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Te Whatu Ora overhaul: No overall road map a year into reform

Oct 12, 2023

Briefings by a powerful committee with the health minister's ear, reveal strife and delays surrounding Te Whatu Ora reforms.

They show that almost a year into the biggest ever overhaul of the country's health system, no one had an overall road map.

"Assessment of reform progress to date has been subjective as there has not been a clear overarching system-level reform roadmap with milestones in place," a report to Health Minister Ayesha Verrall said in May.

A series of briefings and emails released under the OIA show the year-old ministerial advisory committee, or MAC, struggling with its one and only job - to keep the multiheaded hydra of reforms on track.

The "ongoing lack of clarity" it faced is mentioned six times in the briefings.

Crucially, they show that by mid-year, almost a year since Te Whatu Ora subsumed the 20 health boards, the MAC had yet to see any documents about the new shape of regional arrangements for health delivery. Iwi partnership delivery was also unclear.

The MAC was blind to how the whole health system was improving:

"The Committee has noted the delay in progressing the system performance monitoring framework, key system performance measures and reporting mechanisms," it told Verrall in May.

The internal briefings between February to August make even more obvious to the public the reform's already evident struggles.

In August, Te Whatu Ora's sister agency, the Māori Health Authority (Te Aka Whai Ora), copped a bad scorecard in five out of six categories.

The government, however, headlined this review as "reforms on track to deliver real change for Māori", and the former head of Te Whatu Ora Rob Campbell said there was "much in it that is constructive and positive".

Just this week, a coalition of health groups and academics called for Te Aka Whai Ora to be given a chance - five more years to get things right - rather than be given the axe by National and ACT.

The same argument could be made for Te Whatu Ora - that it needs loads more time.

However, it does not have it.

"The period through to 30 June, 2024 is critical to gain momentum for the reform, embed the necessary new foundations to support the new approach, and provide some indicative evidence that the new approach is delivering improved health service delivery," a MAC briefing said.

Signs had to be clear by June 2023, it said. But the papers show the reforms started to slow, and this had not changed.

Month by month

By last December, MAC was aware of many gaps - "lack of a system monitoring framework", "resourcing issues including capability and capacity" - across the three organisations it monitors: Te Whatu Ora, Te Aka Whai Ora and the Health Ministry.

By April 2023, financial "risks identified previously remain".

Worryingly for surgery wait times, a planned care "implementation plan has yet to be sighted", despite a host of changes mooted in late 2022.

MAC was still trying to determine if work was underway to "take stock of shortages in key workforces".

In the fragmented field of data and digital, leadership was lacking, it said.

By late May, Verrall had a paper ready to go to Cabinet about the reforms. The MAC told her while it covered lots of things, it also had lots of gaps:

"The paper is silent on public health in general." Planned care concerns and initiatives were not mentioned. It said little about changes required in primary and community care. It said little about how the agencies would work together. And little again about regional delivery.

The rebuild of ageing infrastructure had not come up.

"We note there is significant underspend in capital expenditure related to facilities and information technology."

At the same time, "Te Whatu Ora is working hard on achieving savings", an agenda update said.

At the reforms' one-year anniversary on 1 July, the head of Te Whatu Ora Margie Apa and Verrall gave the process a 'pass' mark.

MAC went on to warn the agencies that an overall roadmap had to be ready by August. It was not clear if this was done.

The papers hint at tensions and turf protection between the agencies and a ministry largely relegated to an unclear monitoring role.

"There are many people, and different organisations looking at the same data and information ... this creates unnecessary duplication of effort," MAC said, in deciding to call time itself on ordering any more reviews.

Plenty have already been done, into data, public health and the Health Ministry's structure, generating more work for private consultants, including EY and Sapere.

Verrall's office has been approached for comment.

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