Te Whatu Ora: Health experts give appraisals on 1-year anniversary

Today marks one year since the largest shake up of health care services in New Zealand.

Close to 30 entities, including 20 district health boards, were scrapped in favour of a centralised model in the form of Te Whatu Ora and Te Aka Whai Ora, the Māori Health Authority.

Here's a snapshot of what those on the coalface of these reforms have to say.

"Firstly I'd like to acknowledge and thank all the healthcare workers, both those who work for Te Whatu Ora, and the many who also work in our community, who are part of providing healthcare. It's been one of the toughest years.

"One of the most important things that will make a difference for our staff is actually having more staff. Having more workforce to address the shortages that can give us more certainty that when we book people in for care, we're confident that we'll have the staff to provide that.

"It's important that we work together with surgeons and all other medical professionals and specialties to grow that workforce together [It] will be easier for us to plan together as one national network rather than 20 local health systems.

"Having Te Aka Whai Ora (Māori Health Authority) work in partnership with Te Whatu Ora has made a big difference. Having that Māori health perspective at all levels of our decision making and consideration does make a difference in the outcomes.

"One of the important initiatives that we kicked off last month is the establishment of clinical networks. [Their role] is actually to help us tackle access to specialist care where we know we have a postcode lottery.

"We have a long way to go to address and achieve the aspirations of the reforms. But I'm really, really encouraged by the passion and the commitment of our staff and healthcare workers around the country to work towards those aspirations," she said.

"By all measures things seem to be getting worse. From patient experiences, workforce, if anything we've seen health deteriorate since the reforms started.

"Our primary problem is workforce issues. We're seeing a very stressed workforce, patients waiting longer for appointments, patients not being able to enrol in general practices, patients struggling to get the care they need in the hospital system.

"Just very recently there has been some progress with nurses (pay parity agreement) and that's a positive. But unfortunately we've seen more workforce leave than we have coming in. We've lost both doctors and nurses.

"What that means for our patients, is much longer wait times, more difficulty (getting) appointments, people leaving their problems until longer so that they've deteriorated, and people ending up in emergency departments," he said.

"One of the misconceptions about the reforms is that it's all about one big organisation. It's about one organisation having the power to deliver great local services, be that through community pharmacies, general practice or through our hospitals.

"These are small steps at the beginning, but it's the beginning of a bigger change that will have a huge benefit for people's healthcare.

"We have a voice for Māori at the heart of the health system through the Māori Health Authority and through Iwi Māori Partnership Boards. They're one year old today, and they're making great inroads into joining with existing services and helping improve them for Māori and for everyone.

"What the Māori Health Authority helps us realise is that one-size-fits-all systems have failed in healthcare, and health systems need to be much more open to the diversity of need that real people.

"We need time to scale up those those changes and it'll be several years before we get to looking back and saying yes, we're in a markedly different place from where we were," the minister said.

"It's been a challenging time coming out of Covid with a lot of waiting lists, and then we couldn't actually do our best to reduce the size of this.

"As a surgeon, and working with nurses and theatre staff, we haven't seen much of a difference yet, we hope that we will.

"It's quite frustrating to not be able to do your job. It's quite frustrating to inform the patient that his operation has been cancelled at the last minute, and send them home.

"Taranaki (the worst performing region for missing 4-month surgical targets) has a bit of a situation where it's difficult for us to recruit people, as we're not a very well known centre, it's not like Auckland, Christchurch or Dunedin.

"For example, we've been suffering from a lack of ear nose and throat (ENT) services - we have only one surgeon who's doing his best, he's a great surgeon but cannot do things by himself only," El-Haddawi said.

"The aspiration behind it, which is fairness and equity is a is a really good aspiration. No one would disagree with that and it's what our members want really committed to that. And it's the right way forward in the era of limited resources.

"We need more nurses, more beds, more techs, and all of those things. The action on those has been quite slow. It's been a year now and yes, some initiatives are starting to happen, and with the new relaxing of the immigration parameters we are seeing more nurses flow in, we are seeing a few more techs, but it's slow.

"We've got one of the best training programs in the world, which we're very proud of, and (this year) we're interviewing 30 people for 12 to 15 places. But we need to be training more. We'd like to be training 20 a year, but that needs to be funded.

"My three priorities, number one - get functional theatres going to allow surgeons to operate.

"Number two - openness and transparency about the number of operations we can offer based on the funding we have available.

"Unless you're going to put up taxes, there's a limit to what we can actually provide for the money we have, and the New Zealand public needs politicians and the Ministry of the health to be open and honest about that.

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"And number three - I'd like to see attention to clinical networks which involve engagement of a representative group of clinicians and also are members of the public from around the country about what we're actually going to be doing going forward."

"We've had all the hui, we've not had enough 'do-ey'," she said.