Budget 2021: Vote Health

Vote Health is the main source of funding for New Zealand’s health and disability system, while ACC is the other major source of public funding.

The funding provided through Vote Health directly supports the day-to-day operation of strong and equitable public health and disability services delivered by the skilled workforce in our communities, hospitals and other care settings. 

The Ministry of Health has a stewardship role to oversee positive change in the health and disability system. 

The sections below provide summary information on the Vote Health initiatives funded through Budget 2021. Detailed information will be available on the Government’s Budget website from 20 May 2021. 

DHB funding

Budget 2021 provides District Health Boards (DHBs) with cost pressure funding of $2.7 billion over four years, an increase of around 4.37 percent from the existing baseline. This funding will allow DHBs to continue providing health services for New Zealand’s growing and ageing population in the face of inflation and other price and volume pressures. In addition, Budget 2021 provides $700 million in capital funding to support both the delivery of new DHB infrastructure projects and preparatory work on other projects. This will enable a pipeline of investment-ready proposals to be supported over the coming years.


The Government has announced an increase of $200 million over four years in the Combined Pharmaceutical Budget, which is managed by PHARMAC and covers the purchasing of medicines, vaccines, medical devices and other treatments on behalf of DHBs. PHARMAC’s ongoing medicines budget for 2021/22 is now a record $1.085 billion.

Data and digital infrastructure

The Government has announced in Budget 2021 an investment of up to $385 million over the next four years (and a further $15 million in capital funding in 2025/26) to implement Hira, formerly known as the National Health Information Platform, as well as other health sector data and digital infrastructure and capability. Hira will modernise the experience for patients, service users and the health and disability sector workforce. In addition, up to $116.644 million will be invested over the next four years to transform the Ministry’s Health Sector Agreements and Payments systems. These investments into data and digital infrastructure and capability are needed to implement the health system reforms and improve health system performance.

Disability Support Services

The Government is investing 399.2 million over four years to address cost pressures for Disability Support Services. This funding will maintain services to people with long-term physical, intellectual and/or sensory impairment who require ongoing support.

An extra $72.790 million over four years has also been invested to continue three regional disability support service programmes known as Enabling Good Lives (EGL), and to enable work on the overall System Transformation to continue.

In-Between Travel Settlement

Budget 2021 provides $81.822 million over the next four years to progress the In-Between Travel (IBT) Settlement for home and community support workers. This funding will ensure that support workers are paid their ordinary wage rates while travelling between clients and receive paid rest breaks. The package also includes a one-off contribution for employers for higher leave revaluations as a result of the increase in travel time payments.

Bowel screening

Up to $64.014 million will be provided over the next four years to improve access to the National Bowel Screening Programme. The initiative will also fund the rollout of the National Bowel Screening Programme to the final six district health boards (Auckland, Bay of Plenty, Northland, Taranaki, Waikato and West Coast) and fund the associated costs, including the National Coordination Centre, screening laboratory testing and bowel screening regional centres.

Breast screening

The Government is investing up to $55.6 million for a major technology upgrade for the national breast screening programme, along with a further $10 million to support the programme to match population growth and catch up on breast screens missed due to COVID-19 lockdowns.

HPV screening

The Government is investing up to $53 million to implement a new primary test for cervical cancer screening from July 2023, together with the population health-based IT system needed to support this change. The new test is a simple and quick swab that women can do themselves, which is expected to increase participation in the programme, especially for wāhine Māori and Pacific women.

Smokefree 2025

The Government is investing an additional $36.625 million over four years to support the push towards a Smokefree Aotearoa 2025.

Ambulance services

$17.264 million has been allocated from Vote Health over the next four years to address price and volume pressures in emergency air ambulance (rotary) services. The funding will ensure demand is met, services remain equitable across regions and contracted performance levels are maintained. This funding will maintain existing air ambulance (rotary) services through meeting rising operational costs and volume growth.

Emergency Road Ambulance Services respond to over half a million incidents every year and are a key part of the New Zealand health system. In Budget 2021, $83.032 million over four years (including $31.428 million from Vote Labour Market) has been allocated to help maintain emergency road ambulance services and communications centres at existing capacity and performance levels. The funding means patients will experience stable response times for life-threatening incidents and time critical conditions, and improved clinical care and clinical decision-making.

Expanding the Healthy Homes Initiative

The Government has announced it will invest an additional $30 million over the next four years into the Healthy Homes Initiative. The new funding will maximise the effectiveness of the existing programme in 11 District Health Board (DHB) regions and enable the roll-out of the programme nationally.

Cochlear implants

The Government will be investing an extra $7.08 million annually so that an additional 80 people receive cochlear implants every year, nearly doubling the current numbers. Over four years that amounts to an additional $28.32 million.

Implementing Ola Manuia

Budget 2021 provides $16 million for the implementation of Ola Manuia: Pacific Health and Well-being Action Plan 2020-2025. The funding provided through Budget 2021 will support Pacific health providers to develop Ola Manuia implementation plans, enable the Ministry to investigate Pacific models of care across a number of health settings, and support the development of Pacific community hubs, building on the momentum gained during the COVID-19 Pacific response.

Establishing an Aged Care Commissioner

The Government has allocated $8.110 million over the next four financial years to establish an Aged Care Commissioner role and support its ongoing operation. The Aged Care Commissioner role, which will be based within the office of the Health and Disability Commissioner, will give older people and their whānau greater confidence in the quality and safety of aged care, and in the investigation of their complaints. They will also provide leadership to the sector and advocate for quality improvements on behalf of consumers and their whānau. This funding will also increase the resources available to HealthCERT, a business group in the Ministry of Health, to manage additional complaint referrals.

Health and Disability Commissioner

The Health and Disability Commissioner will receive additional funding of $8.7 million over the next three years to undertake its statutory functions in the face of increasing complaint volumes and complexity, and to expand its scope when the End of Choice Act 2019 is implemented.

Health Quality and Safety Commission

The Government is providing an additional $4.2 million to fund the Health and Quality Safety Commission over the next three years. The Health Quality and Safety Commission works with clinicians, providers and consumers to improve health and disability support services. It’s important the Commission is well supported and appropriately resourced through this time of significant health and disability system change.

End of Life Choice Act implementation

The End of Life Choice Act received majority support at last year’s referendum and will come into force on 7 November 2021. The Act provides people who experience unbearable suffering from a terminal illness with the option of legally asking for medical assistance to end their lives. Assisted dying will be an entirely new service within the health and disability system. Budget 2021 provides $11.860 million in 2021/22 to ensure the necessary processes, safeguards, controls, monitoring and oversight are in place to enable assisted dying services to be available from 7 November 2021.

Continuing Mana Ake

The Mana Ake – Stronger for Tomorrow initiative was established in Canterbury and Kaikōura in 2018 to provide support to schools, families and whānau when children aged 5-12 are experiencing issues that affect their mental wellbeing. Budget 2021 provides $12 million in 2021/22 to continue Mana Ake within Canterbury and Kaikōura and to commence co-design of Mana Ake services in five new areas – Northland, Counties Manukau, Lakes, Bay of Plenty and the West Coast. This funding includes $10 million that has been reprioritised from Vote Health in 2020/21.

Preventing Family Violence and Sexual Violence

Budget 2021 provides $5.865 million over four years to ensure that DHB clinical staff can continue to contribute to the Integrated Community Response forums for family violence and sexual violence. This is a multi-agency family violence response designed to ensure the immediate safety of victims and children, and to work with perpetrators to prevent further violence.

Crown response to the Abuse in Care Inquiry

The Crown Response to the Abuse in Care Inquiry is being led by the Minister for the Public Service. Budget 2021 provides Vote Health with $0.750 million in 2021/22 to fund a Secretariat to drive the coordinated Crown approach, legal support for representation, specialist records support, training and support to non-governmental organisations and Crown entities, and support for affected staff.

National Immunisation Programme

The Government is providing an additional $25.030 million over the next four years to the National Immunisation Programme. The goal for the programme is to achieve immunisation coverage of 95 percent or higher to not only protect individuals from vaccine-preventable disease, but also to achieve community immunity to protect those who aren’t able to be immunised. This funding will address a historical funding issue and fully fund the programme. To protect tamariki against measles as early as possible, an additional immunisation event was added at 12 months from 1 October 2020. This investment also provides ongoing funding for the extra costs associated with this that DHBs incur.

Public Health Units

The Government has allocated $37.860 million over four years to enable Public Health Units (PHUs) to address ongoing funding pressures and to build critical mass and infrastructure to provide for an effective public health system. An additional $15.4 million over four years has been earmarked for increasing the number of new public health medicine registrar trainees from 10 to 20 per annum.

Primary Care

$186.608 million has been earmarked in Budget 2021 to maintain access to primary health care services for priority populations. The funding contributes to improving health equity through supporting programmes that provide affordable access to primary care for low-income New Zealanders.

Maternity funding

The Government is investing $17.224 million over the next four years for community-based primary maternity services, in line with projected cost and volume adjustments. This brings the total maternity funding or appropriations to $200 million each year. This will ensure that funding keeps pace with the growth in maternity services, supports initiatives to improve workforce retention and remuneration, and maintains the quality and safety of community-based primary maternity care. Included in the $17.224 million is $5 million for extending the Business Contribution payment into 2021/2022. This payment contributes to the business costs associated with Lead Maternity Carer (community) Midwives being self-employed while delivering community-based primary maternity services.

Family Planning

The Government is investing an additional $3.764 million over the next four years to Family Planning, New Zealand’s only national provider of sexual and reproductive health services. This additional funding will address urgent inflationary costs so Family Planning can continue to meet service demand by responding to changing national, regional and local needs to prioritise health equity for those most affected by poor sexual and reproductive health outcomes.

Planned Care Initiative

Funding of $194.480 million over the next four years allocated in Budget 2021 will allow the existing volume of planned impatient surgical discharges and minor procedures delivered by DHBs at the increased pricing levels to be maintained.

Supporting NGOs

Funding of $3.376 million over the next four years has been allocated to address price and volume pressures faced by the NGOs delivering population health and prevention services, supporting their sustainability and service viability.

Well Child Tamariki Ora

Well Child Tamariki Ora (WCTO) is New Zealand’s universal child health and development service to support children under five years and their whānau/caregivers. It is a significant component of the health sector’s contribution to the Government’s wider work on improving child wellbeing outcomes. In Budget 2021, $16.8 million has been allocated over the next four years to address significant volume pressures accumulated from increases in new baby enrolments for WTCO providers contracted via DHBs. Funding will also support sustainable delivery of the programme through other WCTO providers including Plunket and B4 School Check providers.

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