What can the Titanic teach us about the new health reforms?

25 August 2021

By Simone, Senior Communications Advisor

In April the Government announced major health reforms that would see all 20 DHBs replaced by a single health agency, Health New Zealand, a Māori Health Authority, and a new Public Health Authority to centralise public health work.

In a panel discussion at the College conference titled, There’s nothing new or special about the latest health reforms – it's just rearranging the deck chairs on the Titanic, four health professionals from within the sector shared their views on the reforms, and how they would like to see these entities addressing issues such as health inequities.

The panelists consisted of:

  • Dr Tristam Ingham, Medical Epidemiologist, University of Otago and disability advocate
  • Keriana Brooking, CEO Hawke’s Bay DHB
  • Professor Sue Crengle, Department of Preventive and Social Medicine, University of Otago
  • Stephen McKernan, Director of the Transition Unit for the Health and Disability System Review. 

A fun fact about one of the panelists: Dr Ingham was the one who came up with the COVID ‘bubble’ concept while advising the Ministry of Health on COVID-19.

Views from the panelists were wide-ranging and made for an interesting and thought-provoking session, with the first two panellists making comparisons between the sinking of the Titanic, and the proposed health reforms.


Keriana Brooking opened the panel discussion by outlining how we can learn from the Titanic’s failings when looking at our health sector: 

  • The number of lifeboats needed to ensure the safety of everyone on board was 64. The decision was made to include 48. However, only 20 ended up being installed, and only 18 were launched on the night it sunk.
  • Some lifeboats were launched with only 12 people on board, despite them being able to hold 65 people

Keriana said we need a health system that is different than before, and it needs to be a system that benefits and improves the lives of more people than it does now. “Let’s learn from the mistakes of the Titanic.”

Dr Ingham started by saying just because something is newer, brighter and shinier, doesn’t mean it will automatically be better. 

He told the audience that three percent of women from Titanic’s first class lost their lives when the Titanic sunk, compared to 54 percent of women in third-class. The lesson from this is to remember that equity is not a new issue. 

The audience were told that it wasn’t the structural issues that sunk the Titanic – they were there from the start. It was the culture and belief that the system was infallible and that appropriate safety measures were in place.

The lesson from this is to think of how the old adages ‘do more with less’, and ‘speed over caution’ (or translated in the health sector as throughput vs quality of care) show the limitations of the current health sector.

Professor Crengle gave us a different view. She said the creation of the Māori Health Authority and its role in the new health system gives us one of the most significant opportunities in as long as we can remember, and that she is looking forward to seeing how this is implemented and how the new system will address the important issues. She spoke of the 1991/92 reforms and how they afforded the majority of Māori providers that we have in New Zealand today to enter the health system, noting that before this time there were only a handful, mostly marae-based Māori health providers.

Stephen McKernan said these health reforms were not just a reorganisation of the deckchairs - it is a fundamental rewrite of some of the core components of our health and disability system, and that this rewrite is gearing the whole system, including Health New Zealand, to give effect to equity. He highlighted that there have been 220 engagement sessions to hear feedback from across the sector so what is eventually implemented will be different to what is in place currently and will be “enduring for the years to come.” 

Delegates at the conference then had the opportunity to ask the panelists questions and these covered funding around primary care, system change, retention and wellbeing in the workforce and localities for services.

Those who attended have received an email with information on how to view the recorded sessions from the conference that were held in the main plenary room.