From Fragmentation to Integration - the Canterbury Way



Since 2007, the Canterbury District Health Board has worked to transform a fragmented set of services into an innovative, integrated health care system across primary, secondary and tertiary care. The stimulus for change was a recognition that the existing system was unsustainable and increasingly under pressure as population demographics changed. While this transformation is by no means complete, a number of innovative initiatives have been developed and successfully implemented. Many people contributed to the development of the integrated model, relationships have been fostered and enhanced and leadership has become collective, shared and distributed. The ‘one health system’ is person-centred, based on public health principles and focuses on supporting people to stay well in the community. At the heart of the developing integrated system is the Canterbury Clinical Network (CCN), an Alliance of 11 organisations, including the DHB, the Public Health Unit, the Primary Health Organisations, Pharmacy, Midwifery and Home Care Services. This Alliance works collaboratively with Maori and Pacific providers and other community organisations to ensure a joined up system across the region. In 2015, the NZ Ministry of Health decided to restructure and realign the tobacco control services, and invited bids for new smoking cessation services for local areas. The CCN worked with a range of partner organisations to develop a collaborative submission for a new cessation service. The integrated Canterbury model precluded the development of this service in isolation and the result was a fully integrated smokefree system for Canterbury. Key Words health systems reform, tobacco control,population health planning Key Messages 1. integration is key to a sustainable health system 2. tobacco control is a system, not a set of services 3. collaboration and a collective vision are essential in an alliancing process


Vivien Daley & Matthew Reid

Canterbury District Health Board

Dr Vivien Daley
Vivien has worked in Public Health for many decades – firstly as a community health promoter in alcohol / tobacco, then in the University of Otago as a research fellow in the area of adolescent sexual health, then as project manager for a large Primary Health organisation, Pegasus Health, working on a variety of population health initiatives. Vivien is now the Smokefree Manager for the Canterbury District, with oversight of smokefree and stop smoking initiatives and services across Canterbury. Vivien is a long time member of PHA New Zealand, and has held different roles within the PHA, including Chair of the local branch and a member of the national Council.

Dr Matthre Reid

Matthew is a Public Health Medicine Specialist working in the Planning and Funding Division of Canterbury District Health Board, New Zealand. He focuses on designing and influencing the health system to prioritise health equity, prevention, and quality care. He enjoys using data to explain population health and drive the best use of health resources.