Introduction to localities

The changes we're making to our health system include a new national approach to improve how healthcare is delivered in communities. 

This new approach, which we're calling localities, will focus on avoiding people getting sick and helping whānau stay well; give iwi and communities a strong voice in deciding what’s needed in their local area; and get different health and wellbeing organisations working together better to improve people’s experiences of healthcare. 

The localities approach replaces the way things were done through District Health Boards and Primary Healthcare Organisations. The people who were doing that work are still involved, but they will now work differently.

Iwi and the local community determine their own geographic area that will become the ‘locality’. Localities are small enough to still have a local feel for the people that live there. Everyone in Aotearoa will fit into a locality that reflects their community. 

It is the work that happens within the area, or locality, that will make a difference to people’s health and wellbeing: 

  • Iwi and communities will be involved in deciding on the health priorities for their community.
    For example, one locality might have a need for more diabetes support – and it will be up to local partnerships to agree on whether dedicated services are needed.
  • The care and support that is delivered will be joined up across different health and wellbeing providers.
    For example, someone’s GP, local pharmacist and in-home nurse will work better together to provide the wraparound care and support that person needs.
  • Health and wellbeing providers will be connected to other community organisations that have a role in supporting people. This will ensure that we can better support whānau needs across areas like housing, employment and finances, alongside healthcare.

 

What will change with localities

Things will be different for people once localities are up and running: 

  • They won’t have to talk to as many people to get the full range of care that they need. That’s because different health and wellbeing providers will work together behind the scenes.
  • Healthcare providers will be linked into social care agencies. So, if someone is having trouble paying rent, that will be taken into account when their health and wellbeing is being assessed.
  • People will have more opportunities to influence what healthcare services are available in their communities.

The roll-out of localities will happen over the next two years. New localities are expected to be stood up each quarter so that every area in New Zealand has its own locality by July 2024. But first, we are focusing on testing initial thinking and ironing out details around how service providers and health and wellbeing agencies work together and deliver improved health outcomes.

We will see a change in traditional provider roles and service models over time, and the commissioning and development of new roles and services to meet community need. The insights gained from the first localities will also help determine the support arrangements for provider networks.

This is a collaborative process, and we’re pleased to be launching a national platform where we can share our insights about this new way of ensuring New Zealanders can access health and wellbeing services, where and when they need it, and in the way that works best for them.

Localities explained

Localities are geographic areas that make sense to the people that live there. The exact geographic size, or population it serves, will change across the country, and will be determined through engagement with the community. The boundary lines may follow existing boundaries defined by local government or mana whenua; it will simply depend on what works best for each area.

Once the boundary is determined, people and organisations with influence over community health and wellbeing will collaborate on what outcomes they want to see for their community. This will include Iwi-Māori Partnership Boards, and ideally will include health and social care agencies and community organisations.

A three-year locality plan will be developed in collaboration with the locality partnership, IwiMāori Partnership Boards, Health New Zealand, and the Māori Health Authority. These locality plans will detail how the goals set for a locality will be achieved.

The plans will drive procurement of services by Health New Zealand and the Māori Health Authority and be the basis for monitoring progress. Communities and consumers of health services in the locality will be actively involved in identifying priorities and aspirations for services and outcomes.

Provider networks

Well resourced, coordinated and integrated networks of providers will support the delivery of locality plans.

The shape of these networks will be designed through a process led by Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Māori Health Authority, in collaboration with locality stakeholders, with a focus on integration across services so that people with more complex care needs have a better experience when accessing different parts of the health system.

Provider networks will involve individual providers working together and must include Kaupapa Māori providers and Pacific providers where available, to ensure a focus on equity. There will be different mechanisms for encouraging providers to work together – this may include data-sharing arrangements, shared financial incentives and contracts.

Provider networks will be resourced through organised provider network support services – the agencies best placed to provide the support will be enabled to do so. They will be contracted by the locality commissioning team in consultation with locality partnerships. In some cases, we may choose to provide this support function directly.

It is likely that provider networks will span across more than one locality.

Provider networks will also work to establish and support community-based providers including Māori and Pacific providers, GPs and other community care providers, to work together in comprehensive primary and community care teams – making more services available locally.

Learning from the first localities

The first nine areas to roll out the locality approach were announced in April 2022:

  • Ōtara / Papatoetoe
  • Hauraki
  • Eastern Bay of Plenty
  • Taupō / Tūrangi
  • Wairoa
  • Whanganui
  • Horowhenua
  • Porirua
  • West Coast

These first localities will be focused on helping to refine the locality approach, especially the mechanisms used to join-up care through provider networks. A national collaborative has been established so the nine areas can share insights. Te Whatu Ora and Te Aka Whai Ora will help to hone the locality model for when it is rolled out in future areas.

As the rollout progresses, the first priority will be given to areas where there are high Māori and Pacific populations and rural communities, and then to areas that have already progressed locality design. Other areas that are underway with developing the locality approach will be supported through the locality learning collaborative and teams within Te Whatu Ora and Te Aka Whai Ora.

Locality learning collaborative

The locality learning collaborative is a national learning space created to support shared learning about this new way of working across the sector.

The intention of the locality learning collaborative is to support the first localities to be successful and to refine the locality approach for future rollout. Activities will include informal and formal networking opportunities, sharing understanding and experiences of collective impact, and agile learning to amplify the benefits achieved through innovation.

Future areas that roll out the locality approach will also be able to join the collaborative.

Elevating consumer and whānau voice

The locality approach is focused on planning care and services for community health and wellbeing at a local level.

This gives consumers and whānau an opportunity to have a strong voice in the services that they think are important for their communities. This consumer voice will be channeled through existing community organisations that become part of locality partnerships, Iwi-Māori Partnership Boards and a new consumer voice framework being established, which prioritises community engagement throughout the health system.

Planning at a local level will also enable service providers to share their local insights and expertise about what can be improved or developed to improve health outcomes and the whānau experience.

Embedding a population health approach

Locality planning will be the platform for embedding a population health approach to what services are commissioned for a locality and how they are best delivered. This will be supported through shared data intelligence from multiple sources, including health care providers, to inform effective decision-making and monitoring of outcomes.

The localities approach appreciates that communities have a big influence on the lifestyle choices people make. If we can create better connections across health and social care agencies, we can better promote health and wellbeing and lift the health outcomes of entire communities. The population health approach will focus on wai ora (healthy settings, environments), mauri ora (healthy lifestyles) and whānau ora (collaborating to impact on social determinants of health).