Govt amputates the country’s 20 DHBs in its health restructuring but consults the Treaty to prescribe a balm for Maori

Health, health and health were the subjects of three ministerial posts  – two of them were speeches –  on the Beehive website this morning.

They spell out the government’s plans for comprehensively overhauling the country’s health system.

They also step up the pace in the government’s perturbing programme of creating an “us” and “them” racial divide.

In his speech, Health Minister Andrew Little says he is laying out “a plan to create a truly national public health service”. National, yes, but with a separatist component.

Little described it as a system that takes health services to the people who need them, no matter who they are or where they live, and which draws on the best of what we have now, but will enable doctors, nurses and other health workers to concentrate on patients “instead of battling bureaucracy”.

Then he insisted the restructuring “will reinforce Te Tiriti principles and obligations”.

Readers who check out the three articles of the Treaty for guidance on shaping a health system will be hard pressed to find what this should entail.

Little also brought the concept of a Treaty partnership into considerations:  he said the system must work in true partnership with Māori to improve services and achieve equitable health outcomes.

He said:   

  • All people will have access to a comprehensive range of support in their local communities to help them stay well.
  • Everyone will have access to high-quality emergency or specialist care when they need it.

But if all people can be assured of being treated equitably and fairly by our health system – as this pledge implies – there should be no need for race-focused initiatives based on a dubious reading of a treaty signed in 1840.

Little proceeded (more sensibly) to insist we do not need 20 different sets of decision-makers, plans for capital investment, IT systems or work forces.

Fair enough.  But how far an effective rationalisation programme should be taken is open to question.

Little spelled out four key changes –


A “strengthened” Ministry of Health will be responsible for advising the Government and monitoring the performance of the public health system.

It will set the strategic direction and develop national policy and it will be responsible for regulation and ensuring financial stability.

The Ministry will continue to be headed by the Director General, who will remain the head of the health system.

Statutory roles such as the Director of Public Health and Director of Mental Health will remain within the Ministry.

It will monitor overall system performance, hold organisations to account for delivery, and support the Minister to intervene where necessary.

But it will no longer directly fund and commission health services.  Instead,

“ … it will be leaner, sharper, more agile and focused on its core role.”


A new Crown entity, Health New Zealand, will run our hospitals and commission primary and community health services.

It will replace the country’s 20 district health boards and become NZ’s first truly national public health service.

Little emphasised this is not about cutting services or closing hospitals; nor is it about cutting valuable front-line staff.

A single Health NZ organisation will allow for true national planning for the workforce; it will allow the government to start investing in and building the workforce needed for the future; it will monitor the performance of health services and drive improvement and innovation.

“We will be able to plan for things like IT systems that talk to each other, for capital investment, procurement and other issues that benefit the whole health service, and we will do this while retaining local knowledge and focus.”

Health NZ will have four regional divisions but also will have district offices throughout the country, “which will ensure it is truly in touch with the needs of all New Zealanders”.

Each regional division will be responsible for overseeing and managing a network of hospitals, and commissioning primary and community care services in their region.

Health NZ will take a nationwide system approach but will delegate authority, so front-line health workers and communities have a say in decisions about the health services they need.


The Treaty of Waitangi is one justification for this new agency (”the system must work in true partnership with Māori to improve services and achieve equitable health outcomes”).

Another justification is the ample statistical evidence that Māori suffer, on average, worse health than other New Zealanders.

As well as monitoring the state of Māori health and helping develop health policy, as contemplated by the Health and Disability System Review, we will have a Māori Health Authority with the power to directly commission health services for Māori and to partner with Health NZ in other aspects of the health system.


The Public Health Agency, located inside the Ministry of Health, will lead public health strategy, policy, analysis and monitoring.

It will be the authority on public health knowledge in the system.  It will monitor threats to our health and ensure we are ready to deal with them.

As well as the agency, there will be a new national public health service within Health NZ, comprising the 12 public health services across the country.

The national public health service will commission public health programmes and will provide services that protect and improve the health of the population.

An essential element of this service will be national, regional and local health promotions particularly in communities with the greatest health needs.

The Health Promotion Agency will be part of Health NZ and will work closely with the Māori Health Authority.


Little said the government has “specific obligations to Māori” (by which he means they must be given special treatment), but …

“The system must listen to the voice of Pacific people, disabled people, rainbow and diverse people, and all users of the health system, and design and deliver services that work for them.”

Will this lead to a Disabled People Health Authority, a Rainbow People Health Authority … and so on?

For now, Little is saying only that Health NZ will be required to involve users of health services in its planning, and to explain how it has done so.

A new national consumer forum will champion the voice of health-service users and pool the knowledge and expertise of existing bodies.

Improving the health of Pacific peoples will be prioritised and a new national strategy for Pacific health will be developed.,

The government will similarly ensure Health NZ has the capability to develop and deliver a national health plan for Pacific peoples.

Latest from the Beehive

21 APRIL 2021

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