Health Minister Andrew Little has fired up at a request to commit to one health outcome that will improve within the first year of the Government's half-a-billion-dollar health system shake-up.
The Government announced plans in April to create a new organisation, Health NZ, to replace the 20 District Health Boards (DHBs). It will work in partnership with a new Māori Health Authority. Budget 2021 allocated $486 million to the restructure.
National opposes it, particularly the Māori Health Authority, which leader Judith Collins has described as "separatist". At a parliamentary select committee on Wednesday, health spokesperson Dr Shane Reti asked Little how the restructure will actually improve health outcomes.
"So, $486 million - can you commit to one health outcome that will be better in the first year of establishment? Anything you like, that in a year's time in July 2022, we can look back and say that with $486 million, this is better."
Little cut Dr Reti off before he could finish.
"Dr Reti, let's not get cute about it," he said. "This is a massive system transformation. The whole system will be better."
Dr Reti interjected and again asked Little to point to a specific health outcome that will improve as a result of the health system restructure.
"No, no, no, Dr Reti you're being... no, for a researcher from Boston, actually, that's a pretty dumb statement to make. You know that massive transformation does not happen in a year," Little said.
"When you get to conclusions about how bad the system is, and you agree on system transformation, and you start the work to put it together...
"Dr Reti, you of all people know that when you are changing a health system, the measurable improvements don't happen in a short space of time."
Dr Reti asked Little why there was no business case for such a significant investment from the public purse, particularly in the middle of a pandemic.
"I can't think of any major capital intensive development in health that wouldn't have a business case. Why is there no business case? I'm still sort of none the wiser as to why, before the announcement came out, there was no business case."
Little said the recommendations of the Health and Disability System Review, which influenced the restructure, was the business case.
"When you're doing a business case for capital expenditure, sinking a huge sum of money into a facility that is there to provide services over a 40-50 year period or longer, that is a different proposition to an analysis that says the health system as it is at the moment is not delivering the standard of healthcare that a country like New Zealand should expect in the 21st Century."
Little argued the restructure is necessary.
"The system configured as it is at the moment simply is not delivering," he said.
"At the top level, the Government of the day and the Minister of Health of the day can make some decisions about expectations they want DHBs to deliver on. There's then around effectively 20 negotiations to deliver that and you get varied delivery as a consequence.
"When it's for things like screening programmes as we've seen, even to some extent the COVID-19 roll-out where there has been different delivery levels achieved depending on which DHB it is. In this day and age, that's just not acceptable for a country like ours.
"People should know that when they're engaging with the public health system, they can more or less expect the same kind of standard of care regardless of which front door they go in - if it's not at the premises they're at, they know they can get a comparable level of care if they're required to go somewhere else.
"That's not the system we've got at the moment. It creates inefficiencies and poorer health outcomes for a growing number of the New Zealand population and that's what we have to change."
