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Health Sector Reforms: Localities

We are fortunate to have Ian Powell, former Executive Director of the Association of Salaried Medical Specialists, as one of our members. Ian is a highly regarded health commentator and has followed the 2022 reform of the health sector closely. He has provided this overview of the changes for us.

Localities, KHAG and KCDC

When the Pae Ora (Healthy Futures) Act became law on 1 July 2022 it radically restructured our public health system. This was by vertically centralising the system, primarily through disestablishing district health boards.

An immediate effect was the loss of a local statutory body responsible for the health of geographically based populations, including advocating to government for addressing these needs. This raised the importance of KCDC filling the gap, not as a provider of services, but as a statutory advocate for Kāpiti’s health service needs.

The new act also required the establishment of ‘localities’ in areas such as Kāpiti. This became the initial focus of KHAG, as an advisory body to KCDC. A paper was developed and adopted advising that KCDC would be most effective in advocated improved health services if there was one locality in Kāpiti. It also identified and listed a range of health services that should form part of a locality plan.

Implementation of localities is spluttering and looking to be little more than a geographic map. If there is a change of government we expect they will be history. However, KHAG is now focussing on KCDC becoming a de facto locality. This is consistent with the wellbeing requirements that KCDC is responsible for under the Local Government Act.

As part of this KHAG is developing a compelling case for an innovative integrated care facility based on expanding the Kāpiti Health Centre. This would be a mix of primary care (general practice), 24/7 urgent care, and less complex planned hospital services (including more outpatient clinics, beds and diagnostic support).

KHAG is looking discuss this innovative approach with Health New Zealand (Te Whatu Ora), informally to begin with. It will be a challenge but, as the conqueror of Everest said, nothing ventured, nothing gained.


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