Does Kevin Atkinson have any power (even if he weren’t left twisting in the wind)?

Back in October, I had no idea on what criteria to base my votes for members of the HB District Health Board. Especially with respect to assessing incumbent members standing for re-election.

After quite a bit of digging about, I still can’t answer the question. In part, that’s why BayBuzz will stick with this issue in the coming months.

Arguably, IF regional health indicators were exceptionally positive, or at least trending in the right direction, and, IF Board members could credibly claim they actually had something to do with those outcomes, then we could feel good about assessing members on the basis of their performance.

Unfortunately, it isn’t at all that clear. At the moment, we’re left with more questions than answers. For example …

  • It’s said that people are “sicker” in Hawke’s Bay — more cancer, more heart disease, more diabetes, for example — than in most other areas of the country. But taking that as true, is it true for reasons the Health Board can do anything about? Maybe these afflictions are symptomatic of demographic factors, like disproportionate percentages of poor or elderly people. If so, it wouldn’t seem the Health Board could do much about the outcomes.
  • We read constantly of medical staffing issues, with all types of health professionals underpaid relative to opportunities abroad. Hence, turnover, vacancy, recruitment cost, productivity and morale problems. But again, pay levels are for the most part negotiated at the national level. It can’t be argued that the HB Board underpays relative to other regions, and therefore serves up inferior or too few caretakers. So again, it would seem that the Health Board is off the hook.
  • The day-to-day care most of us receive from our GPs falls outside the “jurisdiction” (certainly, the funding channel) of the Health Board. Instead, for example, Primary Health Organizations (PHO’s) receive funding directly from the Health Ministry to pay for your child’s vaccination (the drug is provided to your GP and he or she bills the PHO for the delivering the service). So, if one thought the path to better health outcomes in the Bay were more preventive care for children, again, is there any role or responsibility there for which Board members can be held accountable?

Let’s make this simple by comparison.

In a month or so, Councillors on the HB Regional Council are planning to set forth some number of specific strategic goals they plan to strive toward in the coming term. Maybe the goals will be too fuzzy to permit real accountability. Or maybe the Council might say something like: “Our goal is to improve water quality — as measured by A, B, C — by 50% over the next three years.” That would be a tangible goal against which the Council could implement specific policies and activities. And then be held accountable. The point: the goal in this hypothetical is matched by authority and capacity to achieve the goal.

But what is an equivalent example with respect to Bay health care and the ability of the Health Board to actually affect outcomes? Can the HB Health Board members say, for example: “Hold us accountable for our strategy to reduce obesity in the Bay by 10% over the next three years”? I think not. And I’d welcome any BayBuzz reader to serve up some examples!

Most importantly, if District Health Boards have so little authority or discretion to affect macro outcomes, to actually shape health care priorities and delivery in a strategic manner, what is the point of having them? Why are we wasting money on a layer of officialdom that can’t influence anything of consequence … and therefore can’t be held accountable — positively or negatively — for anything of consequence?

What do District Health Board members do (not the hospital, not the medical staff) to earn their keep?

These are the kind of questions BayBuzz will be examining more closely. And we will certainly approach Board members and the District Health Board’s CEO, Chris Clarke (another one of those faceless CEO’s who make the decisions that really affect our lives), for their answers.

And if it turns out that all the serious action in the health game takes place at central government, at the Health Ministry, we’ll certainly be asking the region’s incumbent MPs (and those who stand against them in 2008) for their perspectives as well … in due course.

Stay tuned. And stay healthy!


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