My plan for a post District Health Board future

In 2000, the then Minister of Health, Annette King introduced District Health Boards to New Zealand. The intention was to return a degree of democracy to the health system through regionally elected boards. Whilst the idea was good in terms of democracy, as I will shortly explain, it has been hugely financially wasteful. Now, a report has found that not only have they been wasteful, the actual carrying out of their duties has been very poor. It has in recommendations as a result of that poor performance, put forward some substantial changes.

Criticism of the D.H.B. system has been around as long as the D.H.B.’s themselves. I fully expected that when National was in office in 2008-2017 it might have had a go at changing how the health system meets its financial and democratic goals by implementing something along the lines of either what is in the report that has just been released, or my own idea below.

To be clear, I never had any time for District Health Boards in the first place and think that the best thing that can happen to them is their abolition. 20 District Health Boards currently exist around the country. A report into the disability health system found that it was dangerous fragmented, but also has a very poorly run system of District Health Boards. The report also made a recommendation that the number of D.H.B.’s be cut to 8. A South Island General Practitioner has said that a solitary South Island D.H.B. would be plenty.

Instead of having 20 D.H.B.’s sucking up resources and man power that we cannot afford to squander, I propose:

  • A centralized Health Board that operates from Wellington and has 2 elected representatives from each province
  • A regional committee that the two representatives sit on be based in Whangarei, Auckland (x2 for reasons of population representation), Hamilton, Tauranga, Rotorua, Napier-Hastings, New Plymouth, Whanganui, Wellington, Nelson, Christchurch, Dunedin, Invercargill
  • Committee composition include G.P., nurse, a financial officer, 2x representatives, secretary, a community leader(s?)
  • Elections happen at the same time as the local government meeting

I expect that there would need to be an operating budget for each adjusted annually for inflation, and that there would to be established offices. One might say that we might as well just keep the D.H.B.’s then.

Not at all. The Health Board would dispense the funding, pass on Ministry instructions and the Regional Committees would ensure that the regional allocated goes to where it is needed. I envisage at least 2/3 of the current money being spent on D.H.B. operating costs to be saved, which would be in the order of several hundred million dollars per annum.

Given that this comes against a back drop of COVID19, renewed scrutiny on our race relations record and an acknowledgement that the health system has discriminated against Maori and Pasifika people, the changes are welcome. But do they go far enough in addressing the many and complex funding and resourcing problems that we have, as well as building up Intensive Care Unit capacity for major emergencies such as natural disasters and pandemics? That is another story altogether.

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