To say the Health and Social Sectors are undergoing a recalibration is an understatement.

Certainly, transformation is cyclical and plateau’s every 20-25 years and new first principles always need to be regenerated.  
However, there are so many moving pieces, emerging from different parts of the machinery of government, it can feel like one is tumbling through some kind of organised chaos instead.

The mental health inquiry was the first cab off the rank. Huge gaps were finally recognised and the government provided the largest investment, ever.

Yet, both the Ministry of Health and the District Health Boards around the country are in a stand-off about who is going to administer it. Meanwhile, substantial movement across the mental health sector remains in a holding pattern.  

The Bay of Plenty District Health Board designed a new homebase support services model three years ago. It did not work. The dynamics of equity were underestimated. Discussions still continue on what this might look like going forward.

Nationally, both the Ministry of Health and ACC are now looking to roll out similar funding formulas and negotiations have begun on those fronts too.

Our District Health Board are also wanting to restructure the Primary Health sector. Against the wishes of all three PHOs across the Bay, they are moving towards merging the Western Bay and Eastern Bay Primary Health Organisations.

The impact on specialist requirements of delivering health and medical care across the Eastern Bay cannot be underestimated. It seems our own regional clinical profile is instead being overridden by fiscal priorities. The long urban shadow of Tauranga is well and truly taking hold.

This uncertainty is further exacerbated as both the Chair and CEO of our DHB will be departing before the end of the year and new leadership will bring new ideas and variations.

Whānau Ora too remains in a holding pattern. The Government earlier this year provided a significant investment into this programme as well. However, since the announcement, we are told only 5% has been passed onto Commissioning Agencies and providers around the country are waiting to see how the remaining investment is to be structured.

Oranga Tamariki is perhaps the most visible and contested restructure taking place. It was an unworkable model to begin with when the previous government announced it, without any funding either.

Maanu Paul, TPOOM Trustee, attending Māori Inquiry into Oranga Tamariki in Auckland 13 July 2019

To be fair to the current government, they have now funded it. But this is just one part of the battle. Issues around engagement with Māori as well as leadership and the bureaucratic culture within the agency remain significant issues. District planning and codesigning amongst providers will be the next step.

On top of this are numerous inquiries. The Waitangi Tribunal completed Stage One of the Health Services and Outcomes Inquiry earlier this year. Stage Two will begin next month. The Tribunal has already endorsed the establishment of a new independent Māori Health Authority.

Recommendations from Stage One of WAI 2575

The Māori Affairs Select Committee are starting their Health Inquiry shortly and submissions are due by 20 September.

The Ministerial Inquiry into the Health and Disability System announced in January is still ongoing and will not finish until March next year. There have already been some hints that the number of District Health Boards might reduce and new boundaries drawn.

With local government and district health board elections in a month’s time and our national general election likely in September next year, in all probability decisions will not be finalised or implemented for some time yet.

In the meantime, we should buckle in for the ride and make sure our voices continue to be heard.

Published in the Whakatāne Beacon on 27 August 2019.

Dr Chris Tooley

Chris Tooley, Ngāti Kahungunu, CEO of Te Puna Ora o Mataatua.

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