Health and disability system found to lack leadership, is complicated and fragmented

New Zealand's health and disability system lacks leadership "at all levels", is "overly complicated and very fragmented" a report has found.

Nurse, hospital (file picture). Source:

It also found the system is designed around provider interests rather than consumers and does not serve Māori or rural communities well.

The interim report into New Zealand's health and disability system has been released today, after the Government established a review last year to improve its performance, structure, and sustainability.

Led by Heather Simpson, the former chief of staff under former Prime Minister Helen Clark, the review spoke to DHBs, stakeholder organisations, workshops and wānanga.

The review also found "many" examples where the health 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," Ms Simpson said.

The review found the current system is not "performing equally with respect to all New Zealanders".

The report said current and future challenges the health sector would face include increase in demand, the ageing population, effects of climate change and inequalities particularly among Māori, low income and rural communities.

"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."

Ms Simpson said continuing with the current model would not be sustainable.

"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," Ms Simpson said. 

Ms Simpson said overall New Zealand had a good health system, with outcomes and spending in line with OECD countries.

“The system has a dedicated staff who work hard to provide the best care for patients… But it is clear that there is room to do better.”

Ms Simpson wrote in her executive summary:

- Leadership is lacking at all levels and this partly results from a lack of clear decision making frameworks with confused accountabilities and little effective enforcement. 

- The current system is overly complicated and very fragmented.

- Concern about the inequity of outcomes is widespread.

- Māori, as Tiriti/Treaty partners, have not been well served by the system.

- Disabled people want more control over their own lives, and more flexibility and inclusion from the

- Healthcare organisations do not cooperate well, many professionals resist collaborating across disciplines.

- Time, transport, or lack of culturally appropriate services are often as, if not more, significant barriers (for consumers).

- Rural communities face particular challenges and need solutions designed specifically for them.

The report also says a long term, nationwide health and disability service plan and effective strategic planning throughout the system is needed. 

"We have seen many great examples of professionals working together to achieve real progress in some areas," Ms Simpson wrote.

"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."

"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 review panel is set to produce the final report with recommendations by March 31, 2020.