A major review into New Zealand's health and disability system recommends scrapping district health board elections in favour of an all-appointed board, as well as slashing the number of boards around the country.
The Health and Disability System Review , run by Heather Simpson, who was former Prime Minister Helen Clark's chief of staff, found the system is under "serious stress" and it has not served people with disabilities well.
The report found the health outcomes for people with disabilities were "worse and the way the disability support system operates is complex and confusing".
The review called for a Māori health authority to be created as an independent departmental agency to advise on Māori health policy and a new crown entity called Health NZ to lead health and disability services.
"The fact that Māori health outcomes are significantly worse than those for other New Zealanders represents a failure of the health and disability system and does not reflect te Tiriti commitments," it states.
It also recommended an overhaul of DHBs
It found the health a disability sector is complex and fragmented, and suggested slashing the number of DHBs.
Instead of mainly being voted on by the public, the review recommended all board members be appointed by the Minister of Health "against a transparent set of competencies ranging from financial and governance experience through to tikanga Māori and specific health and disability sector knowledge".
It also wanted the number of DHBs, currently at 20, to be reduced to 8 to 12.
The report said New Zealand's health and disability system was under "serious stress".
"Financially, it has had difficulty managing within the resources provided to it for some years," it says.
"From a workforce point of view staff are feeling more and more stressed, facing increasing demands and significant shortages in supply, and the public hear more about deficits than they do good news stories."
The interim report released last September, found New Zealand's health and disability system lacked leadership "at all levels" and was "overly complicated and very fragmented".
It also found the system is designed around provider interests rather than consumers and did not serve Māori or rural communities well.
"Designing a health and disability system that will produce better results in the future requires a recognition that change has to happen right across the system."
Recommendations include:
- A Māori health authority is established as an independent departmental agency to advise on Māori health policy.
- A new crown entity (provisionally called Health NZ) to lead the delivery of health and disability services.
- DHBs, reduced to 8-12 within five years and the provision to elect members should be repealed.
- Regional entities should be managed directly by Health NZ.
- There should be a strong focus on improving equity and health outcomes for disabled people.
- Hospitals and specialist services operate within a national plan, and have clear regional and local plans.
Health Minister David Clark said the review set out a path "towards a better, more sustainable health system with clear lines of accountability".
"This is particularly important when it comes to improving health outcomes for those most in need including Māori, Pacific people, the disabled and rural communities."
He said the decisions on taking up or rejecting recommendations would be made by Cabinet over the coming months, but any change would not make it into Parliament until after the election.
"Meaningful change and improvement will take concerted effort over many years," Mr Clark said.
Green Party health spokesperson Julie Anne Genter was critical of the possible changes to DHB systems.
"The proposed replacement of DHB elections with appointed boards must ensure communities can still have a say in health decisions that affect them, if it goes ahead," Ms Genter said.
"Voter turnout for DHB elections is notoriously low, so we agree that the current system could be improved. It is vital that local voices are heard and that health services match the different needs of different communities."
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