It was accompanied by a damning Deloitte review of Health New Zealand /Te Whatu Ora’s financial performance which highlighted poor financial control, complicated systems relying on manual processes, and loss of expertise and the ability to respond locally.
The new high level delivery plan from Commissioner Lester Levy signals a welcome return to greater local decision making, but there is little detail about it.
In the plan HNZ says devolved service delivery functions will be in place by June.
Mr Brown said he had directed Prof Levy to accelerate the shift to local decision-making and service delivery and set a requirement of local delivery plans to be developed by July.
"This will enable local leaders to plan effectively, be clear about their budgets, allocate resource to where it’s most needed, and deliver better outcomes for their communities."
Quite how all of this is being done is not clear, something we have become used to since the demise of the district health boards and the move to decision making behind closed doors.
There has been no suggestion the revamp, including the reinstatement of a governance board and possibly regional subcommittees, will come with provision for increased public scrutiny in real time.
Mr Brown’s enthusiasm for boosting primary care to help reduce the burden on our hospitals makes sense, but as we have said, the detail is still lacking and important questions such as pay parity for nurses in the sector have been ignored.
However, the plan mentions an increased level of capitation payments for general practices being established by mid-year, but we do not know yet whether it will involve robbing Peter to pay Paul.
Mr Brown’s most controversial announcement has been the push for elective procedures in the private sector.
The idea of having long-term contracts with private hospitals for some procedures, rather than more expensive short-term ones when the public system needs private providers to take the pressure off long waiting lists, is not a new one.
That suggests a limited understanding of the role of the public hospital system, and we wonder how he expects staffing to work since many of the clinicians have dual public and private positions.
If existing clinicians are incentivised to do more work in the lucrative private sector, that must have impact on the level of service at public hospitals, hospitals which often have to deal with private patients in an emergency.
He has asked HNZ to work with the private sector to agree on plans to "recruit, share and train staff which already bridge both the public and private hospitals".
As it stands now, taxpayers pay for the ongoing training of specialists working in both sectors as well as providing the emergency back-up for private patients. Will private hospitals want to pay for that?
Mr Brown is also keen to see emergency department wait times reduce. He says he expects HNZ to empower clinicians at local levels to "fix bottlenecks in real time".
What does that mean? Will ED doctors somehow be able to instantly produce extra staffed beds for patients to go to?
Plans for a new health infrastructure entity to manage and deliver physical and digital assets, with a long-term plan for health infrastructure is welcome.
It was encouraging to hear Mr Brown say he had asked HNZ to look at its controversial plans for removing almost half of its data and digital staff.
The new plan’s silence on public health initiatives is baffling, particularly when it says the National Public Health Service is critically important, and its work can keep people well and out of hospitals.
Mr Brown is not interested in preventative measures such as regulating the fast-food industry.
His statement he is not the health police, but the health minister is a cute soundbite but shows he has much to learn about the burgeoning long-term burden of preventable disease.
