Health and Disability reforms

The Government has announced the  final report of the Health and Disability System Review which makes many recommendations for reforming the health and disability systems, but they will need to be considered by Cabinet and there isn’t much time to do this before Parliament pauses and this year’s election campaign begins.

“The Review makes it clear we have a very good health and disability system – as has been shown by the outstanding performance of our health services in response to COVID-19,” Health Minister Dr David Clark said.

“But it also confirms that our health services and workforce are under considerable stress and our system is complex and fragmented.

The Review’s recommendations include:

  • Shifting to a greater focus on population health
  • Creating a new Crown Entity, provisionally called Health NZ, focused on operational delivery of health and disability services and financial performance
  • Reducing the number of DHBs from the current 20 down to 8-12 within five years, and moving to fully appointed Boards
  • Creating a Māori Health Authority to advise on all aspects of Māori Health policy and to monitor and report on the performance of the system with respect to Māori
  • Greater integration between primary and community care and hospital/specialist services

“Cabinet has accepted the case for reform, and the direction of travel outlined in the Review, specifically changes that will reduce fragmentation, strengthen leadership and accountability and improve equity of access and outcomes for all New Zealanders.

“The Prime Minister will lead a group of ministers that will drive the changes. The group will include the Finance Minister, Health Minister and Associate Health Minister Peeni Henare.

Interesting to see that the Prime Minister will “drive the changes”, not the Minister of health, who seemed sidelined during the Covid pandemic lockdown.

.“One immediate priority will be to lock in many of the positive changes made in recent months in response to COVID-19, such as the greater use of virtual consultations and e-prescribing and the renewed national focus on Public Health.

I have experienced virtual consultations and e-prescribing and I think these are no-brainer options along with in-person consultations when necessary or wanted.

“…reforming our health and disability system is a massive undertaking, and will not happen overnight. Meaningful change and improvement will take concerted effort over many years.

“With that in mind, I will be appointing a Ministerial Committee (under Section 11 of the Public Health and Disability Act) to provide ongoing expert advice.

“An implementation team will also be set up to lead the detailed policy and design work. It will be administered by the Department of Prime Minister and Cabinet.

It is unlikely this will be operating before the election, so will be dependant on the incoming Government probably in October.

There is quite a bit of typical Clark self praise and political palaver in his announcement. Most of that has been omitted from the above extracts. The full release:  Building a stronger health and disability system

The Health and Disability System Review is available at https://systemreview.health.govt.nz/final-report

 

Reforms and funding announced aimed at cleaning up waterways

The Government has announced $700m of funding and a range of regulations aimed at cleaning up waterways. This will particularly affect farming.


Cleaning up our rivers and lakes

Primary sector and other groups will be financially assisted with the implementation of the new clean water standards through a $700 million fund that will create jobs in riparian and wetland planting, removing sediments and other initiatives to prevent farm run off entering waterways.

  • Setting higher health standards at swimming spots
  • Requiring urban waterways to be cleaned up and new protections for urban streams
  • Putting controls on higher-risk farm practices such as winter grazing and feed lots
  • Setting stricter controls on nitrogen pollution and new bottom lines on other measures of waterway health
  • Ensuring faster council planning
  • Requiring mandatory and enforceable farm environment plans
  • These actions will be supported by $700m of funding

Environment Minister David Parker: “Our environmental reputation is the thing that underpins our biggest export earners – tourism and agriculture. It’s time for us to invest in cleaning up our water in order to protect the economic value add it brings.”

Agriculture Minister Damien O’Connor said the package will help to increase the value of our primary exports.

“Our high-value overseas consumers want greater assurances that the food and fibre they buy is produced in a sustainable way. Clean water and sustainable farming is entwined with the economic success of the sector, it isn’t one or the other,” Damien O’Connor said.

Climate Change Minister and Green Party co-leader James Shaw welcomed the reforms and said they were the strongest protections a government has ever put in place for waterways.

The measures announced today, will stop the state of our rivers, lakes and wetlands getting worse, make a significant improvement in five years and return them to health in a generation.

Farmers in New Zealand appreciate the value of high quality water and many have done a huge amount of work to improve their practices over the last 20 years or more.

The changes apply equally to rural and urban waterways, and include specific controls on covering urban streams.

The measures include:

  • Using Te Mana o te Wai as our guiding principle, which prioritises the health of the waterway, then the needs of people and then commercial needs
  • Cleaning up our rivers and lakes
  • Setting higher health standards at swimming spots
  • Requiring urban waterways to be cleaned up and new protections for urban streams
  • Putting controls on high risk farm practices such as winter grazing and feed lots
  • Setting stricter controls on nitrogen pollution and new bottom lines on other measures of waterway health
  • Ensuring faster council planning
  • Requiring mandatory and enforceable farm environment plan
  • The package contains rapid action to stop things getting worse in the short term including controls on high risk farming practices such as winter grazing and feed lots.”
  • There will be lower e.Coli levels where – and when – people swim.
  • There will be a strengthened bottom line for nitrogen toxicity, to provide better protection for 95 per cent of freshwater species, up from 80 per cent under the previous national policy statement.
  • There will also be a cap per hectare on the use of synthetic nitrogen fertiliser, excluding vegetable growers. It will be set initially at 190 kgs/hectare/year with a review by 2023. Fertiliser use increased seven fold between 1990 and 2018.
  • Dairy farmers will be required to report annually to councils the quantity of nitrogen applied per hectare as synthetic fertiliser. Fertiliser companies will have to report on sales to ensure the overall level of use is heading in the right direction.
  • The primary sector, iwi/Māori, local government and their communities will be supported in implementing the package through the investment of more than $700 million from Budget 2020 for predominately freshwater-related activity.
  • Funding will be used to support actions like installing mini wetlands, removing sediment, riparian planting, helping farmers with stock exclusion and developing farm plans, stabilising river banks and providing for fish passage.
  • Rising nitrate levels in drinking water from aquifers has been an increasing concern in recent years. A Ministry of Health-led taskforce is assessing whether New Zealand research is needed into links between nitrate levels and human health impacts and is due to report later this year.
  • Expert specialist advisory groups helped develop the proposals, and we received over 17,500 submissions on the plan we outlined in 2019 – that’s more than any other public consultation process the Ministry for the Environment has run.
  • Concerns expressed by submitters and the primary sector, as well as the impact of COVID-19, have been taken into account. Further in-depth analysis of the costs and benefits has given us a clearer picture of the overall economic effects.
  • Key changes include a longer timeline for farmers on some of the requirements and a decision not to implement a national bottom line for dissolved inorganic nitrogen (DIN) at this stage, although current levels will have to be maintained or improved. Existing permanent fences are not required to be moved via regulation.
  • The primary sector will play a critical role in New Zealand’s economic recovery from COVID-19. So the Government has reduced the cost and impact on them from the proposals put out for consultation last year, without compromising major environmental benefits.
  • New Zealand’s future wellbeing, including the wellbeing of our rural communities, depends on an economy that is both environmentally sustainable and generates high value for its people.
  • For the longer term, there will be a new National Policy Statement for Freshwater Management (NPS-FM) to achieve permanent improvements and uphold Te Mana o te Wai. A new freshwater planning process will speed up the process of getting the NPS into force around the country.
  • To complement these actions, farm plans will be rolled out over time starting with higher-risk catchments and can be made mandatory and enforceable.
  • The Government will work with the agriculture sector to ensure it gets to a space where future generations have the kind of water that they deserve, that they want, and that this country needs. Efforts to achieve high quality water will be rewarded by greater value for our produce.
  • With mātauranga Māori – or Māori principles – for water management as the guide, the Government has developed a clear, robust and enforceable set of policies that will mean all New Zealanders can enjoy and benefit from healthy rivers and clean, safe water for decades to come.

Other changes include:

  • Delaying consideration of a DIN national bottom line (maximum level) for 12 months, to allow time for a thorough review of its environmental and economic implications.
  • Where fences are required they must be a minimum of 3 metres from a waterway, but permanent fences will not need to move to comply with riparian setback requirements, although freshwater farm plans and regional rules may require more than this.
  • Developing mandatory and enforceable freshwater farm plan regimes and phasing their introduction over a longer timeframe.
  • Removal of commercial vegetable growing from the interim intensification rules

The key legislative and regulatory changes are:

  • Amendment to the Resource Management Act to deliver faster regional water plans
  • A National Environmental Standard to hold the line by controlling riskier practices
  • A National Policy Statement based on Te Mana o te Wai sets new bottomlines for swimmability and water health measures
  • Stock exclusion regulations and water take measurement
  • Mandatory and enforceable farm plans