Last month saw both the reinstatement of the elected Hawke’s Bay District Health Board that had been dismissed under the previous government, and the resignation of Chris Clarke as CEO.

Turbulent times! And they aren’t confined to this region. All the country’s DHBs are on a roller-coaster ride. The Waitemata DHB Chair resigned earlier in February. The Otago chairman was sacked just before our DHB was reinstated.

Earlier in the month Ruth Hill reported in the Dominion Post that the health system is “in dire financial straits…heading for bankruptcy”. DHBs have no choice but to live beyond their means, she said, if they are to provide the services we need.

That was also the message of Waitemata Chair Kay McKelvie in giving notice of her resignation. She commented, “You can’t keep screwing and screwing services down, otherwise you start getting problems … Health boards are stuck between a rock and a hard place. You have the choice of being fiscally responsible and disappointing people, or overspending and giving patients the kind of care they reasonably expect”.

The key word in that message is ‘reasonably’. What she was saying is that what you and I need, what it is “reasonable” for us to expect in the way of public health, simply can’t be provided by DHBs within present parameters. Either health boards must overspend. Or they must deny people basic care.

In other words, the system is stuffed.

That makes the job of elected Board members next to impossible. And in Hawke’s Bay over the next few months, they are likely to face an even more complicated situation than usual. They are harnessed with a Commissioner, will have a new CEO, and must sort out how to make an unusually convoluted hierarchy work.

HBDHB gets ‘C’

They are also confronted by impossible financial problems, which are mostly not of their own making.

Health Minister Tony Ryall recently issued dire credit ratings for many DHBs. He said they reflected “the worsening financial situation confronting many boards and the new Government … And we already know that the demand for capital is hundreds of millions of dollars in excess of what is available.”

In the Central and Wellington regions, a number of Boards have ‘B’ credit ratings, like MidCentral (in deficit, risk of further deterioration), Hutt Valley (break-even operations at risk of deterioration) and Wairarapa (projected break-even at risk of deterioration, operation under pressure due to backlog of deferred maintenance).

But, along with Capital and Coast (large deficit, risk of further deterioration) and Whanganui (large deficit, risk of further deterioration, cash flows strongly negative), Hawke’s Bay is in the ‘C’ category. For Hawke’s Bay the verdict is also a “substantial deficit” with the risk of further deterioration, and “no cash to pay for operational expenses or essential capital expenditure”.

So what do we do? Get rid of Boards altogether because the system does not work?

No, because that would be counter-productive. It’s not the Boards that are responsible for most of the problems. They’re a convenient whipping boy for Ministers of Health, a useful place to lay the blame.

But the elected Boards have far less power within the system than either the government of the day, or the health ministry in Wellington. Those are the areas where any real change must take place.

It was the politicians who moved to copy America, even when it was quite obvious we had a far better and more functional health system than America did. It was the politicians who adopted the framework of public-private partnerships – the framework that means so many health dollars are spent not in actually treating need, but in trying to work out who will and won’t get treatment and then in justifying often poor decisions.

It’s the health ministry that advises government and largely controls the parameters within which DHBs act. That might be fine if ministry officials actually understood what was going on in the localities, but too often they don’t.

That’s where the Boards come in. They are needed, especially, to represent those who elected them by telling both ministry officials and government where the system is failing. That doesn’t make them popular. I suspect the main reason our current Board fell foul of the previous Minister was she or he didn’t like their criticism. But it’s an essential role while we think through how to improve our failing system.

Frankly I think it may take an independent Royal Commission to do that. Meanwhile – who’d want to be an elected Board member? Good luck to those returning to the task!

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