Health Minister Andrew Little says there will definitely be job losses as a result of the health sector shake-up, but they won't be on the frontline where there's already a shortage.
On Wednesday he announced the 20 district health boards (DHBs) that currently run the bulk of the health system would be scrapped, replaced by a single decision-making entity Health NZ.
"In the few months that I've been Health Minister as I get around and talk to health professionals... everybody is saying we've got to make change," he told The AM Show on Thursday.
"People are ready for it. People know the current system isn't working well, particularly for patients, so I think there's a real readiness to want to make the change."
Even if some will lose their jobs, Little said part of the change will involve bringing in new leadership and getting rid of back office roles.
"When you're chunking down 20 DHBs into one single national organisation, you don't need 20 chief IT managers, you don't need 20 chief HR managers. So there will be some roles and positions that will go - the frontline health workers, they will stay. We're actually short of those at the moment."
DHBs were a Labour invention, brought in at the start of 2001. National opposed them at the time, claiming they would "increase bureaucracy and costs" and "duplication and fragmentation of services" - Little admitting those fears have come to pass.
"The DHBs did a good job largely for about the first 10 years of their existence. More recently they have failed to coordinate with each other, ensuring patients who can't get treatment in one hospital can easily and readily get to another hospital.
"I take the view that for a country of 5 million people, we don't need 20 different sets of decision-makers making decisions in the health system for that number of people."
National now opposes scrapping the DHBs, leader Judith Collins saying a "Wellington bureaucracy will not work". Health spokesperson Shane Reti instead suggested more modest reforms, such as "exploring the consolidation of some functions across DHBs, like asset management, not getting rid of them entirely".
Little said on the ground, health professionals tell him they "carry on doing what we're doing".
At present, when patients have to access services across DHBs - to access specialist care, for example - it can turn into "a big bureaucratic mess", he added.
"Not every hospital can treat every patient for every condition they've got - they know they have to send some patients to a different hospital, but there's this big palaver that goes with that. They call them 'inter-district flows'. They have to negotiate the costs the hospital sending the patient pays to the hospital receiving the patient."
Rather than a 'postcode lottery', Little says under the new system patients will be treated the same no matter where they live.
"In Invercargill if somebody turns up there for their diagnosis or treatment, it'll be the same protocol that applies in Auckland, Wellington, wherever. We can start working on getting standardised treatments for common conditions - cancer's a classic among them."
AM Show host Duncan Garner pointed out Labour promised to set up a standardised nationwide health service like this in 1972.
"Sometimes good things take a little longer, as the Mainland cheese ad said," said Little.
