Fewer DHBs would mean more money for health

The Herald reports:

Taxpayers forked out almost $66 million last year to pay 444 people to run the country’s 20 district boards.

The bulk of that money, up to $60m, pays for 231 chief executives and their senior executives while 209 board members and four commissioners are paid almost $6m for just 30 days of work each year.

The governance costs seem reasonable, but the cost of 231 senior executives is significant.

have been governed by 11-member boards, seven elected and four appointed by the Health Minister, since their inception in January 2001. Their remuneration and that of executive managers does not include expenses for mileage, travel, meals, accommodation and other costs associated with the job.

While managers work full-time, board members are only expected to attend one monthly board meeting and some committee meetings, around 30 days of work each year.

The workload on board members is often much more than that because of the huge demand on costs and no ability to change their income.

Many professional directors avoid DHB appointments because you have little power yet become the fall people when things go wrong.

Waikato District Health Board member Mary Anne Gill, a former manager at the DHB, said New Zealand had too many health boards and wanted the number cut by three quarters to free up desperately needed health dollars.

Gill believes DHBs should be culled from 20 to five, located in Auckland, Waikato, Wellington and two in the South Island, even if it means she might lose her seat.

That sounds reasonable. You could argue for another for the middle of the North Island.

She accepted the argument for democracy within DHBs but questioned whether the system was working.

“The reality is, as we saw in Waikato last year, that some things actually happen and the board don’t know a lot about it.

“You have to question exactly how much influence elected board members have.”

Elected board members are a sham. They are a mechanism for the Government to avoid responsibility for its funding decisions, by being able to blame DHBs. The Government should appoint all DHB members, so we can then hold the Government to account if things go wrong.

Downs said policy decisions were being made based on the short-term fiscal impacts of 20 different entities as opposed to what was best for patients.

“Almost everyone I spoke with (including chief executives of DHBs) agreed that these issues are exacerbated because there are too many DHBs,” the report said.

“Amalgamation could streamline data sharing, support collaboration between the sectors, reduce administration, increase accountability and simplify shared risk.”

Consolidation would create a larger patient base, free up clinical staff to spend more time with patients rather than focusing on administration and allow more thought to go into where funds would be best spent, she told the Weekend Herald.

I hope the Government does this.

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