DHBs ‘costly, troublesome amateurs’
The undignified death throes of the Waikato District Health Board should not have come as a surprise to anyone. What is a surprise is that district health boards have survived as long as they have.
The boards have had a difficult history since they were first established in the 1970s by a Labour government. They were the first step in a plan for a national, fully government-funded primary health service which an earlier Labour government tried to implement in 1938 with the Social Security Act of that year.
The concept of elected lay people appointing health professionals and managing hospitals and health care has its origins in our colonial past when medical science was relatively rudimentary compared to today. A number of isolated rural
communities built their own hospitals and hired doctors and nursing staff. It was the only way they had of providing essential if costly first aid and basic health care and medical services to remote communities in those early days.
In 1975 Robert Muldoon’s National government decided to introduce similar reforms to the Labour policy with the first Area Health Boards, which were the predecessors of today’s district health boards but they retained the flawed concept of lay management boards.
In spite of the commendable efforts and selfless dedication and hundreds of elected and appointed board members over the years they were never going to be truly successful any more than elected boards of school trustees were. In reality most of these boards are no longer really required and are little more than idealistic impediments imposing another layer of often pointless bureaucracy on professional people trying to do an already demanding job. There are of course a number of exceptions to both but, even if senior teachers and doctors will never say so in public, they would much rather be left alone to do the jobs they are trained to do and report directly to their respective government ministries.
The Waikato District Health Board is not the first to run into difficulties with the complex system, either financially or politically. Following several years of internal issues the former Otago and Southland district health boards were amalgamated to form the current Southern DHB which is still currently run by commissioners and the Hawke’s Bay DHB also had commissioners appointed in the past.
No matter how well intentioned, and most clearly are, lay people will always struggle to effectively manage professional organisations, particularly one as costly and scientifically complex as a health service provider. These are not bowling clubs or sewing circles and are no place for amateurs.
That was clearly shown when the Waikato district health board failed to effectively manage or monitor expenditure by a former chief executive Nigel Murray who eventually resigned and a replacement has yet to be appointed. In the fallout chairman Bob Smock also retired leaving the financial accounts in serious deficit.
It is unlikely they were entirely to blame for the unhappy state of the books which the board is still struggling to address. For several years there has been a widening gap between funding and increasing expectations of all district health boards with Waikato forecasting a $56.1 million deficit for this financial year increasing deficit forecasts in future years. Even a government appointed Crown Monitor has failed to make significant headway due to instability at the governance and leadership level. There are also difficulties with maintaining accreditation from professional clinical bodies.
Of more concern however was the way the decision was made to challenge the findings of a coroner’s court over the death of Nicky Stevens while in the care of Waikato District Health Board’s mental health unit. His father Dave Macpherson was elected to the board following the tragedy and has been campaigning for improved mental health service improvements. He claims the decision to challenge the coroner’s finding, that the death was avoidable, was made ‘‘by DHB leadership, not the Board.’’
While some board members have downplayed the internal strife it is clear that something is seriously amiss particularly when board members engage in personal campaigns, no matter how apparently justifiable and significant decisions are made on behalf of the board without the involvement of all members.
Health Minister David Clark has a clear, if unpleasant, duty to put the Waikato District Heath Board out of its misery sooner rather than later. He might also consider that, if a commissioner can unravel the mess, there is a good case for making such appointments, or something similar a permanent arrangement.
The health needs and requirements of communities are well known to general practitioners and health professionals who deal with them every day. Costly and troublesome district health boards of amateurs were not a good idea from the outset.