Does the 2023 change of government affect the health system?

There have been a number of significant health system changes in New Zealand Aotearoa since 2022 (e.g., the establishment of Health New Zealand | Te Whatu Ora and related agencies by the then Labour Government).

The General Election of late 2023 saw a National, ACT and New Zealand Coalition Government elected. This new government has indicated its new direction and priorities in their Coalition Agreements. You can read parts of these at the end of this article or the full Agreements here:

National/New Zealand First

National/ACT.

A general clause in the Coalition Agreements states: "The Coalition Government’s priorities for this term include rebuilding the economy, improving the quality of Government spending and regulation, lowering the cost of living, dealing to rising crime by restoring law and order and personal responsibility, enforcing consequences for criminals, ending race based policies, introducing more choice and competition into social service provision, delivering better health and education, defending freedom and democracy, providing opportunity for all in education, health, employment, and infrastructure, and improving the lives of seniors."

As changes are worked through your day-to-day health services remain the same

These changes won’t affect who your GP/doctor is or your ability to be seen by a local specialist or go to a public hospital. ACC entitlements should remain unaffected too. Private healthcare will still be available to those who choose it.

Background

Pre COVID-19 the Labour Government made it known that they were going to make major changes to the health system by setting up a more centralised new structure now known as Health New Zealand | Te Whatu Ora. What were previously 20 District Health Boards (DHBs) were replaced with four regional divisions. One of the reasons for the 2022 changes was to reduce what is known as postcode health (i.e., where the type and quality of their health services depended on where they lived) with the aim of achieving more equitable services and outcomes.

The four regional divisions (each of which works with their district offices and local communities to develop and put plans in place to improve the health and wellbeing of their communities) are:

• Northern: this includes Northland, Waitematā, Auckland and Counties Manukau regions.
• Te Manawa Taki: this includes Waikato, Lakes, Bay of Plenty, Tairāwhiti, and Taranaki regions.
• Central: this includes MidCentral, Whanganui, Capital & Coast/Hutt Valley, Hawke’s Bay, and Wairarapa regions.
• Te Waipounamu: This includes Canterbury/West Coast, Nelson Marlborough, Southern, and South Canterbury regions.

For more details about the Coalition Agreements:

The National Coalition Government and their New Zealand First partners agreed to the following:

 Seniors

• Keep the superannuation age at 65.
• Amend the Building Act and the Resource Consent system to make it easier to build granny flats or other small structures up to 60sqm requiring only an engineer's report.
• Progress the review of the Retirement Villages Act.
• Upgrade the Super Gold Card and Veterans Card to maximise its potential benefit for all Super Gold Card and Veteran Card holders.
• Investigate the funding formula for new residential care beds.
• Engage openly and constructively with the aged-care sector.
• Undertake a select committee inquiry into aged care provision to include supporting people with early onset conditions and what asset thresholds are appropriate in 2023/24.
• Explore options to build on the Local Government Rates Rebate Scheme for Super Gold Card holders.
• Work on establishing bipartisan agreement to fund both care and dementia beds that New Zealand needs now and with a focus on the long term needs by 2040.
• Liaise with retirement village owners and occupiers to seek a mutually agreed way forward to safeguard the interests of the 50,000 plus New Zealanders living in retirement villages.

Health

• Abolish the Maori Health Authority.
• Update Pharmac's decision making model to ensure it appropriately takes "patient's voice" into account and increase funding for Pharmac every year.
• Require Medsafe to approve new pharmaceuticals within 30 days of them being approved by at least two overseas regulatory agencies recognised by New Zealand.
• Better recognise people with overseas medical qualifications and experience for accreditation in New Zealand.
• Progress the adoption of digital technology in harder to staff areas and make greater use of Nurse Practitioners.
• Repeal the Therapeutic Products Act 2023.
• Fund Gumboot Friday/I Am Hope Charity to $6 million per annum.
• Renegotiate the Crown funding agreement with St John with a view to meeting a greater portion of their annualised budget.
• Ensure Plunket is funded to do their job properly.
• Ensure proper funding for birthing units and maternity care, including providing for a three day stay for new mothers.
• Repeal amendments to the Smokefree Environments and Regulated Products Act 1990 and regulations before March 2024, removing requirements for denicotisation, removing the reduction in retail outlets and the generation ban, while also amending vaping product requirements and taxing smoked products only.
• Reform the regulation of vaping, smokeless tobacco and oral nicotine products while banning disposable vaping products and increasing penalties for illegal sales to those under 18.

The National Coalition Government and their ACT partners agreed to the following:

Health

• Disestablish the Māori Health Authority. 
• Repeal the Therapeutic Products Act 2023. 
• Broaden the terms of reference of the Royal Commission into the Covid-19 response, subject to public consultation.
• Update Pharmac’s decision making model to ensure it appropriately takes patient voice into account and reform the funding model to account for positive fiscal impacts on the Crown of funding more medicines.
• Require the Ministry of Health to publish a Medicines Strategy every three years.
• Require Medsafe to approve new pharmaceuticals within 30 days of them being approved by at least two overseas regulatory agencies recognised by New Zealand.
• Better recognise people with overseas medical qualifications and experience for accreditation in New Zealand including consideration of an occupations tribunal.
• Investigate build and lease-back arrangements for new hospitals.
• Allow the sale of cold medication containing pseudoephedrine.
• Allow appropriately qualified pharmacists to directly prescribe certain treatments.
• Agree the terms of reference for the statutory requirement to review the End of Life Choice Act 2019 following consultation between the Parties, with any potential future changes to be progressed by way of a member’s bill, recognising this is a conscience issue.
• Examine the Māori and Pacific Admission Scheme (MAPAS) and Otago equivalent to determine if they are delivering desired outcomes.
• Repeal the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act 2022 to remove the requirements for denicotinisation and the reduction in retail outlets.
• Introduce serious penalties for selling vapes to under 18s, and consider requiring a liquor licence to sell vapes.