Locality formation to become more standardised to avoid 'chaos'

“It’s been so free flowing that the sorts of organisations that are participating in locality discussions vary a lot and the kind of way they want to structure their activities varies a lot”

Te Whatu Ora is writing a “localities guidebook” to bring more consistency to this formalised layer of primary and community care gradually being ushered in by the Government’s health reforms.

Twelve localities have been established, of the 60 to 80 anticipated by mid-2024 when all parts of the country must be in a locality.

Te Whatu Ora chair Rob Campbell said after yesterday’s joint meeting with the Te Aka Whai Ora board there has been great freedom to date in the formation of localities, but that has come with a lack of understanding of the expectations of localities.

“…it’s been so free flowing that the sorts of organisations that are participating in locality discussions vary a lot and the kind of way they want to structure their activities varies a lot,” Mr Campbell said, answering New Zealand Doctor Rata Aotearoa at an online media briefing.

“We want [localities] to be free to drive what their community wants in terms of health outcomes but we do need to provide some consistency in terms of the areas they cover, who's involved and how they conduct themselves and how they report.

“Otherwise it would just be chaos.”

Mr Campbell says a great deal about locality formation has been learnt from the nine prototype localities unveiled in April. But the need now is to move to a much more organised type of locality creation.

“It’s reasonably imminent, the production of a localities guidebook which will create some better frameworks for people to use. That will precede the announcement of any new [localities].”

Asked how many iwi-Māori partnership boards have been established and their locations, Te Aka Whai Ora chair Tipa Mahuta told the briefing 11 are going through the parliamentary process.

Eighteen iwi-Māori partnership boards were listed in the Pae Ora (Healthy Futures) Bill, but their names were deleted by the committee of MPs that considered the bill. The committee’s process for establishing the boards was adopted in the Pae Ora (Healthy Futures) Act 2022. It involves the Crown establishing boards by order in council after a potential board has notified Te Aka Whai Ora, and the agency is satisfied the act’s rules have been met.

Te Aka Whai Ora chief executive Riana Manuel told the 1 July meeting of the agency there were 10 boards under way, according to the meeting’s minutes.

In her update yesterday, Ms Mahuta said most of the 11 current boards are in the North Island. She undertook to provide their actual locations later.

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Following media pressure over openness since the two new health agencies came into being on 1 July, yesterday’s joint boards’ meeting marked the first time reporters were allowed to attend either board meeting. Although it was a matter of choice by the boards, it harked back to the former DHBs’ board meetings which were, by law, open to the public and media, apart from specific sections that were conducted behind closed doors.

The open section of yesterday’s meeting was the last hour, in which members were asked to talk about the challenges they see in the health reforms, the changes they think are needed and their vision for healthcare in New Zealand.

New Te Whatu Ora board member and specialist GP Jeff Lowe, the sole GP on the board, talked of “demonstrating the art of the possible”.

“I believe we have fantastic innovation in New Zealand already and most of it happens organically. The issue is that that innovation is not always available to everybody in New Zealand. So it matters where you live and who you are as to what services are delivered.

“Our challenge is to take good innovation and move it at scale and pace and make it available to everybody in New Zealand.”

A member of Te Whatu Ora’s Planned Care Taskforce, he says there is an important opportunity in planned care and the need to “reset” the system.

The question should be asked: where are services best delivered?

“Does it need to be delivered in a hospital? If it doesn’t, we should be looking to get it out to the community where people work live and play and make it more accessible.”