District Health Boards' Performance To Be Made Public

Health Minister Annette King today said the performance of District Health Boards will be made public every year.

"Both DHBs' progress in improving the health of the community and their financial performance will be publicly compared against their stated goals and intentions, and alongside the achievements of other DHBs," Mrs King said.

Mrs King today released Cabinet decisions made this week relating to the accountability framework DHBs will operate under, board committees and powers of the Health Minister and Director-General of Health.

"The decisions clearly show the Government's intent to have efficient and effective health agencies which cannot conduct their business behind closed doors. I am releasing the Cabinet papers as part of the Government's commitment to greater transparency in health decision-making.

"As well as releasing information on a DHB's performance, I will be making their annual plans public. Government has also supported making the committee meetings of the board open to the public, as well as the board meetings.

"DHBs will also be subject to a rigorous series of planning and reporting requirements to ensure they meet their goal to improve the health of new Zealanders, undertake community consultation and spend taxpayers' money wisely."

Mrs King said DHBs would have a Health Improvement Advisory Committee, as well as a Hospital Governance Committee. The health improvement group will advise the board on the needs of the population and priorities for using health funding. The committee will help prevent hospital dominance in decision making by focussing on all health and disability service needs to advance the health and independence of people in the community.

"Boards will also have a Finance and Audit Committee to ensure good governance, and can establish other committees as required, co-opting external experts as necessary."

Cabinet this week also considered the draft New Zealand Health Strategy, which will be launched for public consultation on June 1.

More work is still being done on some elements of DHBs, including the Finance Minister's role, the division of roles between the Ministry of Health and DHBs, investment and balance sheet management and electoral processes.

"More work is also being done on Maori health," Mrs King said.

"In line with our commitment to closing the gaps between Maori health and that of other New Zealanders we decided more work was needed on issues to do with equitable Maori representation, Treaty of Waitangi implications on DHBs and a generic partnership model.

"Some of these issues are complex and require considerable work. We are not going to rush the decision making to achieve a quick outcome. We need to thoroughly consider all the options in order to make the very best decisions for the community," Mrs King said.

Ends

The three Cabinet papers mentioned above are now available on the Minister's website (www.executive.govt.nz/minister/king) and in hard copy from the Minister's office. A summary of the key decisions follows.

Summary of May 10 Health Sector Change Cabinet Papers

1. District Health Board Accountability Arrangements
2. District Health Board Governance: District Health Board Committees
3. DHB Governance and Health Sector Change: The Powers of the Minister of Health and Director-General of Health - Further Issues

(Note the following information is a summary only. The full Cabinet papers are
available on www.executive.govt.nz/minister/king.

District Health Board Accountability Arrangements

This paper covers the accountability framework DHBs will operate under. The New Zealand Health Strategy and New Zealand Disability Strategy provide the strategic context against which DHB documents will be developed.

 The Health Minister will provide annual planning information, including funding levels and specific performance expectations, for each DHB to guide the development of their accountability documentation.

 DHBs will be required to produce two planning documents;

1. A Strategic Plan developed in consultation with the community and endorsed by the Health Minister. This will outline local goals, objectives, targets and strategies - consistent with the New Zealand Health Strategy and New Zealand Disability Strategy. It will take a five to ten year perspective. A needs analysis of the community, involving consultation, will be the basis for the plan's development.

2. An Annual Plan incorporating funding and a Statement of Intent will be made public. It will be the formal negotiated accountability document between the board and the Health Minister. It will outline the required outputs and performance.

 DHBs will have two main legislative reporting requirements;

1. Regular performance reports, including monthly financial and quarterly performance reports against the annual plan, to the Minister of Health.

2. An Annual Report including audited financial statements to be tabled in Parliament.

 Boards will use nationally consistent standards to facilitate their public benchmarking of performance. The Ministry of Health will publish DHBs comparative performances annually.

DHB Governance: District Health Board Committees

This paper covers the purpose, size and membership of committees, their meetings and the roles of the DHB board and the DHB Chief Executive.

 Boards will be required by legislation to have two committees;

1. A Health Improvement Advisory Committee - providing advice on health gain and the management of the interface between primary and secondary care. It will advise on service prioritisation issues. It will mitigate the risk of hospital dominance in decision making and facilitate better integration between primary and secondary care.

2. The Hospital Governance Committee - overseeing and monitoring the hospital's performance. It will not be involved in day to day hospital management – the job of the Chief Executive and the management structure below her/him.

 The committees will be advisory and subordinate to the board. The board could delegate authority (but not accountability) to the committees as it saw fit.

 The board determines committee membership, which would comprise both board members and external expertise as required.

 One Chief Executive will be responsible for the management of the district health board's functions, including service delivery by publicly owned hospitals. Each DHB will develop its management structure below the Chief Executive level.

 Each DHB will establish a Finance and Audit Committee as part of good governance.

 DHBs can establish other committees as they require them.

 Committee meetings, like board meetings, will be open to the public.

DHB Governance and Health Sector Change; The Powers of the Minister of Health and Director-General of Health - Further Issues

This paper covers three issues. The ability for the Health Minister to merge or
divide boards, provisions in the new health and disability sector legislation
relating to investigations and inquiries ordered by the Minister or
Director-General of Health, and the ability of the Minister to establish a
Mortality Review Committee under a broad provision to establish committees.

 That officials will undertake more work on whether it is appropriate for the Minister to have the power to merge or divide DHBs, as well as DHBs being able to merge voluntarily

 Provisions in the Resource Management Act 1991 relating to inquiries and investigations may be an appropriate model for health and disability sector inquiries. Officials are to undertake further work on this issue and will report back to Cabinet.

 That the new health and disability legislation will give the Minister the ability to appoint committees where necessary. Section 46 of the current Health and Disability Sector Act contains this provision.

 That the new health and disability legislation contain provision for a Mortality Review Committee and that child, maternal and perioperative mortality be the committee's primary focus.

 The Mortality Review Committee will have powers to access the information it needs to carry out its functions and that it also protects personal information about individuals, including health professionals.

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