My View: Reforms headed in the right direction

VIEW - Lloyd McCann, former member of the expert review panel for the health and disability system review

The reform announcements Minister Little and Minister Henare made last week has garnered much attention and commentary. The proposed reforms are ambitious and, in my view, the right direction of travel for our system. 

The announcements demonstrate an evolution in thinking from the Health and Disability System Review final report recommendations. Stephen McKernan and his Transition Unit team should be commended, because they have used the Review’s recommendations as a base and taken the plan to ‘the next level’. Given our experience over the last few months with Covid19 we have seen our context and environment change dramatically, so this type of approach and thinking is what is required to ensure our system can deliver for our people. 

More detail and opportunity
Based on the announcements and the material available through DPMC documentation it is clear, that there is plenty to work on in terms of detailed implementation and roll-out. There is a huge opportunity for people across the sector to contribute to this important work. We have a great opportunity to ‘step-up’ and ‘step-in’. The vision and direction of travel have been presented very well – let’s roll up our sleeves and help enable the transition.
 
Equity
The proposed Māori Health Authority (MHA) represents a potential positive disruptor for the equity agenda and for the entire system.

There is some commentary that the proposed MHA is ‘separatist’. This in my view fails to acknowledge the incontrovertible evidence that our Māori population experiences significantly poorer outcomes across the board when it comes to health. It also misses the point that, the language and the clear direction of travel signalled is partnership-based, honouring principles of Te Tiriti o Waitangi. This is a bold step, but a necessary step to break our colonial modes of thinking and service delivery. 

Digital and data
Whilst the announcements did not explicitly focus on digital and data, Minister Little’s speeches in recent weeks highlight the importance of this domain as an enabler for the system. 

The proposed structural reforms further reinforce the importance of digital and data. From both a transitionary and stead state perspective, data and digital flow will be a critical asset to aid the system building that will be required in the next few months. 

The work Shayne Hunter and his team have been doing on the National Health Information Platform is critical to enable the localities work in primary and community care. Regional and national capabilities will also rely heavily on data and digital functions to drive integration. There is now also a clear mandate to continue the work on regional collaboration and planning already set in motion through the response to Covid19.

A movement doesn’t stop
The digital health movement should not and does not need to stop to wait for the structural changes to be embedding to continue to aid the transformation of our health system.

Clearly there are challenges to be navigated given the breadth and depth of legacy applications and infrastructure supporting current service delivery. We can’t simply turn the lights off on this. We do need a two-speed approach here though where we can leverage new opportunity to drive innovation and adoption. We will also need to make more deliberate progress in the inter-operability space to support the reform, which will also assist with our legacy challenge. This work is urgent.

Additionally, our drive to empower consumers will also aid the system transformation. It is heartening to see that the reforms take consumer voice into account. We will need to continue to ensure we actively invite consumers in to be part of the transformation process. The data and digital domain gives us a tangible entry point for consumer partnership and participation.    

High stakes and high expectations 
Our future system will rely on greater access to high quality information to inform decision making across the board. All stakeholders have this expectation. 

There will never be a perfect system design. We need to accept and acknowledge this now. We have an opportunity to get in behind these reforms and to make it work. The stakes for our people are too high to not make this work. 

Lester Levy’s framing of the proposed reform and implementation is incredibly useful for us all – he has referred to the work as ‘System building’. I’m looking forward to getting my sleeves rolled up and to making a contribution. 

Lloyd McCann is a former member of the expert review panel for the health and disability system review

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