The role of District Health Boards

Had an interesting meeting tonight with David Choat, who is a member of the local DHB.

I have always been a bit confused about the role of these boards.

Do they govern the health services within budgets and targets set by ministers, almost like a company would - and largely in secret?

Or are they publicly accountable bodies whose elected members have a responsibility to debate the hard issues in public, air disagreements and alternatives, and come to transparent calls?

The culture is the former. David is a bit more aligned with the latter.

What do you think?

Comments

[Hilary]

Their meetings are usually open to the public (although I don't think the public takes much notice) and only go into committee when talking about staff matters or politically sensitive stuff about negotiating around budgets. DHBs have it tough a lot of the time. Not enough money, lots of demands including from ministers like the current one with very strict targets for a very small list of favoured conditions which don't include such major issues as mental health and disability support. I've been on a DSAC for a term and I was quite impressed about what I saw re good intentions generally of the board members and senior staff (admittedly it was under the exceptionally good Ken Whelan). But so many conflicting agendas to manage, so many silos, poor communication across many areas and conflicting systems even IT, so little money to stretch across primary secondary and tertiary health care. Vital to have elected board members there especially those with good links to the community. So to answer your question: yes the minister sets their budgets and targets and would probably like them to do their business in a secret and corporate and competitive way. But they are also public bodies run for and by the people of the region, and need to be brave enough to engage the public in their debates and welcome them into governance roles. This is what the 2000 Health Act envisaged after a decade of neo-lib corporatisation in the 1990s.