Professor Des Gorman | |
I have been married to Christine for 32 years and we have three adult daughters and one granddaughter. I have dual Australian and New Zealand citizenship and am ethnically European and New Zealand Māori. My iwi (tribe) is Ngapuhi. In part because of personal experience, I am strongly committed to promoting indigenous peoples� health. |
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As for all OECD nations, significant reform in New Zealand is essential if future health services are to be sustainable, affordable and fit-for-purpose. Under the general objective �umbrella� of �best-value for funding�, and of reducing the demand for and the cost of health care, is a common perspective that a slowing is needed in the rate of having to build, equip and staff, and operate new hospitals. In turn this disinvestment will only be possible if health care that is currently hospital-based is �successfully shifted� into community settings and, wherever possible, into the home. In addition to the recognition of and urgent attention to a shortcoming in �leadership� skills and development, the following four key �enablers� are the centre of attention. The first is a shared care record. The second is a hybrid, blended and organic approach to funding health care and to rewarding providers that is sensitive to both service quality and cost. The third is a highly diversified regulated and unregulated, and informal and informal workforce that enables workers to be essentially employed �at the top end of their licence�. The fourth is a much greater engagement of health care consumers � beginning with �ownership� of health records and �advanced care plans�. New responsible and tactical central agencies were introduced in 2009 and 2010. Progress to date has met expectations and New Zealand is considered World-leading in many domains. Planning systems have been rendered transparent and contestable, and both simplified and aggregated. Models of planning now account for the inherent uncertainty of future health need and are clinician-led. Clinician engagement has been extensive and a cultural shift is occurring that encourages optimism about a �healing� of the rift between the governors and managers of the New Zealand health system and the clinician workforce. A core philosophical triad of a shift to �generalism� and to �workforce redeployabliity�, and to reform by disruptive innovation is in place. The latter is based on coalitions of willing managers and clinicians and uses a �Trojan Horse� strategy. A number of successful innovations have been proven, but subsequent uptake and implementation has been relatively disappointing � the focus in 2012 will be on targeted implementation and on building the relevant adaptive capacity of the health system. |