Ministerial Review Group Report

The following organisations have supplied us with their response/submission to the Horn report.

Association of Salaried Medical Specialists
The recycling of restructuring obstructs senior doctors and dentists who make long-term careers in the health system, generally outlasting repeated iterations of management fashions and successive governments. Read more

PHONZ
PHONZ members are generally supportive of the analysis of the issues and challenges confronting the health sector as set out in the MRG Report. Read more

The New Zealand Health IT Cluster

General Practice Nursing Alliance
The following themes all have a direct impact on the quality of care we can deliver and have our full support. Read more

IPAC
Welcomes the report of the Ministerial Review Group (MRG), as a comprehensive and pragmatic approach to achieving more efficient and effective use of public health dollars. Read more

RNZCGP
"The College is pleased to see that the report's authors understand
that increasing investment in primary care will play a large role in ensuring the
sustainability and cost-effectiveness of New Zealand's public health system." Read more

Health Care Aotearoa Response
The Ministerial Review Group (MRG) Report is silent on health inequalities. Read more

Mornington Health Centre
As a healthcare provider of the Mornington PHO I support the work that it does and believe that my ability to influence this work would be severely diminished in a larger PHO. Read more

Dr Robyn Blake, Mornington Health Centre

Christine Lyall, Mornington Health Centre

HealthLink Limited
Our response is confined to Appendix three of the report, specifically the sections relating to improving the use of information technology within the sector. Read more

NZMA
We are generally supportive of the aims of this report, and of the recommendations it makes, although in respect of many of them, our support is conditional on the detail which has yet to be determined. Read more

The following is a list of organisations that made submissions to the Horn Report

(Individual responses are not included.)

Age Concern New Zealand
Bupa Care Services
Canterbury Community Primary Health Organisation
Capex Systems Ltd
Capital & Coast DHB
Careerforce
Chiptech
Counties Manukau DHB
Crown Health Financing Agency Board
Diabetes New Zealand
District Health Boards New Zealand
Environmental Science & Research (ESR)
ERMLive
General Practitioners (Royal New Zealand College of)
Hawkes Bay DHB
healthAlliance
Health  Information Strategy Advisory Committee (HISAC)
healthLink
Health Promotion Forum of New Zealand
Help4U
Home Health Association INC (New Zealand)
Institute of Health Management (New Zealand
McKesson
Maori PHO Coalition (National)
Medical Administrators (Royal Australasian College of)
Medical Technology Association of New Zealand
Midwifery and Maternity Providers Organisation (MNPO)
National Health Committee
National Service & Technology Review Advisory Committee (NSTR)
Non Government Organisations
Nurses Organisation (New Zealand)
Orthopaedic Association (New Zealand)
Physicians (Royal Australasian College of)
Platform
Public Health Association of New Zealand (PHA)
Public Service Association (New Zealand)
Quality Improvement Committee (QIC)
Richmond New Zealand
Salaried Medical Specialists (Association of)
Sexual Health Medicine (Australasian Chapter of)
South East and City Primary Health Organisation
Standards New Zealand
Summerset Group Limited
Surgeons (Royal Australasian College of)
Talent Point
Telarc SAI Limited
Te Ora
University of Otago, Wellington, Department of Public Health
Waikato DHB
Waikato Maori Mental Health Service Trust (Hauora)
Wairarapa DHB
West Coast DHB
West Fono Health Trust

Public responses to "Meeting the Challenge" are available on the Ministerial website.

What's it all about?

Background

Health minister Tony Ryall announced the formation of the Ministerial Review Group on 28 January, with the intention of it performing its task and disbanding within six months.

In a media release announing the review Mr Ryall said the Group would be reviewing expenditure to improve spending quality and services to patients and would plan ways to give doctors and nurses more say in the health system."

Former secretary to the Treasury Murray Horn was appointed chair.

Terms of reference

Ministerial Review Group membership

Report released

Ministerial Review Group Report - Meeting the challenge and its annexes - was released on Sunday 16 August to wide ranging comment. ( DAILY NEWS: Size does matter 16 August)

Among its 170 recommendations, which will be open to submissions, were some key proposals affecting the primary care sector including:

* establishment of a new National Health Board to oversee the planning and funding of national services and to monitor DHBs
* a reduction in the management fee paid to PHOs with populations of less than 40,000 in a bid to encourage more collaboration and amalgamation.
* a three-year time limit for PHOs to prove they are sustainable
* DHBs to abolish barriers restricting the ability of GPs to leave or join a PHO.
* delegated funding by DHBs to PHOs for provision of a wider range of services and, in some cases, financial risk sharing
* scaling back the PHO Performance Programme and using savings to  accelerate the introduction of QI4GP - Quality Information for General Practice
* expanded roles for Pharmac and the National Health Committee
* a new crown entity to provide shared 'back room' services to DHBs
* replacement of the Quality Improvement Committee with an independent national quality agency.

Ministerial Review Group Report released
Media release from health minister Tony Ryall

Primary care sector response to the Horn report was, in general, positive. New Zealand Doctor reporter Lucy Ratcliffe rounded up some comment the day following the release of the report. ( DAILY NEWS: Primary care gives thumbs up to ministerial group's report - 17 August)

Report's independence challenged

Within days of its release, the report's independence was challenged by the Opposition in Parliament and in the media.

In question time on 19 August, deputy Opposition leader and former health minister Annette King asked why Mr Ryall had removed some of the more controversial recommendations from early drafts of the report. In particular, she asked about the removal of a statement that "Spending health dollars on improving life expectancy will be an investment in growth only if people work longer before they draw taxpayer-funded superannuation".

In response to further questioning from Labour health spokesperson Ruth Dyson, Mr Ryall denied he had seen a draft copy of the independent report or instructed that recommendations be changed.

However, he subsequently tabled the early versions of the report he had seen with the Office of the Clerk. Mr Ryall's office said the statement regarding superannuation was not in the drafts he saw and copies of the tabled draft reports obtained by New Zealand Doctor confirmed that assertion.

Tabled reports

* Making it work: Enhancing the Sustainability of and Patient Experience in the NZ Health and Disability System. DRAFT 28 June Read more
* Meeting the Challenge: Enhancing Sustainability and the Consumer Experience within the current legislative framework for Heath and Disability Services in New Zealand. DRAFT 20 July 2009 Read more
* Annex 6: Compreshensive list of recommendations DRAFT Read more

According to Ms Dyson one draft asked the minister whether a recommendation, concerning who would be eligible for medical procedures and where those procedures would be carried out, would involve the minister in too much controversy. That recommendation was substantially reworded in the final report, which Ms Dyson alleges to be based on the minister's response to the Ministerial Review Group.

Secret health report makes frightening recommendations
Media release from Labour health spokesperson Ruth Dyson

Deadline for submissions

Organisations and indiviudals wanting to comment on the MRG report have until 18 September to get their thoughts to the minister. (DAILY NEWS: Send ideas fast - minister - 24 August)

Wider comment on the report

The following are links to media releases from some health sector organisations and political parties commenting on the Horn Report

Govt proposal ok in principle but devil in detail
Media release from Health Cuts Hurt
"Health Cuts Hurt supports the principles behind the Government's decisions about the public health system announced today but is concerned that the devil is in the so far undelivered detail." Read more

NZMA welcomes health system changes
Media release from Dr Peter Foley, Chair NZMA
October 21 2009 - The New Zealand Medical Association (NZMA) today welcomed the announcement by the Government of substantial changes to the health system.  Read more

How will patients benefit from health restructuring?
Media release from Labour Spokesperson Ruth Dyson
It's hard to see how patients needing health treatment will see any benefits from the restructuring of health and the establishment of a new bureaucracy by the National Government of a new health body, Labour Health spokesperson Ruth Dyson says. Read more

Chuffed: Government has listened to concerns over proposed health restructuring
Media release from Association of Salaried Medical Specialists
October 21 2009 - "We are chuffed that the government has listened to advice from us and others on the health proposed by the Ministerial Review Group (Horn Report)," said Mr Ian Powell, Executive Director of the Association of Salaried Medical Specialists, today. Read more

Major push to lift public health performance
Media release from Tony Ryall Minister of Health
Health Minister Tony Ryall today announced a major drive for better value for money in health. He intends to free up resources for more and better front line services. Read more

Feedback on MRG Report now online
Media release from Minister of Health Tony Ryall
Health Minister Tony Ryall has received over a hundred  public responses to the Ministerial Review Group Report "Meeting the Challenge"  Read more

Ryall creates divisions in his own cabinet with planned restructure
Media release from Labour Health spokesperson
Minister of Health Tony Ryall's determination to bulldoze ahead with a major restructure of the health system is creating divisions with his own colleagues, Labour Health spokesperson Ruth Dyson says. Read more

Horn Report: Reducing Bureacracy - Yeah right!
Media release from ASMS
Unfulfilling an election promise
The government went into the last election with the commitment to reduce health bureaucracy, including bureaucratic wastage including in particular time spent on
unnecessary activities. Read more pdf

Horn report: Avoiding parliamentary scrutiny
Media release from Association of Salaried Medical Specialists
Previously we outlined our concerns about the proposal in the Horn Report for the creation of a new health bureaucracy, the National Health Board (NHB). Read more

GPs' college welcomes health report
Media release from the Royal New Zealand College of General Practitioners
The Royal New Zealand College of General Practitioners has welcomed the acknowledgement by the ministerial review group of the critical importance of primary care. Read more

Health cuts and more bureaucracy - broken election promises from Ryall
Media release from Labour's Health spokesperson Ruth Dyson
Health Minister Tony Ryall was today big on rhetoric but refused to give New Zealanders the assurance they want that there would be no further cuts to health services Labour's Health spokesperson Ruth Dyson says. Read more

Ministerial Review Report: What we already knew, wrestling with 80s dogma, say Greens
Media release from the Green Party Health and Wellbeing spokesperson Kevin Hague
Green Party Health and Wellbeing spokesperson Kevin Hague said that the report from the taskforce led by Murray Horn, released by the Minister of Health, Tony Ryall, today represents a mishmash of sound analysis of some of the problems besetting the health sector along with dopey restructuring proposals. Read more

PHA welcomes renewed focus on quality as a way to reduce health inequalities
Media release from the Public Health Association
The Public Health Association (PHA) is welcoming the Ministerial Review Group's recommendation that developing more integrated models of health care should help reduce inequalities between various groups. Read more

More expensive health restructuring concerns PSA
Media release from the Public Service Association
The Public Service Association remains concerned that the government is looking at yet another expensive and disruptive restructuring of the health sector. Read more

Regions to lose services and decision making abilities under proposed health restructure
Media release from Labour's Health Spokeperson Ruth Dyson
A report released by Health Minister Tony Ryall that recommends restructuring the health sector will strip regional DHBs of frontline health services and decision making ability Labour's Health spokesperson Ruth Dyson says. Read more