A bit of history

District Health Boards (DHBs) served New Zealand well for many years, but over time the system became too complex and fragmented. Te Whatu Ora - Health New Zealand was established to run the health system across New Zealand, with functions delivered at local, regional and national levels.

An interim Health New Zealand organisation was established in September 2021 to help drive the development of the permanent entity and its role within a newly transformed system. This was transitioned to Te Whatu Ora on 1 July 2022 when the Pae Ora – Healthy Futures Act received Royal Assent.

What’s changing? / He aha ngā panonitanga?

To begin reforming the health system, the 20 DHBs were disestablished and their functions were merged into Te Whatu Ora, which now leads the day-to-day running of the system for the whole country. Te Whatu Ora also assumed the operational functions of the Ministry of Health, such as managing national contracts.

Te Whatu Ora manages all health services, including hospital and specialist services, and primary and community care. Hospital and specialist services are planned nationally and delivered more consistently across the country. Primary health, wellbeing and community-based services are planned and then purchased through four new regional divisions of Te Whatu Ora. Each region works with their local offices to develop and implement plans, based on local needs to improve the health and wellbeing of their local communities.

Te Whatu Ora is responsible for improving services and outcomes across the health system. Working in partnership with Te Aka Whai Ora - Māori Health Authority, Te Whatu Ora is developing an interim New Zealand Health Plan – a blueprint for what the health system will deliver over the next two years.

DHB and some Ministry of Health employees transitioned to Te Whatu Ora with existing terms and conditions before or on 1 July 2022.

Why? / He aha ai?

Who you are or where you live should not determine the range and quality of services you receive. The reforms will give people access to consistent quality care when they need it, to help people live longer in good health and have the best quality of life.

DHBs were set up 20 years ago to give communities a greater say in decision-making, but they have also created some barriers between areas. Over time, this has led to a focus on individual districts and not on what is best for New Zealand as a whole – creating variation and inequity between areas and populations. It has also led to complexity and duplication, with DHBs replicating functions such as procurement, IT systems and asset management that could be done more efficiently either nationally or regionally.

Our health system has become too complicated for a small nation. Decisions which impact everyone, like where we invest in new hospitals or services, are not made nationally. Too much time is spent enforcing boundaries between districts and professions, and not enough emphasis on how we can collectively work for the benefit of five million New Zealanders.

While there is excellent practice within our system, it is hard to find and spread innovation across so many organisations. Opportunities to improve are missed. Although DHBs were intended to bring care closer to communities, people still had little involvement or voice in key decisions.

What will it look like in future? / Ka pēhea ā raurangi?

Establishing Te Whatu Ora and Te Aka Whai Ora is just the start line for change. For those working in health services and for the people receiving those services, not much will change in the short term. Te Whatu Ora regional and local functions will ensure continuity of services in the health system.

It will take time, months or even years, to make the changes we need to achieve the health service envisioned by the Pae Ora (Healthy Futures) Act.

However, as Te Whatu Ora establishes its new role and functions, the way services are planned and commissioned will change. There will be a focus on consistency and quality, as well as strengthening national and regional networks.

Primary and community care will be better tailored to the needs of communities, and people will have more opportunities for their voice to be heard on services and how they’re delivered. Over time, this will lead to more innovative services which better reflect community priorities and needs, including more accessible digital and virtual care.

Hospital and specialist services will be far more consistent, with more equity of access across New Zealand. People will have access to the right care at the right time no matter of where they live. Shifting the emphasis towards primary and community care will also allow more people to be cared for close to home, and to play a greater role in their own care. Patients and employees will be able to move between areas to access care and work where needed.