Clark backs reduction in number of DHBs
Health Minister David Clark wants to cut the number of district health boards.
Cutting the 20 DHBs to between 8 and 12 was one of the heftiest recommendations of the major review of the health and disability sector, which was published yesterday. Clark said he personally backed this recommendation ‘‘absolutely’’.
‘‘The report identifies that we are likely to have roughly half the number of DHBs in five years’ time,’’ he said.
But changes might take a while to come. The Government, and the three parties that make it up, haven’t accepted any of the specific recommendations, although Cabinet, comprised of Labour and NZ First ministers has endorsed the ‘‘direction of travel’’.
Changes will be talked out among the current Government and won’t be implemented until after the election. That would mean each of the three parties could campaign on the recommendations, should they choose to. In the case of DHBs, the report didn’t make any recommendations on which to merge.
It appears that smaller DHBs would be more in line for amalgamation, rather than large ones, including the three Auckland DHBs.
Clark said the Government would need to do ‘‘locality planning’’ before any amalgamations took place to make sure that services were available for people where they live. Clark also offered tentative support for ending DHB elections, saying people often didn’t know the candidates they were voting for.
The report, by former prime minister Helen Clark’s chief of staff, Heather Simpson, recommends several other massive changes including a new centralised Health Agency, with a board split 50-50 between Ma¯ ori and non-Ma¯ ori.
David Clark said that Cabinet had ‘‘accepted the case for reform, and the direction of travel outlined in the review’’.
He said Cabinet was particularly keen on the changes that ‘‘will reduce fragmentation, strengthen leadership and accountability and improve equity of access and outcomes’’.
The review is so significant, its implementation won’t be handled by the health minister alone. Instead, it will be driven by Prime Minister Jacinda Ardern. She’ll lead a group of ministers that will drive the changes. The group will include David Clark,
Finance Minister Grant Robertson and Associate Health Minister Peeni Henare.
Green and NZ First ministers are not part of the group.
Green Party health spokeswoman Julie Anne Genter, while welcoming the review, questioned one of its key recommendations: that district health board members be directly appointed by the minister, rather than partially appointed through local body elections.
‘‘The proposed replacement of DHB elections with appointed boards must ensure communities can still have a say in health decisions that affect them, if it goes ahead,’’ Genter said.
‘‘Voter turnout for DHB elections is notoriously low, so we agree that the current system could be improved.’’
NZ First is yet to address the report, although the party has MPs in Cabinet who have, therefore, endorsed the report’s ‘‘direction of travel’’.
The report recommends the health budget gets a guaranteed adjustment each year to account for population growth and demographic changes.
This would effectively guarantee large annual increases to the health budget to avoid accusations of health being ‘‘cut’’ by stealth through increasing its budget in absolute terms, rather than by population.
The Government announced the review in 2018. Clark said his first priority would be to lock in changes made during the recent pandemic.
‘‘One immediate priority will be to lock in many of the positive changes made in recent months in response to Covid-19, such as the greater use of virtual consultations and e-prescribing and the renewed national focus on public health,’’ he said.
‘‘Reforming our health and disability system is a massive undertaking, and will not happen overnight. Meaningful change and improvement will take concerted effort over many years.’’
‘‘Reforming our health and disability system is a massive undertaking, and will not happen overnight.’’
David Clark
Health Minister