The Government's plan to shake up the New Zealand health system has been met with shock, concern and scepticism from some.
The major restructure will see the 20 district health boards replaced by one new body, Health New Zealand, which will plan services for the whole population.
The also includes a Māori Health Authority and a new agency with responsibility for public health.
Canterbury DHB Board Member Aaron Keown said it was alarming that there were no numbers attached this early on to the reform.
"The size of it is a little concerning and quite a surprise. There are two numbers that should be here. The financial cost - because essentially we will be borrowing money to deliver anything - and there's also the human cost.
"Show me the definite health outcomes that are going to make New Zealanders better off healthwise by centralising the system. If they are there I am 100 percent supportive."
National described the move as "reckless" and said that replacing all DHBs across the country would see regions and smaller communities lose their voice and autonomy.
The rural sector, particularly in the South Island, had a lot of questions.
Rural General Practice Network chief executive Grant Davidson agreed with the national approach but said a rural plan needed to be a priorty to serve an already-stressed workforce at risk of leaving.
He was concerned the country's rural population of 700,000 people could get missed out again.
"Biggest disappointment was the minister went through a list of priority populations and despite the Simpson report indicating that rural were completely disadvantage in the system, rural wasn't mentioned at all in his speech. The devil is going to be in the implementation details."
Health NZ will have four regional divisions but also district offices.
Pasifika GP Network chair Dr Api Talemaitoga works as a GP at clinics in Christchurch and South Auckland and said regional and primary healthcare providers would need a voice.
"I don't want us to lose the innovation and community voice that I think we should listen to and that is why I like the four regional entities."
Wayne Brown has chaired the Northland, Auckland and Tairāwhiti DHBs, and is also mayor of the Far North and said there was an "army of administrators" needing to go and said it was a "good idea" so long as it reduced bureaucracy rather than "shift it to Wellington, which has got ability to grow a cancer in bureaucracy down there."
Brown hoped a national body would allow specialists in main city hospitals to share their expertise with the regions remotely.
But the reform had been broadly welcomed by the Disability Rights Commissioner, Paula Tesoriero, who was pleased to hear recognition that the existing system has not served disabled people well.
"Last year around one in five (21.5 percent) disabled adults reported not visiting a GP due to cost, compared to 12.7 percent of non-disabled adults according to the New Zealand Health Survey," she said.
But, despite this shiny announcement there was still plenty of unanswered questions surrounding the reform and the devil will be in the detail.
The reform will be phased in over three years.
Better access needed to health system - Little
Health Minister Andrew Little told Checkpoint the government's plan is not about saving money - it's about a structure that enables better decisions and a better flow of patients through the health system.
"It's improving the service and the accessibility of the service."
The reforms are essential in part because patients could not access services within another district health board, he said.
"We have a structure at present that makes it darned hard for a clinician or a senior hospital administrator to say 'look, this patient would be better served getting their treatment in a different hospital'.
"We break all that down and we can provide more timely treatment in healthcare and in some cases more sophisticated treatment if we break down all those barriers and give patients the opportunity to get the best healthcare available and where capacity is available."
He was determined that some secondary services would be pushed out into the community, which was happening overseas and needed to happen in this country.
No frontline workers or support workers would lose their jobs, he said, but there may be some questions over middle and senior managers.
There would be no need, for example, to have 20 IT or payroll senior managers, "but in terms of healthcare and healthcare provision nothing needs to change".
He was not concerned that people would lose their chance to have a voice via the election of a DHB every three years.
Most people did not know who their DHB members were, nor did they attend meetings except perhaps around the time of the local body election, he said.
"I'm confident that we'll have a much richer community input into health decisions than we do at the moment."
RNZ
