Cure sick DHBs with the right leadership
If you need a house built, you hire a builder. If you need someone to fix your car, you hire a mechanic. Seems simple, right? But what about when you need someone to run your local health system?
Then, in New Zealand at least, you hire random members of the public who may have no relevant experience whatsoever. Naturally.
Given such a context, it should be entirely unsurprising that District Health Boards around the country are requiring government bailouts left, right and centre. This week it was reported that the Government has been forced to pay $368 million in emergency funding to embattled DHBs over the last two financial years. Nine out of the nation’s 20 DHBs have required bailouts to pay for expenses as mundane as basic operational costs, such as the salaries of nurses, doctors and other hospital workers.
There’s no doubt that the health system is under considerable pressure. Wait times for surgery are long, emergency rooms are overflowing in winter, buildings are old and in need of repairs, and staff are overworked, among other issues facing the public health sector. Some of this can arguably be attributed to numerous successive terms of underfunding under the previous National Government, but with continued deficits and emergency funding requests, questions should also be asked about the governors tasked with running DHBs.
Democratic elections for District Health Boards have always seemed bizarre to me. Though it’s important to listen to the views of the community when designing services to serve them, the idea that anyone, regardless of their experience, qualifications and skill set (or lack thereof ) could be elected to a position where they are tasked with effectively running the health system in their region seems a bit bonkers.
Yes, the Ministry of Health has the power to appoint up to four members to provide professional experience, but the balance doesn’t seem right. When the majority of the board is elected, it’s quite possible that the majority of the board may not have the right expertise (if any at all) to run what is a complex and enormous organisation.
When the majority of the board potentially doesn’t really know what it’s doing, that’s highly unlikely to result in robust discussions around the board table leading to sound, fiscally prudent decisions.
Not all boards are created equal, and it’s important to note that some DHBs are managing their budgets effectively. When just under half, however, are in the red and requiring emergency assistance, you can hardly argue that the system is working well. This isn’t a case of outliers skewing perception. There are serious problems around the country, and hard questions need to be asked.
One of the problems is that name recognition tends to have an impact in democratic elections. Famous candidates and incumbent board members are likely to be re-elected (unless they’ve screwed up monumentally and it’s been reported by the media) regardless of their career histories, or how well they’ve performed. There is no independent body that conducts performance reviews of DHB members. If someone useless is popular with the electorate, they’ll likely loiter on a district health
Those putting themselves forward without relevant expertise or experience are either misguided or even possibly arrogant to decide that they have what it takes to govern in a sector they have no grounding in.
board for years and the public will be none the wiser.
Another problem is that with an ageing and growing population, the health system is going to face higher demand and more complex issues than ever before. Call me crazy, but in a sector that is likely to face significant challenges, you don’t really want laypeople at the helm. You want experienced, skilled professionals who are expert strategists and competent governors to help the organisation not only to weather the storm, but to emerge stronger afterwards.
None of this is to denigrate board members’ good intentions and enthusiasm. People with wonderful ideas and an abundance of passion are often drawn to roles where they hope to make a difference. Mike King’s I Am Hope project is one such cautionary tale that I believe is relevant here. While no one could doubt that organisation’s passion, nor deride the dedication and vision of its leaders, the fact that it ran out of money with no further funding secured in advance suggests that its governance was not particularly sound.
Making a difference in an organisational setting, providing quality services for clients and ensuring at the very least that the bills are paid and the doors stay open, is a challenge that requires good governance, conducted by directors who have the right mix of skills, experience and foresight to plan for best and worst-case scenarios, pivot quickly when things aren’t quite right, and steer an organisation through times of both struggle and success.
District Health Boards desperately need such governors. I would suggest that at least half of each health board around the country should be appointed experts, or even better, 60 per cent. Retaining a minority of elected board members would allow DHBs to stay connected with their local communities, without giving the balance of power to people who may not have the skills to wield it properly.
A comprehensive review of the health system (chaired by Heather Simpson) is due to be released in the first quarter of 2020, and I hope it recommends either the abolition of democratic elections for District Health Boards (accompanied by the establishment of a community consultation structure below board level and specialist Ma¯ori representatives) or a reduction in the percentage of elected board members on DHBs.
I’d argue that as New Zealand faces perhaps some of its biggest health challenges yet, we don’t really want people who don’t have a mix of business and governance experience and specialist knowledge of health systems running our DHBs. Depending on how you look at it, those putting themselves forward without relevant expertise or experience are either misguided or even possibly arrogant to decide that they have what it takes to govern in a sector they have no grounding in.
It’s time to make the hard calls needed to cure our sick and haemorrhaging health system.