Comment: I recently sat down with clinicians, health leaders and policymakers for a frank conversation about what is and is not working in New Zealand’s health system.
What struck me was not the disagreement, it was how much we all agreed on.
Clinicians spend too much time chasing information. Patients repeat their history as they move between services. Digital tools that should ease the workload often add to it. All of this means decisions are frequently made without a complete view of the patient or the pressure building elsewhere in the system.
None of this is new. That is the problem.
For years, the health debate has followed the same script. Demand rises, waiting lists grow, staff come under more pressure, and then we ask how much more money the system needs.
Of course funding matters, but money alone will not fix a system that does not work as one. The deeper problem is its design.
New Zealand does not have a single health system in any practical sense. We have services, organisations, databases, applications and funding arrangements that have grown up separately.
We have built the parts, but we have never properly connected them.
Health information is now spread across more than 6000 applications that do not work well together. That fragmentation follows patients into consulting rooms, emergency departments and their own homes.
A clinician treats someone without immediate access to information held elsewhere. A patient explains their medical history again because their record did not follow them. Staff hunt for information, check it and enter it into another system.
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Each failure may look small, but across roughly 20 million GP appointments, 1.8 million urgent-care visits and 1.4 million emergency-department presentations a year, it becomes a national problem.
Clinicians spend too much time chasing information. Patients repeat their history as they move between services. Photo: Getty Images
Today’s pressure is only the beginning
The system would need to change even if demand stood still, but we all know that’s not the case.
Around 17 percent of New Zealanders are 65 or older. Over the coming decades, that will rise to between a quarter and a third of the population.
That means more people living with long-term and complex health needs, and proportionately fewer people available to fund and provide their care.
No plausible funding increase removes the need to use our people, infrastructure and information better.
Yet health policy remains trapped in the immediate crisis. This year’s budget. The latest waiting-time target. The service under the most visible strain.
Each demands attention. But fixing problems one at a time will not produce a system capable of carrying the weight coming towards it.
It is the equivalent of repeatedly repairing rooms in a house without asking whether the foundations can carry another storey.
Transformation does not mean starting again
People have good reason to be wary of health reform. The sector has endured repeated restructures, shifting accountabilities and digital projects that promised more than they delivered.
The answer is not another reorganisation, nor is it one enormous system intended to replace everything already in use.
Real transformation means making the services and investments we already have work together.
We know connection can work at national scale. The National ePrescription Service processes about 12.5 million electronic prescriptions a year, roughly 93 percent of all prescriptions in New Zealand. It connects prescribers and pharmacies and shows whether medicines have been dispensed, substituted or collected.
This is a useful foundation. But it remains a pocket of connection within a much larger fragmented environment.
The next step is not to invent another pilot. It is to connect and scale what works.
That starts with a trusted shared-care record containing the information clinicians need most often, available within the systems they already use.
It means a simple national entry point that helps people see their results, appointments, medicines, referrals and care plans, without removing phone or in-person choices. And it means giving health leaders a more timely view of demand, capacity and patient flow, so the system can anticipate pressure rather than continually react to it.
None of those ideas is radical. What has been missing is the commitment to deliver them as parts of one national plan.
This is not a shopping list for technology
I lead a health technology company, so it is reasonable for readers to question my interest in this debate.
But this is not an argument that technology, or any one company, can fix healthcare. The hardest questions are not about software. They concern leadership, standards, governance, trust and whether successive governments are prepared to stay the course.
The Government cannot achieve better outcomes by purchasing disconnected solutions one at a time, nor can it outsource the responsibility for designing a coherent national system.
It must set the direction, require interoperability across publicly funded health systems, establish shared standards and hold the system accountable for measurable progress.
Brad Porter, Orion Health CEO. Image: Supplied.
The next government has a choice
New Zealanders will elect a government later this year that inherits a health system under immediate strain and a much larger demographic challenge approaching.
It can spend the next term responding to the loudest pressure of the day or it can address those pressures while also beginning the longer work of building a health system designed for the future.
That will require political ambition of a different order. System-wide transformation will extend beyond one budget and one election term. It needs a staged delivery plan, clear public reporting and enough consistency to survive changing ministers and governments.
But transformation does not require us to wait years before seeing any benefit. The work can begin with practical changes: making essential health information available wherever a person receives care, reducing the administrative work involved in finding it, and giving patients a clearer path through the system.
The most frustrating conclusion from my conversations with clinicians, health leaders and policymakers is that the case for change is already widely understood. The people closest to the system can see the problems and how it can be improved.
What we have lacked is not awareness. It is the national resolve to bridge the gap between agreement and action.
New Zealand cannot keep funding fragmentation and call it reform. The next government must give the health system something it has gone too long without: a plan to make the whole system work as one.