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The interim report from the Health and Disability System Review is missing “an unequivocal expectation of equity in the health and disability system” says a Māori health expert.

The Health and Disability System Review Panel has released its interim report this week, delivering the following key messages:

  • a more collaborative and cooperative approach is needed, requiring changes in attitude and culture. These need to be led from the centre and applied consistently throughout the system.  Mandates need to be clarified and accountabilities clearly defined
  • the focus must be on the consumer, and what consumers value and need most, with more choice about how needs are met
  • if future demand is to be manageable, the emphasis must be on preventing ill health and promoting wellbeing. This means more focus on population health and much faster progress on the vision set out almost 20 years ago in the Primary Health Care Strategy
  • an effective Treaty/Tiriti based partnership must be developed with Māori to improve Māori health outcomes and to embrace a Māori world view
  • a clearer decision-making framework is required, that allows decisions to be made in a timely manner, at the appropriate level and enforced effectively
  • hospital and specialist services need to operate as a cohesive network
  • funding streams, particularly within community and primary care, need to be simplified and more emphasis put on teamwork and maintaining health and wellbeing rather than on simply treating illness
  • disability services planning needs to be more visible in the system with more flexibility in the way services are funded and delivered
  • there needs to be a long term, nationwide health and disability service plan and more effective strategic planning throughout the system
  • implementation of data standards, data stewardship, identity management and interoperability must be accelerated
  • workforce strategies need to anticipate and address projected shortages, and
  • the current distributed model for the design and delivery of capital projects is expensive and may not be sufficient to meet the scale of investment required.

The Review Panel outline how New Zealand’s health system is facing the same challenges as many other countries, including rapidly increasing demand, an ageing population, the health effects of climate change, the potential created by advances in clinical practice and digital technologies, and persistent inequities of outcomes, in particular among Māori, low income and rural communities.

The Panel is working with a Māori Expert Advisory Group to assist the review. However, Dr Rhys Jones (Ngāti Kahungunu), Senior Lecturer, Te Kupenga Hauora Māori, University of Auckland is disappointed the review did not take a more “Treaty-compliant approach”.

“What appears to be missing from the report is an unequivocal expectation of equity in the health and disability system. This is a critical omission. The report notes that normalisation and acceptance of inequalities in health for Māori are demonstrated by the health system’s failure to respond, despite overwhelming and consistent inequities in Māori health outcomes. Yet it does not articulate a clear expectation of equity in its key directions, and therefore implicitly perpetuates this normalisation and acceptance. If we are to achieve equity in health outcomes for Māori, that has to be a non-negotiable starting point across the entire system. From there, mechanisms are required to hold all health sector organisations to account for delivering equitable outcomes,” says Dr Jones.

However, the New Zealand College of General Practitioners is pleased to see that the report highlight some of the challenges they identified, including health inequity, the lack of integration and collaboration across health organisations, and the need for better quality data systems and technology to facilitate collaboration.

National’s Health spokesperson Michael Woodhouse is disappointed not to see more detail in the report about how the system can be improved.

“The report explicitly states that there’s ‘nothing surprising here’, but if none of this is new, the Government should tell us what it’s going to do to ensure New Zealand’s health system better serves New Zealanders.

“At this point, all we have is yet another review with no tangible outcomes for New Zealanders who are struggling now with increased surgery wait times and poorer performance on a range of key measures, including immunisation and cancer treatment.”

However, the Panel says the review is still “a work in progress” with recommendations not due until 30 March 2020, when the Panel’s final report will be delivered.

The Panel members are Heather Simpson (chair), Shelley Campbell, Professor Peter Crampton, Dr Lloyd McCann, Dr Margaret Southwick, Dr Winfield Bennett and Sir Brian Roche.

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