Empty hospital debacle highlights what was lost with end of DHBs

It was recently revealed a brand new, $300 million eight-theatre hospital building, Totara Haumaru, which will focus on elective surgery, will sit unused at North Shore Hospital for months and months. Apparently, this is because Health New Zealand/Te Whatu Ora needs to work out how to staff and fund it.

Is this debacle a side effect of the Labour government abolishing local health boards? It seems very hard to believe a board of North Shore and West Auckland locals, and a local DHB chief executive would have allowed this to occur.

There were many flaws with the district health board (DHB) health system, and having 20 DHBs was probably too many. But there were some real advantages. Among these was having a local board to scrutinise the performance of the local hospital and health service, and advocate for local needs.

I know this from experience, as when I was in the Ministry of the Health, I heard very robust private and public advocacy from board members. And local board meetings opened the boards to public scrutiny, although often decisions were made in private and Official Information Act requests - or leaks - were required to access information.

Most significantly, having a local chief executive meant there was someone with the power to make things happen at that DHB. The Waitemata DHB, which used to run North Shore Hospital, had a very effective chief executive, and an articulate and engaged board. I am confident, if they were still in charge, the new hospital building would be up and running.

The desperate need for more elective surgery services is clear. In November 2023, it was announced that, shockingly, over 8700 people in the Northern region were waiting over four months for a procedure in June 2023.

Things have got worse. In fact, since then, the numbers waiting over four months increased over 30% to 11379 people at the end of January 2024.

Although Labour abolished health targets, the requirement remained for patients to get their procedure within four months of a specialist doctor determining they need it. Health New Zealand’s statement of performance expectation signed off by the Labour government had a “target” of no one waiting over four months. National has formerly reinstated this as a health target.

Totara Haumaru didn’t unexpectedly fall out of the sky. Approval for this project was given about seven years ago. Initial site works took place in 2020. The build started in June 2021 with occupation scheduled for early 2024.

When projects like this were approved, the then DHBs were routinely asked to come up with a workforce plan so when a hospital building opens it is staffed. A project business case also required a DHB to show they had the finances to operate it. I suspect the abolishment of Waitemata DHB got in the way. It is a constant frustration for those who now work for Health New Zealand that decisions have to be made in Wellington. And it seems to take ages for these decisions to be finally made.

Following the October election, Health New Zealand cannot have been surprised the new Government would focus on elective surgery. National’s manifesto made clear shorter times for elective surgery would be a target. The Government’s 100-day plan said the Government would set a target to reduce elective surgery wait times.

So, you would think Health New Zealand would have done all they could to open Totara Haumaru. It is therefore hard to understand how Health New Zealand’s head of hospitals, Fionnagh Dougan, could say, “we don’t have the total number of staff required along with the work, to open the facility” and that funding to run the hospital in 2024/2025 was still being decided.

Health New Zealand has known for years when the hospital building would open, what the staffing needs would be, and how much it would cost to operate it. And that the number of patients waiting over four months for surgery is growing alarmingly.

The move away from local hospital boards to a national provider is radical for New Zealand. For decades before 2022 we had local organisations providing local hospital services and, in some cases, funding other local health services. Until 2022 DHBs provided these services.

Those with longer memories will remember hospital and health services, crown health enterprises, area health boards and hospital boards. All of these had local boards, and a chief executive with wide decision-making powers.

The move to a national provider reduces local autonomy, and obviously increases the risk bureaucracy will get in the way of local decision making.

It is unlikely the Government will want to radically restructure the health system again. Further major structural change is the last thing the health sector wants or needs. But the Government may wish to look at changes to allow a more effective local voice, and to devolve decision making to a local level.

This should prevent debacles like a new hospital building sitting unused happening elsewhere in the country.