Te Whatu Ora / Health NZ spent many months working on the plan but it is now caught up in a financial crisis. Photo: UnSplash/ Stephen Andrews
A plan to transform healthcare nationwide through fewer specialist hospitals, more ambulances to link them and more community care is in limbo.
Te Whatu Ora / Health NZ spent many months working on the plan but it is now caught up in a financial crisis.
"Health NZ is still working through the details of how the organisation will deliver services under the recently announced reset," a spokesperson told RNZ.
"We expect to be able to provide more information on these matters in the coming months."
The National Service and Campus Plan (NSCP) was the organisation's overarching attempt to follow the lead of the likes of the UK, Denmark and Netherlands.
The aim: "transformational shifts" in how people get healthcare, in part to hold back on the demand for inpatient beds overwhelming the system.
It "is the first stage in creating a deliberate plan for the future", to align services with geographic and demographic needs, said a briefing about the NSCP to the government in April, released under the Official Information Act.
"The configuration of our health services and facilities needs to be nationally planned for all New Zealanders to have equity of access and outcomes."
This meant complex care moving to fewer specialist hospitals, and less-complex care - "walk-ins" - of higher frequency moving to "less-complex settings".
A downside was sicker people "may have to travel further", so road and air ambulances would have to be better.
The NSCP also talked up having more partnerships with private providers, and investment in "hospital in the home".
"Virtual healthcare will play [an] increasing part," said the briefing.
This depended on a big uptake of telehealth, but that has not worked out so far either. Telehealth hit a high during Covid-19, used for primary health appointments about 20 percent of the time, but fell to just 8 percent last year, other reports showed.
It also depended on much more costly digitisation within Health NZ and a new national health information platform called Hira. But that programme had $380m cut from it in Budget 2024, and was also in limbo.
The digitisation work and the NSCP were both subordinate to a 10-year investment plan being worked on now, the heart of the "reset" that has followed the board being sacked and Commissioner Lester Levy being appointed.
Lester Levy. Photo: RNZ
The NSCP emphasised "becoming one system". Levy and Health Minister Shane Reti have put new stress on a four-region focus.
However, the Health NZX spokesperson told RNZ: "As with many functions, there will be a national lens on how we plan the future system of service delivery and the models of care in our community and hospitals."
The old NSCP was meant to be delivered by the Hospital and Specialist Services Unit, but the national director of that has just been cut.
The problem facing any plan is of tsunami proportions: In all regions, the number of over 80-year-olds - who needed 10 times more hospital stays than a 45year-old - would double by 2043, the briefing noted.
And by 2043, almost 5000 new hospital beds would be needed if the model of care did not change.
"An uplift of 4900 beds is unaffordable and does not account for the model of care charges we are expecting to make."
The solution had been seen as more clusters of complex care and better networks of non-complex care, starting with Northland and Tai Rāwhiti/Hawke's Bay.
It would be cheaper and faster to expand community networks, which would "reduce transfer to general and specialist hospitals" where capacity pressure was worst, the briefing said.
The sacked board endorsed the NSCP in December. Reti asked to see it earlier in the year. How much of it remains under the reset, remained to be seen.
