Health NZ Told to Restore Local Decision-Making Under New Government Directive

The directive sets a clear expectation: the health system must become more responsive, more locally empowered, and more focused on frontline delivery.

Health Minister Simeon Brown has presented Health New Zealand’s Annual Report to Parliament and unveiled a new Letter of Expectations outlining the Government’s priorities for the remainder of the financial year and into 2025/26. The directive sets a clear expectation: the health system must become more responsive, more locally empowered, and more focused on frontline delivery.

Brown says the previous Government’s restructuring—merging 20 former district health boards into a single national agency—centralised decision-making to an excessive degree, weakening local responsiveness and clinical input.

“The previous Government’s mega-merger of our health system removed local decision-making and centralised too many decisions into Health New Zealand,” he said. “We want a nationally and regionally planned system, but one that has strong clinical input and buy-in at the hospital level.”

Restoring Local Control Across Four Regions and 20 Districts

A major theme of the Letter of Expectations is the devolution of authority. Brown has instructed Health New Zealand to rapidly shift decision-making to its four regional divisions and 20 district teams, positioning clinicians and local leaders closer to the decisions that affect patient care.

“That means devolving decisions to the people who are closest to patients and communities,” he said. “People need a health system that is responsive, and this shift in decision-making will support faster, better outcomes for patients.”

The changes are designed to remove unnecessary bureaucracy, cut delays in staff recruitment, and ensure operational decisions can be made near the frontline, not in Wellington.

Minister’s Priorities for the Health System

The Letter of Expectations outlines a substantial work programme that Health New Zealand must deliver over the next 18 months. Key priorities include:

• Continued progress on achieving Government health targets – especially shorter wait times, improved emergency department throughput, and faster access to cancer treatment.

• Strengthening primary and community care – including better access to GPs and more support for early intervention and long-term condition management.

• Devolving decision-making – ensuring a nationally coordinated but locally delivered health system.

• Growing and supporting the health workforce – with an emphasis on recruiting frontline clinical staff and speeding up appointment processes.

• Building modern health infrastructure – upgrading facilities, digital systems, and hospital assets to meet future needs.

Brown emphasised that decentralisation does not mean fragmentation. Instead, decisions must be made as close to communities and patients as possible, while ensuring national consistency in standards and performance.

Accountability, Efficiency, and Financial Discipline

The Minister said Health New Zealand must operate with stronger governance, clearer delegations, and rigorous accountability. “Health New Zealand must deliver on the priorities outlined in my Letter of Expectations while ensuring its operations are efficient, transparent, and focused on patients,” he said.

The Government is investing record levels of funding into the health system, and Brown said New Zealanders expect clear results from that investment. While Health New Zealand has made “good progress” in stabilising its financial position, he noted that challenges remain, and further efficiencies must be found without compromising service delivery.

Focus on Targets, Wait Times, and Better Access

The Government’s health targets remain central to the system’s work: reducing wait times, cutting emergency department delays, and making primary care more accessible. Brown said strengthening frontline services must be an immediate priority.

“New Zealanders deserve a health system that works for them. That means meeting targets, reducing wait times, and ensuring care is accessible close to home. Health New Zealand plays a critical role in delivering timely, high-quality healthcare. I have made my expectations clear – I will continue to hold them to account for delivering results.”

The Letter of Expectations sets a firm direction for a health system entering a period of transformation—one where decision-making power shifts back to local clinicians and communities, with the goal of faster care, stronger performance, and better outcomes for all New Zealanders.