Yesterday was DAY 28 of New Zealand in lock down as we try to fight the COVID19 pandemic.
Ever since their formation in 2000, in order to give New Zealand health services and the financial expenditure on them a more democratic face, I have had a problem with the manner in which D.H.B.’s operate. It is not that I am against having a democratic representation of our health care expenditure. On the contrary I believe it is absolutely necessary. But is there a better way to govern the health system?
The D.H.B.’s have long been plagued by accusations, many of them valid, of poor fiscal management. In 2019 for example it was found out that they had underpaid thousands of staff over several years, amounting to $590 million having to be forked out. More historically nurses and general practitioners have complained about the lack of urgency in supplying P.P.E. and other equipment in a timely manner. In 2010 the Auditor General released a report into spending on supplies and services.
Another issue has been the prioritisation of key projects. In Christchurch a multi-story car park building is meant to be completed in mid 2020 for staff working at the central hospital. Construction is yet to begin. This is causing many medical staff to fear for their safety coming off late or early morning shifts when it is still dark – I know a nurse whose car was stolen, trashed and abandoned.
In 2004, the Ministry of Health released its National Health Emergency Plan: Infectious Diseases. Section 4.8 which looks at equipment and supplies, acknowledges that hoarding of equipment might be an issue. It also mentioned challenges facing the prioritisation and distribution of equipment. At the end of Section 4.8 it says:
In planning inventory levels, D.H.B.’s must consider the need to provide supplementary or additional equipment and supplies (e.g. P.P.E. and emergency medicines)directly to primary care services.
The regional co-ordination teams will be responsible for prioritising equipment supplies and allocating them to hospitals and primary care services in line with national advice and guidelines.
Appendix III of the same document is the plan for a pandemic event such as COVID19.
Admittedly not all of the problems facing D.H.B.’s are of their making. Staff are taking P.P.E. from examination rooms, which in late March just as lock down was starting was causing shortages in some facilities. It was also causing anxiety about adequacy of supply.
New Zealand needs to get a more efficient governance model than District Health Boards if we are going to improve the quality of care that our medical system can provide. This is a view shared by others. And something that has not been ruled out by the Minister of Health, David Clark. A review was being led last year by Heather Simpson into how well D.H.B.’s work.
So, my question is:
How well do the D.H.B.’s work? If they do not work well, can the be fixed or does the entire D.H.B. governance model need to go?