Intended for healthcare professionals


What can England’s NHS learn from Canterbury New Zealand?

BMJ 2013; 347 doi: (Published 29 October 2013) Cite this as: BMJ 2013;347:f6513
  1. Nicholas Mays, professor of health policy 1,
  2. Judith Smith, director of policy2
  1. 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2Nuffield Trust, London, UK
  1. nicholas.mays{at}

That integrating health and social care in a similar system is possible

A recent King’s Fund report describes impressive progress made by Canterbury New Zealand.1 It moved from a situation in the mid-2000s when the main acute hospital was regularly “gridlocked” with no possibility of affording additional capacity, to one where there is an extensive system of care coordination across hospital, community, social, and primary care. As a result, emergency medical admissions, lengths of stay, and readmissions have fallen appreciably. This raises two important questions: how was this achieved; and what can the English NHS learn from Canterbury, given the strong similarities between the two countries’ systems?

What did Canterbury do? From the mid-2000s, Canterbury District Health Board (which is the statutory local funder of health and social care, and also the manager of hospital and some community health services) began a process to persuade local health professionals and the public that provision in the district was financially and clinically unsustainable. The board argued that it needed to plan for the coming 20 years on the basis of “one system and one budget,” transcending the usual organisational and financial divisions. New strategic goals and principles were …

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