Health and disability system review

In August 2018, then-Minister of Health Dr David Clark announced a wide-ranging review designed to future-proof our health and disability services, appointing Ms Heather Simpson as Chair to lead the Review alongside an Expert Panel.

The scope of the Review is outlined in the Terms of Reference. The Review considered the overall function of the Health and Disability system to ensure the system is better balanced towards wellness, access, equity, and sustainability.

The final recommendations were released in June 2020.

Terms of reference


The Government has established a review into the New Zealand Health and Disability System (the Review). This review will identify opportunities to improve the performance, structure, and sustainability of the system with a goal of achieving equity of outcomes, and contributing to wellness for all, particularly Māori and Pacific peoples.


The New Zealand Health and Disability System has many strengths, and intersects the life of every New Zealander. It is looking after New Zealanders well, especially when we are acutely ill or injured.

Overall, New Zealanders are living longer and healthier lives. However, the way the current system is operating means that many people, particularly those on low incomes, wait until they are sick, instead of accessing the care they need to stay well. Disparities of outcomes exist across the system, especially for Māori and Pacific peoples. In reviewing the New Zealand Health and Disability System we can identify opportunities to do more, and to address these inequities.

The system is under pressure, facing significant contextual change, and will need to operate very differently if it is to continue to deliver for New Zealanders. The rapidly changing global, societal and technological context within which New Zealand’s Health and Disability System operates makes a review timely.

The current devolved Health and Disability System has a complex mix of governance, ownership, business and accountability arrangements. This complexity can get in the way of ensuring public money is spent, and invested, in a manner that provides health care to the public in a coherent and smart way.

Scope of Review 

All New Zealanders should be able to aspire to improving levels of health and wellbeing. The goal for the New Zealand Health and Disability System, as currently set out in legislation is that it is strong, effective and delivers equitable health outcomes for all New Zealanders. The Review will investigate where the system is not currently achieving this core equity goal, and understand the drivers of this (whether it be service delivery, or the broader social determinants of health). The Review will focus on the future needs of New Zealanders and make recommendations on changes to the Health and Disability system to ensure all New Zealander’s have confidence that the system will assist them and their families to live well.

The Review will consider the overall function of the Health and Disability system to ensure the system is better balanced towards wellness, access, equity, and sustainability.

The Review will provide a report to the Government, including recommendations, on:

  • A sustainable and forward-looking Health and Disability System that is well placed to respond to future needs of all New Zealanders and which:
    • Is designed to achieve better health and wellness outcomes for all New Zealanders
    • Ensures improvements in health outcomes of Māori and other population groups
    • Has reduced barriers to access to both health and disability services to achieve equitable outcomes for all parts of the population
    • Improves the quality, effectiveness and efficiency of the Health and Disability System, including institutional, funding and governance arrangements.
  • How the recommendations could be implemented.

In examining the points above, the Review will consider:

  • Future needs of the population and how they may differ from the issues seen today (such as the impact of population change and growth, upon service demand, workforce availability and risks that may need to be managed)
  • Importance of primary health care as the foundation of a person-centred Health and Disability system The role of public health and prevention in supporting health and wellness
  • The role of public health and prevention in supporting health and wellness
  • Contribution of and the interaction between health and other social sector agencies in supporting health and wellness
  • Capacity of the Health and Disability system to deliver the appropriate level of care and ensure the care is safe and high-quality
  • Distribution of services, including current investment practices and future infrastructure needs
  • Optimising workforce (development, scopes of practice, inter-professional collaboration, retention, cultural competency, and distribution)
  • The role of data and evidence in informing policy development, investment decisions, and provision of services
  • Potential opportunities and risks associated with current and emerging technologies and the implications for, including but not limited to, delivery of services, clinical tools and settings, communication and transport
  • The Government’s overall Fiscal Strategy.

The Government expects that the Review will work alongside other reviews, and consider their outcomes and findings as appropriate in preparation of the recommendations of the Review.

The following areas are outside the scope of the Review:

  • The ACC scheme itself (although the relationship between the Health and Disability system and the ACC scheme is within scope)
  • PHARMAC (although the relationship between the Health and Disability system and PHARMAC is within scope)
  • Private health insurance (although its interaction with demographic drivers of health care need is within scope) 
  • The MidCentral Prototype (for Disability service delivery) that is currently underway (however, learnings from this work will be considered during the development of the Review’s recommendations).


The review will be undertaken by an expert review panel (the panel), comprising of a Chair and up to six Panel members. The expert review panel (the panel) will be supported by a secretariat of officials and it will be able to seek independent advice and analysis on any matter within the scope of its Terms of Reference.

Process and Timing

The panel will be expected to engage with stakeholders including DHBs, PHOs, other health providers, health professionals, and the public in developing its recommendations. Engagement with the public will enable consumers, family and whānau to be included and heard.

The panel had its first meeting in August 2018, and will issue an interim report to the Minister of Health no later than 30 August 2019, and a final report to the Minister of Health no later than 31 March 2020. These dates may be varied with the consent of the Minister of Health.

Message from the Chair

Tēnā koutou,

The Review is now complete and our final report is available. Putting this report together has involved a huge amount of effort from a wide range of contributors.

The Minister of Health commissioned the Review so the key recommendations are directed to Government. These are decisions the Government needs to make to allow the system to evolve into one which has the promise to change both the way New Zealanders view their health and disability system and in the level and equity of the outcomes it achieves.

I am confident that if the system changes proposed by the Review are implemented and funded over the next few years, the system will grow stronger, the outcomes will be more equitable and the overall system will be much more sustainable.

My sincere thanks go to all those who have contributed to the Review. A special acknowledgement to my colleagues on the Review Panel, and their commitment to delivering the best possible future for our health and disability system. Also thanks to the Review’s Māori Expert Advisory Group, whose input and experience has been greatly appreciated.

Naku iti nei
Heather Simpson

Expert review panel

Heather Simpson: Chair

Heather Simpson has a background in health economics and was an economics lecturer at Otago University. From 1999-2008 she was Chief of Staff to then Prime Minister, Helen Clark. She went on to work at the United Nations Development Programme and is currently a special advisor in the Prime Minister’s office.

Shelley Campbell

Shelley Campbell brings an array of business, health, and governance experience to the Review panel. As CEO of the Cancer Society, Waikato/Bay of Plenty, she manages a large budget and is responsible for 750 staff and volunteers. She is a member of the New Zealand Order of Merit – health and disability, and an Honorary Captain of the Royal New Zealand Navy.

Professor Peter Crampton

Professor Peter Crampton is Dean of the Otago Medical School at the University of Otago. He brings significant academic expertise to the Review panel, and is a specialist in public health medicine. His research is focused on social indicators and social epidemiology, health care policy, and health care organisation and funding.

Dr Lloyd McCann

Dr Lloyd McCann brings governance, business and health sector experience to the Review panel. He is CEO and Head of Digital Health at Mercy Radiology and Healthcare Holdings Limited, and was previously Director of Medical Services and Chief Operating Officer at MercyAscot Hospitals and Mercy Radiology. He has served on various advisory panels, and has presented at health and business conferences.

Dr Margaret Southwick

Dr Margaret Southwick has worked as a Senior Lecturer, Head of School and Dean in the nursing departments at various tertiary institutions in New Zealand. She serves on various advisory committees and her governance experience will be a valuable contribution to the Review panel. She was previously Chair of the Nursing Council and was awarded the Queen’s Service Medal for contributions to Pacific Communities in 2009.

Dr Winfield Bennett

Dr Winfield Bennett was Group Manager, Funding, Planning, and Performance at Hawke’s Bay DHB. He has helped to lead: the development of the New Zealand Primary Healthcare Strategy, planning and funding teams at Capital & Coast and Hawke’s Bay DHBs, and litigation management and development of cost benefit assessments at PHARMAC.

Sir Brian Roche

Sir Brian Roche brings extensive governance, leadership and business experience to the Review panel. In 2017, he was named a Knight Companion of the New Zealand Order of Merit for services to the State and business. He was Chief Executive of the New Zealand Post Group from 2010 to 2017 and was previously Chairman of the New Zealand Transport Agency Board.

Māori Expert Advisory Group

The Māori Expert Advisory Group was established in December 2018 to ensure that Māori perspectives on key aspects of the Health and Disability System Review are well considered and understood, and shape the Review's deliberations on system options for addressing inequity in health outcomes.

Sharon Shea (Chair)

  • Auckland based
  • Principal, Shea Pita & Associates Ltd
  • CEO, Manawaroa Ltd

Sharon is widely-recognised as a leader in the field of health and Māori development strategy, Whānau Ora, outcomes framework development, quality assurance and systems design, particularly in respect to issues affecting Māori.

Board member of Auckland DHB, Northland DHB, Healthcare Applications Ltd, Allliance HealthPlus PHO.

Bachelor of Laws and a Bachelor of Arts from Auckland University. Masters in Comparative Social Policy from Oxford University (Awarded with Distinction). Sharon was recently awarded a MNZM for services to Māori health and development.

Iwi affiliations: Ngāti Ranginui, Ngāti Haua, Ngāti Hine and Ngāti Hako.

Dr Terryann Clark

  • Auckland based
  • Associate Professor, Nursing – Faculty of Medical and Health Services, University of Auckland and Child and Youth Friendly Cities Coordinator, Manaia Health PHO

Dr Terryann Clark is a registered comprehensive nurse with extensive experience in youth health, community health, sexual health, health promotion, youth mental health and Māori health. She works part time as a senior lecturer. She is a founding member of the Adolescent Health Research Group (AHRG) and was the principal investigator of the Youth'12 national youth health and wellbeing survey in secondary schools(external link). She currently leads an HRC project exploring the influence of whanaungatanga on Māori youth outcomes, and co-leads a youth health survey called Youth'19 Rangatahi Smart Survey(external link) with Dr Terry Fleming from the University of Victoria.  

  • RCpN (Nursing) Manukau Institute of Technology
  • MPH (Public Health) University of Auckland
  • PhD (Nursing) University of Minnesota, USA
  • Fellowship in Adolescent Health

Iwi affiliations: Ngapuhi

Takutai Moana Natasha Kemp

  • Auckland based
  • CEO - Te Kaha o Te Rangatahi Trust – South Auckland

Takutai Moana is the CEO of Te Kaha O Te Rangatahi Trust, a Māori Youth Health and Wellbeing Provider located in South Auckland, New Zealand/Aotearoa. She is also one of three CEOs who are part of the Kotahitanga Whānau Ora Collective. Takutai Moana has worked in the New Zealand health sector for the last 18 years. She is experienced in Community Development and has also worked in Māori Health Funding and Planning roles.

Iwi affiliations: Ngā Rauru, me ngā Iwi O Mōkai Pātea ko Ngāti Tamakōpiri, ko Ngāti Whitikaupeka, ko Ngāi te Ohuake, ko Ngāti Hauiti rātou ko Ngāti Paki me Ngāti Hinemanu

Dr Dale Bramley

  • Auckland based

Dr Bramley is the CEO of the Waitemata District Health Board. Waitemata DHB is the largest DHB in the country serving a population of 630,000 people. He has medical qualifications from the University of Auckland (BHB, MBChB), a Master’s Degree in Public Health (first MPH class honours) and a Master’s Degree in Business Administration (MBA) from Henley, United Kingdom. He is currently the New Zealand chief examiner of the New Zealand College of Public Health Medicine and an adjunct professor at AUT University. He is a Fellow of the Australasian Faculty of Public Health Medicine and a Fellow of the New Zealand College of Public Health Medicine. Currently Dr Bramley is the Deputy Chair of the Health Quality and Safety Commission. A recipient of the international Harkness Fellowship in 2003. He has previously served on the National Health Committee and the National Ethics Committee.

Iwi affiliations to Ngā Puhi and Ngāti Hine.

Linda Ngata

  • Christchurch based
  • Executive Management - Te Rūnanga o Ngā Maatawaka

Since 1993 Linda has been overseeing the operations of Te Rūnanga o Ngā Maatawaka drawing on her financial, operational and general management skills to successfully lead out initiatives, projects and programmes in the education and training, social services, health, housing, economic development, Māori, community development and building financial capability sectors

Te Rūnanga O Ngā Maatawaka are contracted by the Ngā Hau E Whā National Marae Charitable Trust, Board of Trustees to manage the operations of the Marae and Linda has been pivotal in shaping the services sited at the Marae in Otautahi.  The success of the services can be attributed to her securing resources and forming critical relationships with several agencies and groups where collaboration, mediation, partnership and interpersonal communication skills are paramount.

She was involved in the development of the Integrated Safety Response initiative rolled out in Christchurch and also provided an enormous resource through three (3) of her staff members becoming Lead Professionals and seconded to the implementation phase of the Children’s Team Project in the communities of interest

Iwi Affiliations - Ngāti Porou

Assoc. Professor Sue Crengle

  • Invercargill based

Sue obtained her medical, MPH, and PhD degrees from the University of Auckland. She holds specialty qualifications in general practice and public health medicine. Sue has worked as a GP in Māori providers and ‘mainstream’ providers. Sue was a recipient of a Harkness Fellowship in Health Policy 1999–2000. Her research interests include health services research, inequities in health, and child and youth health. Sue works part-time as a GP in Invercargill and as an Associate Professor Hauora Māori in the Department of Preventive and Social Medicine, Dunedin School of Medicine, Otago.

Iwi affiliations: Waitaha, Kāti Mamoe and Kāi Tahu Iwi




In this section

Back to top