Tīhei Mauri Ora

Ko te wehi ki a Ihowa, nāna nei ngā mea katoa.

Kei ngā maunga whakahī, ngā tai mihi tāngata, ngā awa e rere nei, ngā mana whenua, toitū ki a koutou.

He tātai whetu ki te rangi, mau tonu, he tātai tangata ki te whenua ngaro noa. Kei ngā mate o te wā whakangaro atu ra koutou.

Me aro ki te hā o te tangata – kei ngā mataora, tēnā koutou katoa. He mihinui tēnei kia koutou ngā kai pānui tēnei ripoata hauora hauā arotake wā poto.

Ko te whakaaro I te mutunga ka whai matauranga koutou ki hea Pūrongo mō Tēnei Wā – Hauora Manaaki ki Aotearoa Whānui.

Noho ora mai,
Heather Simpson

Photo of Heather Simpson.

Heather Simpson | Chair

The attached report is both too short and too long.

It is too short because the health and disability system we have been tasked with reviewing is a huge network of interrelated organisations each of which is committed to providing quality care or services to their customers. Almost 8.5% of the entire New Zealand workforce is employed in some form in the health sector. This is a group of professional and committed individuals who often go above and beyond what is expected of them to assist those in need and to make the system as effective as it can be.

To do full justice to the range of issues facing this system and provide real insight into where the system could improve in the future could easily fill many volumes.

But it is also too long because we recognise that it is the complexity of the system, and the difficulty this causes for people to navigate it, that is often at the heart of individuals’ and organisations’ dissatisfaction with the way the system performs. For this reason, it would have been nice to produce a simple, easily readable, short analysis of the challenges and future directions that would have allowed everyone to understand and comment on the issues and potential solutions.

The reality, however, is that, despite the commitment and good intentions of most of those working in it, the current system is not performing equally with respect to all New Zealanders.

Significantly, te Tiriti o Waitangi / the Treaty of Waitangi guaranteed Māori their full rights and benefits as citizens, yet more than 80 years after the establishment of our public health system, the health and wellbeing outcomes for Māori are still significantly poorer than for non-Māori New Zealanders.

When we project forward and consider the demographic, technological, societal, cultural, and environmental changes that are rapidly overtaking us, it is clear there are challenges ahead. Continuing with the current model of care, based largely on a Western medical model, employing more and more medically qualified staff focused on treating illness, rather than promoting wellness, will not only be ineffective in achieving the equitable outcomes we desire, it will not be sustainable. The numbers of staff required will not be available and the cost would be prohibitive.

This interim report aims to achieve three things. It reflects back the issues people and organisations have told us are hampering the achievement of better outcomes, checks whether the available evidence supports what we have heard, and signals our initial thoughts on where we believe the biggest gains can be made to improve the performance of the system.

The distressing part of listening to and reading the wide variety of submissions we received was the degree of concurrence in the views of what people want the system to achieve and how they want it to behave. This would seem to be a good thing, but the reality is that these views have been being expressed, and supposedly agreed with, for decades. Yet the system changes have been only marginal at best.

We have seen many great examples of professionals working together to achieve real progress in some areas. We have seen rural communities demonstrating a degree of flexibility and cohesiveness that could be a model for the rest of the system. We have observed examples of where the adoption of new technologies or processes has fundamentally changed the outlook for patients in particular areas. And we have seen examples of governance arrangements between iwi, Māori and DHBs which are supported by all parties.

But we have also seen many examples where the system continues with practices that the evidence no longer supports. We see communities and whānau facing a system that looms as a confusing monolith, telling people what is good for them, rather than a system that works with them to improve their overall wellbeing in ways designed for them not for the system. And we have seen rural communities forced to make do with a level of service accessibility that is simply unacceptable.

The challenge is not to reinvent the wheel. Many strategies are already in place, and this interim report is a reality check on where the system is at.

The work of the Panel in the next phase will focus on the specific changes we believe will have maximum effect on moving the system on the path to equity, responsiveness, and sustainability.

There are no recommendations in this interim report. That needs to wait for further analysis and much more discussion, but it is clear to us from this phase of our work that if the system is to be more equitable and more sustainable, significant change needs to happen.

  • The system needs to work:
    • in a much more cohesive, collective, and collaborative style within a set of agreed values and principles that apply throughout the publicly funded system
    • in partnerships both within the system and, more importantly, with those who choose or need to use it.
  • The system needs stronger leadership at all levels and clearer, enforceable mandates and accountabilities.
  • Māori need to be able to apply their Tiriti / Treaty rights and to have authority within the system to design and provide services that best suit their needs and allow them to embrace mātauranga Māori and fully express their cultural identity, and the system needs to support this.
  • The long talked about move to give more emphasis to preventive care and the promotion of wellness needs to become a reality. This requires the growth of more multidisciplinary services and a reduced dependence on models that drive throughput ahead of service.
  • Health services need to be planned more strategically, with more meaningful engagement with communities and better connections to other agencies with responsibilities impacting on key socioeconomic and cultural determinants of health.
  • Workforce strategies need to be strengthened to ensure the future workforce better reflects the community it serves and has the skills necessary to operate effectively under different models of care.
  • Data needs to be much more at the centre of decision making in the system, and this requires us to be much more determined about the type, standard, and relevance of the data that is collected.
  • The urgency for making improvements to outcomes for Māori, Pacific peoples, and low-income and rural households means priority needs to be given to getting more appropriate services to these communities, rather than simply making system-wide changes in the hope that the benefits trickle down.
  • The prospect of ever-increasing numbers of people with disabilities compels us to recognise that living with disability should no longer be treated as the exception. People living with disabilities have the right to expect equitable outcomes from the system, and we must ensure services strive to achieve that.

This report notes many other changes that the Panel considers need to happen.

Phase Two of the review will focus on building the details of changes to achieve the above. This will be done in conjunction with the sector and will include further consultation on specific proposals.

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