It is called the poisoned chalice for a reason.
In what should have been a triumphant month for Health Minister Andrew Little, in which the Government’s far-reaching reform of the health system is put into effect by Parliament, he has instead been confronted by the news several important hospital buildings are on the brink of falling below earthquake resistance standards.
"When [Dunedin MP] David Clark was health minister he got them to do an asset management plan so that we know what is coming down the pipeline. So we knew that there was big demand for capital spend on health and that there will be for some time, and we just have to manage that as carefully as we can," Mr Little said.
"It is about knowing what is in front of us so that we can respond accordingly."
Such potentially expensive and embarrassing surprises tend to crop up more often in health than any other portfolio, one of the reasons why politicians tend not to put their hand up to be health minister.
Mr Little assumed the portfolio in the midst of a pandemic, and with a major restructuring of the system initiated by Dr Clark to be finalised and implemented.
The legislation authorising the reforms, the Pae Ora (Healthy Futures) Bill, should be passed by Parliament this week, but that will not mean an end of the process for Mr Little.
Saying that the country’s 20 district health boards will be replaced by central organisations Health New Zealand and the Maori Health Authority is one thing, but putting into effect the regional and local structures intended to function below them will take longer.
"There has been a hell of a lot of planning and preparation put in, but for front-line health workers not a hell of a lot will change on July 1," Mr Little said.
"At the very senior level there will be some changes, but the reforms are about getting the organisational structure in place. We have a chief executive of Health NZ, we have a chief executive of the Maori Health Authority, we have boards in place, and once they take legal responsibility they will then work on their organisational structure."
Briefings had been given to most of the general health workforce, but for them it would be business as usual until told otherwise, Mr Little said.
"Over time, as clinical governance beds in and you have nationwide clinical governance teams, you will see some change in practices and processes," Mr Little said.
Those changes will involve bringing into effect one of the main aims of the reforms, to standardise access to healthcare nationwide and try to eliminate what has come to be called the "postcode lottery" for provision of services.
Hospitals will be managed within regions, with the expectation that surgical and clinical resources will be allocated on an equity-for-all basis.
"It is about streamlining administration and having one point where decisions are made but in terms of local input, we do that through the locality planning process because just being reliant on an elected DHB member has not allowed for a rich capture of local input," Mr Little said.
"Every saving we can make on administration will turn up on the front line in terms of what goes into health services."
Below the regions will be "localities", upwards of 60 areas representing a distinct community or geographic location, each of which will have a locality co-ordinator and a locality plan to inform Health New Zealand of its needs.
"Their job is to work out what we need for that locality. What are the gaps, what do we need funding for, what services do we need commissioned and how do we want that commissioned?"
"What we want that process to do is for health practitioners and health services to think about how they can best deliver their services and what support they need to do it."
As well as reforming the health sector, Mr Little is about to embark on a building spree.
Last month’s Budget confirmed more than a billion dollars worth of spending on new hospitals, and his visit to Dunedin last week was timed to coincide with the beginning of construction work on the $1.47billion new Dunedin Hospital.
Mr Little is philosophical as to whether, due to cost escalations being a fact of life at the moment, that the hospital will actually cost that by the time the second inpatient building opens in 2028.
"We expect that when Health NZ takes over that they are managing costs and while designs are being finalised they are keeping an eye on that," he said.
"Obviously, we want a proper hospital for Dunedin — it has to meet Dunedin’s requirements - but we need to keep an eye on the bottom line as well as we go through the process."
