I was searching for some information relating to the current health reforms underway in New Zealand and ended up on the Te Whatu Ora Health New Zealand Waitaha Canterbury (formally the Canterbury District Health Board).
What came up on this website was the following dated 19/09/2022 was the Kings Fund Report “The Quest for Integrated Health and Social Care – a case study in Canterbury, New Zealand. As well as a further Kings Fund report in August 2017 – Developing accountable care systems: lessons from Canterbury NZ
What is it about this country that we seem incapable of learning the lessons that are right in front of our noses.
As the New Zealand Health reforms dismantle the very things that were working and are being picked up and copied in other countries, it does beg the question as to what it is we are trying to achieve. Too much of what is happening in the country seems to be being based on a “false rhetoric” that changing structures and demonizing what was previously in place will somehow create a different set of outcomes – some examples look no further than Polytechs, housing intensification, the RMA, Three Waters, etc.
After much fanfare and promising a better future Te Whatu Ora Health New Zealand was created to make the health system better. After going live on 1 July 2022 and after millions being spent on consultants it is interesting to reflect on what has been delivered?
- The creation of an interim health plan for the next two years – one would have thought that would have been clear before making such a major structural change
- A planned care review with 101 recommendations out of the 1990’s that didn’t work then
- A workforce crisis – yes, a crisis
- Failures of care dominating the media
What is most concerning is that it is hard to see how this is going to be better – that is normally the reason for change. I have received calls from around NZ from those working in the health systems deeply concerned about the direction of travel and the heavy amount of PR spin coming from Wellington. No longer are health professionals able to speak out and no one seems to know who is accountable. It appears that clinical staff are increasingly feeling that they are not being heard. But what is even worse is that they no longer feel that their backs are covered by those in Wellington.
From the Te Whatu Ora website
“Changing the System – Were building a simpler and more coordinated health system that will support all New Zealanders to live better and longer”.
I thought that was what we had already been doing here in Canterbury.
Progress is a funny thing. For all those board members who participated in forcing out the old CDHB management team hang your heads in shame. You were the ones who were supporting the problem. Not the executive.
Developing accountable care systems
Here is the report from the UK: https://www.kingsfund.org.uk/publications/developing-accountable-care-systems.
“The King’s Fund, an acclaimed British health authority, has published a report on the Canterbury health system – Developing accountable care systems: Lessons from Canterbury.
The report provides an account of the transformation of the Canterbury health system, and draws out key lessons for the UK’s National Health Service (NHS). The Canterbury Health System model of integrated services and collaboration is being used extensively overseas (particularly in NHS England, Scotland, Wales and in Ireland, as well as a number of states in Australia).
I hope you find the report interesting – it is an important read.” Introduction from David Meates, former Chief Executive, Canterbury DHB
The Canterbury Health System has been internationally recognised for its collaboration and integration
The 62-page report, The quest for integrated health and social care: A case study in Canterbury, New Zealand by Nicholas Timmins and Chris Ham from The King’s Fund, highlights some of the key achievements and struggles of the Canterbury Health System since it set upon a more integrated pathway in 2007.
The report tells the story of the journey towards Canterbury’s goal of providing integrated care for all. The King’s Fund report confirms that Canterbury has been doing the right things and in fact rated us higher than we might have expected, comparing us very highly on the international stage.
The report provides in-depth analysis and quotes the key people involved in our journey of transformation. We invited the Kings Fund to put our system under the microscope and asked for a ‘warts and all’ assessment of how we are doing.
Key findings from the report
- The stimulus for change in Canterbury was a health system that was under pressure and beginning to look unsustainable.
- Canterbury adds to the small stock of examples of organisations and systems that have made the transition from fragmented care towards integrated care with a degree of measurable success.
- Creating a new system takes time – Canterbury has been working to create ‘one system, one budget’ for at least six years and the journey is far from complete.
- It takes many people to transform a system. A small number of leaders were at the heart of Canterbury’s transformation, but this leadership rapidly became collective, shared and distributed.