The new governance arrangements for the public health sector and the need for wider public sector reform

Abstract

Across the OECD countries the organisation of the public health service is subject to frequent scrutiny. In New Zealand there have been five major changes to the governance model for the public health service since the public finance and state sector reforms of twenty years ago. Reliance of politicians and public sector leaders on structural change may well continue. To anticipate the potential limitations and strengths of the reforms approved by the Cabinet in late 2009, this paper assesses the report of the Ministerial Review Group (MRG) and subsequent Cabinet decisions against seven themes relevant to improving the future capacity of public sector organisations. A central conclusion of the MRG’s report is the need for a new public health delivery model. To this end a key MRG recommendation is the creation of an independent National Health Board (NHB) to plan and monitor health service delivery through the District Health Boards. Consistent with this are proposals for the centralisation of some supporting functions and improved regional coordination. Cabinet has been more constrained in the changes eventually to be made. For example the NHB is an entity within the Ministry of Health. The Cabinet decisions also put in place initiatives to centralise support functions and improve regional coordination. However, little consideration is given to “consumers”, who are at times patients, and the special relationship which exists between medical professionals and patients. From this perspective, the MRG’s recommendations display strong managerial predilections. This paper concludes that to improve the new public health service delivery model, additional changes will be required. These changes are centred on: (1) improving consumer/patient and health professional/patient relationships; (2) building from this the other elements of a supporting service delivery value chain, including appropriate structures and funding mechanisms; and (3) nurturing an allied and uniting continuous improvement culture able to bring about change to the entire health system through its components within the public, private and voluntary sectors.