Of warm hearts and frozen wallets

There was no collective gasp at a remarkable build, rather a reminder Te Whatu Ora will call the shots

Locality, locality, locality. It is primary care real estate, in essence, and it is fast acquiring the tropes essential to a gripping episode of build-it-andweep TV show Grand Designs.

We’ve got workforce shortages, project management problems and the ubiqutious baroque dreams on a minimalist budget all pulled together with a passion that refuses to see boundaries.

And so our reporter Alan Perrott went along to a meeting of the country’s largest locality pilot, south Auckland’s Ōtara-Papatoetoe. As we have come to expect of providers working in south Auckland, steeped in their COVID experience of making stuff happen, there was plenty of passion. With a multitude of agencies keenly involved in this locality, good project management is a must.

But before I come to the great reveal, let me take you back to March 2022. It was 12 months after former health minister Andrew Little had presented the Cabinet with his White Paper recommendations for radical reform of the health system. It was the time of the Transition Unit, three months short of the passing of the Pae Ora (Healthy Futures) Bill and the creation of Te Whatu Ora.

Our cover story in March 2022, “Hands up if you can explain localities”, was born out of our own frustration at not having a clear idea of what a locality, first mentioned in Mr Little’s Cabinet paper and cemented in the reform legislations, might look like. By and large, primary care sector representatives felt the same.

The Transition Unit shone some light, clarifying that localities and locality networks, words that tended to merge in discussion, were different in practice. A locality, as the proposed legislation stated clearly, would solely be a geographical area, not a community of shared interest as some had previously speculated.

Locality networks would be groupings of primary and community healthcare providers and social service organisations.

A month later, Mr Little announced the first nine locality pilots. The previous year’s Budget had set aside $45.98 million over four years to develop these pilots and test the locality approach.

Mr Little, in his speech, described a locality as a “set of relationships between government health agencies, providers, the community, iwi and the iwi Māori partnership board”.

Not quite so clear then?

Still, it was stated, Te Whatu Ora’s locality coordinator would pull the threads together to make a locality plan, to be agreed to by the local iwi Māori partnership board and Te Aka Whai Ora, as the basis for commissioning services.

The locality pilots took their respective batons and ran with them.

In the 12 or so months since the first nine locality pilots were named, another two have joined the list, and another 22 are expected before the end of the year.

As recently as early last month, Te Whatu Ora national director, commissioning Abbe Anderson seemed relatively relaxed about deadlines for “draft plans”, happy instead with presentations showing the direction of travel for the localities which she could okay as she visited.

The only concrete deadlines Dr Anderson noted are contained in the legislation – all locality boundaries to be identified by July 2024 and locality plans by July 2025.

Which brings us to the great reveal when the Ōtara-Papatoetoe locality met with Dr Anderson.

Right from the start, the Ōtara-Papatoetoe pilot locality led by South Seas Healthcare’s Silao Vaisola-Sefo has taken Te Whatu Ora at its words – network, collaborate, community, integrate, aspire.

With up to a dozen full partners and another 50 or so in its network, this locality network ranges from legacy agents like PHOs ProCare and the National Hauora Coalition, to community groups such as The Asian Network.