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Health and Disability System Review – Final Report – Pūrongo Whakamutunga

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Health and Disability System Review – Final Report – Pūrongo Whakamutunga HEALTH AND DISABILITY SYSTEM REVIEW | AROTAKE PŪNAHA HAUORA, WHAIKAHA HOKI Published March 2020 by the Health and Disability System Review. This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to copy, distribute and adapt the work, as long as you attribute the work to the Crown (Health and Disability Sector Review, New Zealand) and abide by the other licence terms. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/. Attribution should be in written form and not by reproduction of any such emblem, logo, or Coat of Arms. Liability While all care and diligence has been used in processing, analysing, and extracting data and information in this publication, the Health and Disability System Review gives no warranty it is error free and will not be liable for any loss or damage suffered by the use directly, or indirectly, of the information in this publication. ISBN print: 978-0-473-52333-6 ISBN online: 978-0-473-51856-1 Citation: Health and Disability System Review. 2020. Health and Disability System Review – Final Report – Pūrongo Whakamutunga. Wellington: HDSR. This report is available from www.systemreview.health.govt.nz/final-report PAGE | ii FINAL REPORT | PŪRONGO WHAKAMUTUNGA Whakataukī E kore e taea te whenu kotahi ki te raranga i te whāriki kia mōhio tātou ki ā tātou. Mā te mahi tahi ō ngā whenu, mā te mahi tahi ō ngā kairaranga, ka oti tenei whāriki. I te otinga me titiro tātou ki ngā mea pai ka puta mai. Ā tana wā, me titiro hoki ki ngā raranga i makere nā te mea, he kōrero anō kei reira. The tapestry of understanding cannot be woven by one strand alone. Only by the working together of strands and the working together of weavers will such a tapestry be completed. With its completion let us look at the good that comes from it and, in time we should also look at those stitches which have been dropped, because they also have a message. Nā Kūkupa Tirikatene (1934–2018) PAGE | iii HEALTH AND DISABILITY SYSTEM REVIEW | AROTAKE PŪNAHA HAUORA, WHAIKAHA HOKI Table of contents Message from the Chair / He mihi nā te Heamana...................................................... 1 Executive summary / He whakarāpopoto ................................................................... 3 Introduction .................................................................................................................................... 3 Section A: Overview and context / Tirohanga whānui me te horopaki ....................... 9 1 Background / He whakamārama..................................................................... 10 Terms of reference ........................................................................................................................ 10 Expert review panel and advisory group ....................................................................................... 11 Developing our final recommendations: Phase Two and the Final Report .................................... 12 2 People and communities / Ngā tāngata me ngā hapori .................................... 13 The people of Aotearoa New Zealand ........................................................................................... 14 Addressing the equity challenge ................................................................................................... 22 3 Hauora Māori / Māori Health ......................................................................... 23 Te Hauora Māori ki Tua / Future of hauora Māori ......................................................................... 24 Te Tiriti o Waitangi / Treaty of Waitangi ....................................................................................... 25 Mātauranga Māori / Māori knowledge systems ............................................................................ 29 Te whiwhinga ōrite mō ngāi Māori / Health equity for Māori ....................................................... 33 Te waihanga i te āpōpō / Building the future ................................................................................ 37 Section B: Settings / Ngā whakaritenga o te pūnaha ................................................ 39 4 Governance and funding / Te mana tautiaki me te whāngai pūtea ................... 40 Findings from the Interim Report .................................................................................................. 40 A cohesive system ......................................................................................................................... 42 System leaders are empowered to be effective ............................................................................ 48 Communities and their needs drive the system ............................................................................ 50 System informed by evidence and research .................................................................................. 52 Collaborative planning .................................................................................................................. 53 Funding arrangements for an efficient and effective system ......................................................... 57 Building the future ........................................................................................................................ 63 PAGE | iv FINAL REPORT | PŪRONGO WHAKAMUTUNGA Section C: Services / Ngā Ratonga ........................................................................... 65 5 Services introduction / Ngā ratonga tīmatanga ............................................... 66 Introduction .................................................................................................................................. 66 Connected and whānau-centred services ...................................................................................... 69 More services planned locally ....................................................................................................... 71 The system recognises different populations and needs ............................................................... 72 Transparent and evidence-based planning .................................................................................... 77 6 Population health / Te hauora taupori ............................................................ 79 A population health approach drives all parts of the system ......................................................... 79 Embedding the change .................................................................................................................. 82 Protecting the population ............................................................................................................. 90 Strengthening the system ............................................................................................................. 92 Building the future ........................................................................................................................ 96 7 Tier 1 / Taumata 1 ........................................................................................... 97 Introduction .................................................................................................................................. 97 Refocusing the system on people .................................................................................................. 99 A local network of services to keep people well .......................................................................... 103 Addressing access ....................................................................................................................... 107 Investing in services that promote health and address inequity ................................................. 110 Funding consumer and whānau-centred Tier 1 services .............................................................. 119 Building the future ...................................................................................................................... 123 8 Disability / Te Huātanga ................................................................................ 125 Disability in New Zealand ............................................................................................................ 125 More visibility and integration of disability in planning ............................................................... 128 Improving equity and health outcomes for disabled people ....................................................... 130 Delivering services that address inequity and better meet people’s needs ................................. 132 Funding and contracting to provide services ............................................................................... 139 Leading by example in employment ............................................................................................ 141 Building the future ...................................................................................................................... 145 9 Tier 2 / Taumata 2 ......................................................................................... 147 Delivering Tier 2 services ............................................................................................................. 147 Demand for Tier 2 services .......................................................................................................... 151 Planning and designing a cohesive system .................................................................................
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