Te Whatu Ora

Health New Zealand - Te Whatu Ora is the primary publicly funded healthcare system of New Zealand. It was established by the New Zealand Government to replace the country's 20 district health boards (DHBs) on 1 July 2022. Te Whatu Ora is charged with working alongside the Public Health Agency and Te Aka Whai Ora (the Māori Health Authority) to manage the provision of healthcare services in New Zealand. Margie Apa was appointed chief executive of Te Whatu Ora in December 2021.

Mandate and responsibilities
Health New Zealand is responsible for the planning and commissioning of health services as well as the functions of the 20 former district health boards. The Ministry of Health remains responsible for setting health policy, strategy and regulation. Health New Zealand also works with the Te Aka Whai Ora (the Māori Health Authority) to improve Māori health outcomes and services.

As of 2022, the agency is New Zealand's largest employer, consolidating the DHBs' combined work force of 80,000, with an estimated annual operating budget of NZ$20 billion and an asset base of about NZ$24 billion.

Leadership and structure
Health New Zealand is headed by Chief Executive Margie Apa and Nick Chamberlain, the National Director of the National Public Health Service. The organisation's board members include former National Party Member of Parliament Amy Adams, Tipa Mahuta, Karen Poutasi, Vanessa Stoddart, and Medical Council of New Zealand Chair Curtis Walker. Economist Rob Campbell was formerly chair of the board, but was removed from this position on 28 February 2023 by Minister of Health Ayesha Verrall following public comments Campbell made about co-governance which were deemed to be not politically neutral.

Health New Zealand consists of four regional divisions, with regional commissioning boards overseeing the provisioning of primary and community health services, in coordination with the Māori Health Authority. These four new regional divisions consist of:
 * Northern: Northland Region, Waitematā, Auckland and Counties Manukau;
 * Te Manawa Taki: Waikato, Lakes, Bay of Plenty, Tairāwhiti, Taranaki;
 * Central: MidCentral, Whanganui, Capital & Coast/Hutt Valley, Hawke's Bay, Wairarapa;
 * Te Waipounamu: Canterbury Region, West Coast Region, Nelson Marlborough, Southern, and South Canterbury.

As the successor to the district health boards, Health New Zealand is responsible for running all hospitals and health services including the DHB's 12 public health units and the former Health Promotion Agency. These public health units dealt with areas such as drinking water, infectious disease control, tobacco, and alcohol control.

Announcement
On 21 April 2021, Minister of Health Andrew Little announced plans to replace the country's 20 district health boards with a new public health agency called "Health New Zealand", which would be modelled after the United Kingdom's National Health Service. Health New Zealand would work alongside the new Māori Health Authority, which is now responsible for setting Māori health policies and overseeing the provision of Māori health services. In addition, a Public Health Authority was established to centralise public health work.

The National Party's health spokesperson Shane Reti criticised the government's plan to replace the district health boards with a new centralised agency. He claimed that centralisation took away autonomy from local regions and suggested that the government instead explore the consolidation of some functions such as asset management across the DHBs rather than abolishing them entirely. Reti claimed that the public was unaware of the cost of the government's planned restructuring and the potential disruption it would cause.

Formation
In mid-September 2021, the government announced the interim board members of Health New Zealand. The agency will be chaired by Rob Campbell. Other board members include Sharon Shea (co-chair of the interim Māori Health Authority and current chair of the Bay of Plenty District Health Board), former National MP Amy Adams, chartered accountant and lawyer Cassandra Crowley, former Labour Member of Parliament Mark Gosche, former Director General of Health Karen Poutasi, senior executive Vanessa Stoddart, and general practitioner and kidney specialist Curtis Walker.

On 19 May 2022, the government allocated NZ$13.2 billion to facilitate the establishment of the Health New Zealand and the Māori Health Authority over the next four years. This amount included $11.1 billion to address the cost pressures of the previous district health board system and $2.1 billion to set up the two new health entities.

In October 2021, the government introduced the Pae Ora (Healthy Futures) Bill which formally entrenched various health reforms including the replacement of the district health board system with Health New Zealand. The bill passed its third reading on 7 June 2022.

Launch
On 1 July 2022, Health New Zealand formally launched as Te Whatu Ora, with the new entity assuming responsibility for all hospitals and health services formerly run by the district health boards. In addition, the 12 public health units, which operated within the DHBs, and the former Health Promotion Agency were transferred into Te Whatu Ora. The new entity also assumed the commissioning functions of the Health Ministry and the commissioning and delivery functions of the DHBs.

2023 dismissal of chair
In late February 2023, Te Whatu Ora's chair Rob Campbell criticised the National Party's proposal to scrap the Labour Government's Three Waters reform programme in a LinkedIn post and accused its leader Christopher Luxon of "dog whistling" on the issue of co-governance. Campbell's remarks were criticised by National MP Simeon Brown and ACT Party leader David Seymour, who accused him of breaching the Public Service Commission's policy requiring the directors of Crown entities to remain politically neutral. Campbell defended his remarks, stating that they were made in his capacity as a private citizen and denied violating the Commission's political impartiality policy.

On 27 February, Prime Minister Chris Hipkins criticised Campbell's Three Waters remarks as "inappropriate." On 28 February, Health Minister Ayesha Verrall used her discretionary powers under section 36 of the Crown Entities Act 2004 to relieve Campbell of his position as head of Te Whatu Ora. Though Campbell had apologised to Luxon and Verrall, the latter had demanded that he resign by 10:30 am on 28 February. Campbell had refused to resign and defended his right to criticise National's Three Waters policy.

2023 Winter Health Plan
On 4 May 2023, Verrall announced that Te Whatu Ora would play a leading role in the Government's 2023 Winter Health Plan that would include 24 initiatives to support community care and reduce hospital demand. These initiatives include using telehealth services to support primary care, ambulances and paramedics, remote patient monitoring, equipping pharmacies to treat minor ailments, community radiology services, increasing primary options for acute care, incentives to support aged residential care, improving access to allied health and community response services, investing in mental health services, bivalent COVID-19 boosters, and influenza vaccination campaigns, recruiting international nurses and health professionals, and continuing to invest in COVID-19 monitoring, response, and services.

Equity Adjustor Score
In February 2023, Te Whatu Ora Te Toka Tumai Auckland introduced an Equity Adjustor Score, which seeks to reduce inequity in the New Zealand health system by using an algorithm to prioritise patients based on clinical priority, time spent on the waitlist, geographical location, ethnicity and deprivation level. In June 2023, the Equity Adjustor Score has sought to improve health outcomes for Māori and Pasifika New Zealanders, who have experienced higher levels of deprivation and health problems than other ethnic groups in New Zealand. Health Minister Verrall, Pasifika health expert Sir Collin Tukuitonga, Te Toka Tumai Auckland interim lead Dr Mike Shepherd, and University of Auckland medical education senior lecturer Dr Mataroria Lyndon defended the Adjustor Score's prioritisation of Māori and Pasifika, citing inequalities in the health system, higher obersity rates, and lower life expectancy within these communities. National Party health spokesperson Shane Reti and ACT Party leader David Seymour objected to the Adjustor Score's ethnic criterion, describing it as racial discrimination that did not properly address social and health inequalities.

2023 vaccine data breach
In early December 2023, Te Whatu Ora investigated an administrator who was accused of spreading COVID-19 misinformation using COVID-19 vaccination data obtained from the organisation. The employee had allegedly developed a database for the vaccine rollout and had been interviewed on a conspiracy theory website. On 3 December, Te Whatu Ora lodged a police complaint against him over the vaccine rollout data breach. On 4 December, he was identified as Barry Young, who appeared at the Wellington District Court on the charge of accessing a computer system for dishonest purposes, which carries a maximum seven year prison sentence. After being released on bail on 5 December, Young was interviewed by American conspiracy theorist Alex Jones on his website InfoWars. On 8 December, Te Whatu Ora enlisted the services of international cybersecurity and forensic experts to investigate the COVID-19 vaccine data leak.

On 19 December, after Te Whatu Ora previously said that the data was anonymised, the agency admitted that the data could make identifications of people, with considerable effort. By 16 February 2024, Health NZ acknowledged that at least 12,000 people had their personal information compromised. Several of the affected individuals had their data leaked by a US blog.

2023 Crown observer
In mid December 2023, Health Minister Shane Reti appointed Ken Whelan as a Crown observer to Health New Zealand, citing ongoing challenges that the agency was facing following the previous Labour Government's 2022 health reforms.

2024 resignation
On 12 April 2024, Health NZ chair Dame Karen Poutasi resigned as chair and board member prior to the end of her 18-month term, effective immediately. Health Minister Shane Reti said that Poutasi had been asked to remain in the role until a successor could be appointed in May 2024.

Diversity and representation
In mid August 2022, Radio New Zealand reported that Health New Zealand lacked Asian members on the organisation's 51 leadership roles despite Asians making up 15% of New Zealand's population according to the 2018 New Zealand census. Population and migration researcher Dr Francis Collins advocated legislation ensuring greater minority representation in leadership and decision-making. Asian medical professionals Doctor Carlos Lam and Vishal Niwi of the Asian Network criticised the lack of Asian representation and input within Health New Zealand's leadership. In response, Health NZ's chief executive Margie Apa claimed that the organisation was committed to diversity in its workforce but admitted they had not set targets for representation on the grounds that its employees and management were required to serve all communities equitably.

In March 2024, The New Zealand Herald reported that a Health NZ manager had instructed a staff member to stop using the Māori language greetings in emails after two patients objected. The staff member disagreed and shared her story in a Reddit post. In response, Health NZ's chief people officer, Andrew Slater, described the manager's response as an overreaction. Former Health NZ chair Rob Campbell criticised the agency for its lack of "cultural leadership" and for failing to address racism.

Weekly meetings
In late August 2022, Health NZ was criticised by the opposition National Party's health spokesperson Shane Reti for abandoning the previous district health boards' practice of holding public monthly meetings. Health NZ has closed its meetings to the public and media, releasing only brief summaries of its board meetings. The organisation's chair Rob Campbell defended the decision to exclude the public and media from its initial board meetings on the grounds that they dealt with sensitive issues such as staff appointments and Cabinet decisions. Campbell and chief executive Margie Apa held half-an-hour media briefings following board meetings to discuss the contents of their meetings with the media.