DHBs ‘not past use-by date’

The chairman of South Canterbury District Health Board has dismissed the findings of a study that suggests DHBs are past their use-by date.

The article, published this month in the Journal of Health Organisation and Management, raises questions over the way health board members are elected and whether boards are needed.

However, SCDHB chairman Ron Luxton disagrees with the findings, saying while improvements could be made, the boards were ‘‘still relevant’’.

‘‘I don’t know that I would agree with the fact that DHBs are past their use-by date.

‘‘I think there is room for improvement, there is room for better regional shared services, room for better national shared services in terms of finance, procurement and things that can be done on a regional and national level.

‘‘There are improvements that can be made but I certainly wouldn’t go along with the premise that DHBs are past their useby date.’’

As part of the research, conducted at Lincoln University, agendas and minutes from 32 Canterbury District Health Board meetings were analysed and coded following standard content analysis methods.

Of the 32 meeting documents, 12 were taken from September 2009 to September 2010, the remaining 20 were from February 2012 to October 2013, a period in which the Canterbury earthquakes increased the need for decisions specific to the region, co-author Dr Greg Clydesdale said.

‘‘The gap in time is to reduce the distorting effects of the earthquake, although it still influenced the latter period.’’

The research found there were no public presentations to the board in the period studied.

‘‘This suggested that the current structure is not the best way to facilitate public participation,’’ Clydesdale said.

He said health boards have had a poor run recently, and that may be due to how their members are appointed.

‘‘Health management and governance have become highly specialised but, every three years, voters with no knowledge of healthcare decide who should be on the board,’’ he said.

‘‘It is an exceptionally poor way to appoint people to such a specialised activity.’’

Luxton said it was important local communities have some means of import into the governance of their health system.

‘‘. . . we are the smallest DHB in the country and yet we continue to provide healthcare sustainably. That is, we live within our means which affords us to do the refurbishment and renewal that we’re doing now.

‘‘We still on most measurements meet the targets that we set. Comparatively with other DHBs we are in the top third in terms of performance,’’ Luxton said.

‘‘. . . we are the smallest DHB in the country and yet we continue to provide healthcare sustainably.’’

Ron Luxton

‘‘We are probably the largest employer in the area and I think all those things combined will have some kind of local input in the delivery of those services,’’ Luxton said.

Clydesdale said the analysis also raised questions about whether a board was necessary as their research revealed 99 per cent of all motions presented to the board were accepted.

‘‘This rubber stamping of management proposals raises questions whether the boards are adding value to the decisionmaking process,’’ he said.

‘‘Often the board are not given any options, in which case, we need to ask, ‘why are they needed?’’’

Clydesdale also questioned whether board level was the appropriate level to engage with the public.

Luxton said the SCDHB had advisory committees which included community members on them representing various sectors such as age, welfare, disability and other relevant sectors.

‘‘We have a consumer advisory council that advises management. It is made up of consumers of health, we have a clinic governance board as well to govern the clinical and ethical side of things and then we have our board committees all of which have extra public participation to advise the board,’’ he said.

‘‘On top of all those the board has seven elected members as well. There is room for public input in just about all the areas that we deal with.’’

Luxton said most people involved in health governance did so for altruistic reasons and not for remuneration as they wanted to give back and provide a service to their communities.