disability system in New Zealand can evolve into a system which delivers health outcomes for all New Zealanders both equitably and efficiently.  In the end there was no consensus on the extent to which the Māori Health Authority should control the funding and commissioning of services for Māori.  But while that is a significant difference, and is a debate which is sure to be ongoing, it should not detract from the rest of the recommendations.

I firmly believe that, the changes being proposed by this Review have the potential to deliver a system which is a truly New Zealand system.  A system which embeds te Tiriti principles throughout, where Māori have real authority to develop and implement policies which address their needs in ways which respect
te Ao Māori, and a system where all New Zealanders, Māori, Pacific, European, Asian, disabled, rural or urban, understand how to access a system which is as much about keeping them well, as it is about treating them when they become sick.

It is important to acknowledge also that the real strength of our health system comes from the people who provide the care and deliver the services. 

The job of this Review was to recommend system level changes which will allow those staff to be more effective.  Staff need to be able to use all their skills to the best of their ability and consumers and whānau need to feel that the system is working for them. Policy makers need to have confidence that when decisions are made to introduce a new policy, effective levers are in place to translate those policies into action and create feedback loops to continually improve performance.

Equally importantly it should be a system where financial management is driven through clear accountability lines so that any government can be confident when it allocates funding to improve the system, it will be able to track where the money has been spent and will be able to see the changes which have come about as a result of the expenditure.

I am confident that if the system changes proposed by this Review are implemented and funded over the next few years, the system would grow stronger, the outcomes would be more equitable and overall the system would be much more sustainable.

So my sincere thanks go to all those who have contributed, to the Director and the staff of the secretariat, and especially to the Panel members and the members of our Māori Expert Advisory Group.

I commend the Review and its recommendations to the Government.

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