Simpson Review’s proposal to restructure the healthcare system should be
aligned with other reforms to enable a coordinated approach to public service
governance, planning, funding and delivery,” says Infrastructure New Zealand
CEO Paul Blair.
Health and Disability System Review chaired by Heather Simpson found that while
New Zealand continues to have a good public health system internationally, it
was now under serious stress.
finding is supported by analysis released last week that found an average of
$1.4 billion per annum of capital investment in healthcare would be required
over the next decade. This is around three times what DHBs spent in the past
decade and illustrates just how large the backlog is in one aspect of health
is not clear from this report how additional health operating and capital
expenditure needs will be met. True innovation in service delivery will be
required to bring in partners, adopt tele-health, and leverage iwi and third
Simpson Review comes at the same time as the Government is reviewing water
services and the planning system, as well as investigating electricity prices,
port infrastructure and is considering support to local government through the
in known and severe issues in transport and housing, plus $136 billion worth of
demand for ‘shovel-ready’ projects, and it is very clear that the public purse
is highly stretched and a major rethink of domestic public service provision is
should deliver public services, who should fund them and how do we get the
range of public service providers working together collaboratively and
“Demand for health services often sits at the end of a very long chain of
public policy decisions in transport, water, housing, education, welfare,
justice and other sectors.
need alignment in the way decisions across these sectors are made, certainty of
investment and the ability for both national and local priorities to be
“There is no such
alignment currently and it is undermining our ability to plan spatially, invest
to meet growth and recognise when things are going wrong.
are over twelve different interpretations of what constitutes a region in
New Zealand for the purposes of administering public services, in addition to
the existing 20 DHB areas. (Click here to see a
map from the McGuinness Institute). Each has its own boundaries, decision
making processes and funding streams.
important than a reduction in the number of DHB areas, as per the Simpson
report, is regions with agreed governance, investment, funding, partnership and
planning arrangements across transport, health, education and other public
would enable delivery of regional spatial plans. We could then align health
investments with those in transport and other sectors based around improving
public outcomes, rather than minimising the fiscal cost of each service within
is what we need to get on top of simultaneous crises across almost all of our
key public services.
it can’t happen if the Simpson report’s findings are progressed independent of
wider reform initiatives underway.
“New Zealand needs a much more fundamental discussion around who
makes decisions for public services, where the money comes from and who is held
to account if things go wrong,” Blair says.
A copy of Infrastructure New Zealand’s Building Regions Report can be found here.
For further information and
comment contact Paul Blair on 021 902 436