The Ministry of Health (Māori: Manatū Hauora) is the public service department of New Zealand responsible for healthcare in New Zealand. It came into existence in its current form in 1993. The organisation was founded in 1901 as the Department of Public Health in 1901, and was renamed to Department of Health in 1922.
History
Origins
The Ministry of Health's origins can be traced back to the Department of Public Health, which was first established in 1901 at the advice of the Central Board of Health. The Department of Public Health assumed responsibility for the provision of Māori health services between 1906 and 1909, when Māori medical health services were returned to the-then Department of Native Affairs. In 1910, the Public Health Department resumed responsibility for the control of Māori health. In 1911, a Māori Nursing Service was established as part of the Department of Public Health.[3]
Growing strains
Under the Health Act 1920, major organisational changes were mandated. Seven separate divisions were created within the department, each headed by its own director. The department was renamed the Department of Health in 1922, dropping the word public.[4][5] The structure remained relatively static even when the Social Security Act 1938 was passed where the New Zealand government took a larger role in health purchasing. The department remained actively involved in policy (as opposed to purchasing).[3]
In 1947 the department assumed responsibility for the administration and operation of psychiatric hospitals after the Mental Hospitals Department was abolished and became the division of mental hygiene at the department.[6]
By the 1970s problems had appeared in the health system. The high growth rate in hospital expenditure was occurring at a time when the economy was slowing down. Thus, the government was unable to sustain funding this growth. This led the health system to undergo a series of changes over a 20-year period from the 1980s.[3]
Fourth National Government, 1990–1999
During the 1990s the Fourth National Government attempted to stream-line the system in a series of reforms such as separating the government purchasing and provision of health care services. Four regional health authorities (RHAs) were created to oversee the purchasing of health services while general practitioners, specialists, and hospitals were tasked with delivering health services. Public services were also turned into quasi-commercial Crown health enterprises (CHEs).[7] In 1993, the Department was renamed as the Ministry of Health.[3]
A poster produced by the Ministry of Health for 1962 World Health Day
In December 1999, the separate government health service purchasing entity, the Health Funding Authority, was merged with the Ministry of Health.[9] Critics were anxious as to how the Ministry would perform as a funder, as they commented that the Ministry had in the past only performed as a policy organisation. However, supporters of this move stated that they believed this would make these agencies more accountable.[citation needed]
In February 2001, the Fifth Labour Government also launched the "New Zealand Primary Health Care Strategy" (PHCS) with the goal of improving public access to primary health care and reducing health inequalities.[10] By 2008, the Primary Health Care Strategy had succeeded in reducing fees for doctors' and nurses' visits in "higher need areas" and for patients aged over 65 years. In addition, consultation rates increased across all age, socio-economic, and ethnic groups in New Zealand.[11]
As part of the PHCS programme, the government encouraged the development of Primary Health Organisations (PHOs) to provide some primary health care services at the local level and to transition health care services from fee-for-service arrangements to capitation funding for health professionals who are members of these organisations.[11] By early April 2003, 34 PHOs had been established throughout New Zealand.[12]
In addition, the Fifth Labour Government established District health board (DHBs) in 2001 as subsidiary organisations of the Health Ministry. They were responsible for providing and funding health services within a defined geographical area. At the time of their dissolution in July 2022, there were twenty DHBs.[13] They were also responsible for running hospitals and funding some health provisions in their respective areas. Funding for these DHBs was allocated according to the Ministry's population-based funding formula.[14]
Sixth Labour Government, 2017–2023
In 2018, the government launched the He Ara Oranga inquiry into mental health and addiction.[15] In 2021, this resulted in the creation of Te Hiringa Mahara, an independent Crown entity that promotes mental health and wellbeing.[16]
On 10 September 2019, Prime Minister Jacinda Ardern and Health MinisterDavid Clark announced the establishment of a Suicide Prevention Office within the Health Ministry to address the country's suicide rate. Key changes include shifting from a mental health service model to a community-based one and supporting people bereaved by suicide. There were also plans to later establish the Suicide Prevention Office as a separate standalone government service.[17]
In October 2021, the government introduced a parliamentary bill called the Pae Ora (Healthy Futures) Bill, which created the new public health entities and strengthened the Health Ministry's stewardship role.[20] This bill passed into law on 7 June 2022.[21] On 1 July, the Pae Ora (Health Futures) Act came into effect; with Health New Zealand, the MHA, and the Health Ministry's Public Health Agency assuming the district health boards' former provision of healthcare services.[22][23]
Sixth National Government, 2023–present
In March 2024, the Health Ministry proposed slashing 180 jobs following a cost-saving directive from the National-led coalition government.[24] In early April 2024, the Public Service Association expressed concerns that proposed job cuts at the Health Ministry would lead to the closure of the Suicide Prevention Office and other specialist roles. The PSA's statement was disputed by the Minister for Mental Health Matt Doocey, who said he had not been briefed about the closure of the Suicide Prevention Office. Doocey said he had spoken with the Director-General of Health to ensure the Office would remain open. Doocey reiterated that mental health and suicide prefention remained a priority for the New Zealand Government.[25]
Organisational structure
The directorates and business units of the Ministry include:[26][27]
The former National Health Board (NHB), which was set up in November 2009, dealt with issues such as rising costs, increased demand, an ageing population and shortages of staff with a view to improving the quality, safety and sustainability of health care.[28]
^"Ministry business units". Ministry of Health – Manatū Hauora. 1 July 2022. Archived from the original on 10 July 2022. Retrieved 11 July 2022. The Ministry is made up of directorates and business units, each with its own functions and areas of responsibility.
^"National Health Board: About us". Ministry of Health. 2012. Archived from the original on 25 February 2013. Retrieved 6 March 2013. The public health and disability system faces serious challenges which range from rapidly rising costs to increased demand for services, an aging population and international shortages of skilled clinical specialists.[...] The National Health Board (NHB) was established by the Government in November 2009, to address these issues and improve the quality, safety and sustainability of health care, for New Zealanders. [...] The NHB is made up of a Ministerial appointed Board and a branded business unit within the Ministry of Health.
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