New Health and Disability System - Opportunities For Physiotherapy


PNZ Chief Executive Sandra Kirby and Professional Advisor Chris Bloomfield were in attendance when the Minister of Health Hon Andrew Little and Deputy Health Ministers Hon Peeni Henare (Māori Health), Hon Dr Ayesha Verrall (Public Health) and Hon Aupito William Sio (Pacific Peoples) announced the new health and disability system at Parliament on Wednesday 21 April 2021.

With changes generally going beyond recommendations from the Health and Disability System Review, the first opportunity to raise the profile of physiotherapy came immediately after the announcement when Sandra attended a sector briefing with the Minister of Health and Transition Unit senior staff on behalf of Allied Health Aotearoa New Zealand (AHANZ). PNZ will now continue to work to raise the profile of physiotherapy within the new system and keep members updated.

The Health and Disability System

The Minister outlined five key system shifts at the announcement:

  1. The health system will reinforce Te Tiriti principles and obligations.
  2. All people will be able to access a comprehensive range of support in their local communities to help them stay well.
  3. Everyone will have access to high quality emergency or specialist care when they need it.
  4. Digital services will provide more people the care they need in their homes and communities.
  5. Health and care workers will be valued and well-trained for the future health system.

Two new entities were also announced, a Maori Health Authority and Health New Zealand (please note these are placeholder names), to be set up this calendar year and operational from 1 July 2022. An interpretation of other key changes include:

  • A smaller policy-centred Ministry of Health (MoH). The role of Director General of Health will remain in overall control and the statutory functions of MoH remain unchanged.
  • Nationally organised and funded hospitals/secondary care. The current DHB structures will not exist. There is no detail yet on physiotherapy/allied health in this national system.
  • Te Tiriti commitments and improving Māori health equity are central to the system. The Māori Health Authority will be commissioning kaupapa Maori services and working collaboratively with Health New Zealand to ensure that all services are addressing health inequalities.
  • A move towards preventative and primary health care as well as regional/locality primary and community care.
  • All public health will be centralised (currently there are 12 Public Health Units and the Health Promotion Agency).

The Minister’s speech is on the Beehive website, along with the speech by Associate Minister for Māori Health Peeni Henare on the role of the Māori Health Authority. A white paper is also available from the Department of Prime Minister and Cabinet website and full Cabinet paper here.

The Opportunities for Physiotherapy

The Minister and the Transition Unit have stressed the importance of the shift towards equitable primary care services with the options to address health issues early and in evidence based ways. This is the obvious space for access to physiotherapy, and where our advocacy priority lies. Alongside this we do need to be aware of what changes might happen for physiotherapy in the hospital/secondary care sector which will be nationalised.

The work we did with NZIER Better Outcomes through Increased Access to Physiotherapy has given us some of the evidence we are using to continue positioning funded primary care physiotherapy for long term conditions as the best health funding option. It is possible that First Contact Practitioners, as per the NHS model in the UK, could eventuate. The level of detail is not that clear.

We also have a report on funding models in primary care completed in conjunction with AHANZ. The Hidden in Plain Sight report highlights that allied health practitioners represent a ready-workforce able to support a shift to more effective and more pro-active prevention, person-centred care, and collaborative, interdisciplinary team-based approaches that are most appropriate for people with complex health issues including long-term conditions.

Locality Pilots

In April 2022 the Minister announced the first nine pilot localities helping form the new Health and Disability system. Localities are designed to be a “place-based approach to planning and delivering health and wellbeing services” and seek to embed a stronger community centered health focus across the health system. They are geographical locations and may, but don’t necessarily, follow existing boundaries set up by mana whenua, local government or health authority.

The next step for these localities is to develop their locality plan. The Transition Unit says there are three characteristics for a locality.

  1. It is a partnership with mana whenua, recognising their tino rangatiratanga.
  2. The approach supports locally led solutions that take a holistic approach to wellbeing, acknowledging the range of other factors that impact on a person’s health.
  3. The locality approach will join up care across communities and improve integration with different layers of the health and social system.

PNZ is working to ensure that evidence based physiotherapy and allied health interventions in areas such as long term conditions, pain management and older peoples health is included in the planning stages of localities. We understand more localities will be added over the next two years with the aim of every area having its own locality by July 2024.

Page updated April 2022