What do New Zealand's health reforms mean? Your questions answered

We’re committed to ensuring that our health system works for all New Zealanders – so we’re taking big steps to improve health outcomes, support our frontline workers, and promote equitable access to healthcare across the country and across communities.

If you’re still not quite sure what these reforms mean, you’ve come to the right place.

The reforms announced this week will bring about fundamental structural changes to the way our health system is organised and services are delivered. This might sound high-level, but these changes to the shape of the system will have real-world positive impacts for patients – in terms of the quality and accessibility of care – and for health workers’ ease of working and institutional support.

The final design of this new health system is not set in stone: the framework that we’ve devised will be fleshed out in the coming months with the help of Aotearoa’s health sector and our diverse communities. Through outreach and kōrero, we’ll be figuring out – together – how best to serve all New Zealanders, no matter who they are or where they live.

In the meantime, you can find answers to some of your immediate questions below.

If you’ve needed health services recently, you might have a few answers to this question. Most worryingly, those answers might differ depending on what neighbourhood you live in or how you identify. Māori, Pacific, rural, and disabled communities, among others, are underserved by our current system. These discrepancies in patient experience – and, consequently, in health outcomes – are a key motivating factor for this structural reform.

The changes that have been announced are a result of a three-year review of our health system. While the existing system performs well overall across several measures, it is plagued by persistent issues of inequity and inconsistency in access to and delivery of services. The system has become increasingly complex and fragmented, leading to duplication and redundancy. At the same time, demand on our health system is growing due to an ageing population and an increased burden of chronic disease.

Our review found that the current system is struggling to keep up with that demand.

Our frontline healthcare workers – nurses, doctors, and carers working tirelessly in our hospitals, GP clinics, care homes, and elsewhere – are remarkably dedicated and passionate. They work extremely hard. But the current system can weigh them down with bureaucracy, leaving less time for their primary purpose: patient care.

For these reasons, we’ve assessed that far-reaching reforms are needed to reshape our health infrastructure to support our front lines and to fairly serve all New Zealanders.

Simply put, we’re aiming to build a system that helps all New Zealanders get the care they need, no matter who they are or where they live. We’re dedicated to making delivery of health services equitable and consistent. We want to cut out redundancy and duplication between regions, allowing health workers to more easily share best-practice, coordinate across organisations, and deliver quality care.

The structural changes outlined so far are designed to build a single truly national health service. Health authorities will be both closer to communities and more nationally connected. While ensuring consistency across Aotearoa’s hospital and specialist services, this system will also be responsive to local realities: our upcoming process of consultation will allow us to tailor primary and community care to communities and to increase our capacity for patient-led care.

So far, the confirmed reforms are designed to reshape the high-level structures that are the basis of the country’s health system. Other changes focusing in detail on service delivery will come in time, but the plans already laid out will provide infrastructure capable of shepherding through those changes and supporting our front lines.

The resulting system will look substantially different from our current one. The Ministry of Health will still oversee this system, advising the Government on policy and strategy and monitoring the overall performance of the public health system. But the day-to-day running of the health service will be managed by a new organisation: Health New Zealand (Health NZ, for short). Instead of 20 DHBs, a single Health NZ will ensure simplicity, consistency, and quality of care.

Another new organisation, the Māori Health Authority, will be in charge of commissioning health services for tāngata whenua, advising the Government on policy related to hauora Māori, and monitoring how well the system is performing for this community. For the first time, Aotearoa will have health services created by Māori for Māori. This major step seeks to guard against persistent inequities: our health system has failed to perform for tāngata whenua, who suffer from more avoidable deaths and lower life expectancy.

With the Māori Health Authority – and with strengthened Māori-iwi partnership boards acting as influencing and decision-making voices for iwi and whānau in each locality – we embed the principles of te Tiriti o Waitangi into every level of our national health system. Support for Māori health and care providers will also work to expand kaupapa Māori services, increasing reach into these communities and improving health outcomes for all New Zealanders.

A new Public Health Agency within the Ministry will provide national leadership on public health policy, strategy, and intelligence, while a new national public health service within Health NZ will unify our Public Health Units, to ensure they’re quipped to respond to challenges like COVID-19. The Health Promotion Agency will be merged into Health NZ, making sure that population health – and proactive efforts to keep people well for longer – will be enshrined in the heart of our health system.

Changes to the way primary and community care are delivered, and the way hospital and specialist services are run, will give us a fine-tuned balance between national consistency and knowledge sharing, on the one hand, and locally tailored care, designed to best serve specific communities, on the other. The details of this service delivery will be worked through with communities and with the health workers serving them.

Primary and community care is the main way most New Zealanders interact with the health system. This sector includes GPs, pharmacies, aged care homes, Māori and Pacific community providers, midwives, community mental health services, physiotherapists, dentists, and so on. The people you go to when you want a check-up, or you need some everyday healthcare.

Under the new system, these healthcare providers in your area will be connected via locality networks. The same providers will be delivering health services, but the care they provide should be more seamless and accessible. These networks will mean that patient records and care pathways will follow patients as they access different services. Better use of digital technology will bring care closer to home. And better tailoring to meet community needs will ensure kaupapa Māori services are available and funding for the sector is sustainable in each locality.

Health NZ and the Māori health authority will shape these services in consultation with communities. Structural changes will mean that GPs no longer need to be funded through a primary health organisation – this will allow communities to explore more flexible options in how they coordinate and manage care.

These services deal with more serious, complex, or rare medical conditions – they include hospitals and outpatient specialist services, many of which currently find themselves under pressure.

In large part, this is because they’re not managed as a coherent network on a nationwide or regional basis. This makes it hard to ensure consistency and accessibility of care, and to manage costs. (As a result, funding can be drawn away from community and primary care.)

In the new system, specialist and hospital services will be planned at a national level and managed via regional networks. With this model, we’ll be able to provide specialist services where they’re most needed. There’ll be more consistency of care (improving, for instance, availability of quality care for rural and small urban communities) and greater certainty around access to complicated or specialist care.

The reduction in administrative work and complexity because of greater coordination and less fragmentation will mean less pressure on staff and less hassle for patients. Funding and staffing will follow need, reducing competition between districts.

The Māori Health Authority will be an independent body, with its own kaupapa, that sits within our overarching health system. It will play a similar role to Health NZ – implementing policy and commissioning services – but it will specifically aim to tackle Māori health inequities. It will also be empowered to guide the Ministry of Health on policy and assess the performance of the entire health system for tāngata whenua.

While funding allocations are still to be finalised, the Government is committed to financially equipping the Māori Health Authority to do the mahi that has been set down for it – and that is so clearly needed to ensure equitable access and quality of care for all New Zealanders.

No matter who you are, where you live, or how you identify, these reforms will have a positive impact on your healthcare and your health. In our future health system, you’ll still have a GP and a local hospital, but they’ll provide more accessible care that is better tailored to your needs and the needs of others in your community.

You’ll be able to voice an opinion, as we seek to create a system that best serves the many, diverse communities of Aotearoa. If you’re a member of a historically underserved community – Māori, Pacific, disabled, Rainbow, or rural – we’re particularly keen to reach out to ensure that these big changes are responsive to your needs.

We want everyone in New Zealand to feel seen and supported by our public health service. Talking to as many of you, from as many different backgrounds as possible, is a key step toward that goal.

Don’t worry: these changes sound huge – and they are! – but they won’t have any immediate, confusing effects on the way you access and receive healthcare (as a patient) or provide it (as a frontline worker). The reforms will be phased in over the coming three years, to ensure that no existing services – including the COVID-19 vaccination rollout – are disrupted.

Right now, we need to set about creating interim versions of the new health authorities. Health NZ and the Māori Health Authority will be established, and DHBs and the Ministry of Health will be supported to prepare for the transition to a new structure.

Consultation with various stakeholders will get underway. In the upcoming months, health authorities will be working with you – and others in your communities – on the details of how our future health system will work.

Further announcements on funding, workforce and digital health will come. In the meantime, rest assured that we’ll be communicating openly with you on progress, seeking your input, and ensuring that health services are delivered uninterrupted.