On Wednesday I was given the opportunity to make some remarks to the first meeting of the re-constituted DHB Governance Board. Here’s what I had to say …

Thank you for this opportunity to address the Governance Board. I have two concerns I would like to present today.

The first deals with the DHB’s public education and advocacy role.

The second, not unrelated, deals with public accountability and the need to clarify for us locals the new modus operandi under which this re-constituted Governance Board will function.

So first, public education and advocacy.

Three of the statutory functions of the DHB prescribed by the Public Health & Disabilities Act include:

  • regularly investigate, assess, and monitor the health status of its resident population, any factors that the DHB believes may adversely affect the health status of that population, and the needs of that population for services;
  • promote the reduction of adverse social and environmental effects on the health of people and communities;
  • issue relevant information to the resident population, persons in the health and disability sector, and persons in any other sector working to improve, promote, and protect the health of people.

These legal duties mandate that the HBDHB should perform a strong public advocacy role on behalf of its local constituency. And, I believe, it should do so even if that advocacy is not comfortable to central or local government. But over the past year, the DHB has failed in this defining responsibility. The DHB has been stunningly silent and passive on a number of important issues affecting public health in the region. Four examples:

1) As required by Government policy, the use of inefficient woodburners that exacerbate PM10 pollution in the Bay’s urban airsheds must cease. The adverse health consequences of fine particle pollutants is irrefutably established. A report published last week in the NZ Medical Journal called NZ’s care for respiratory illnesses like asthma “deplorable in a First World country.” Yet some local elected officials are making downright stupid and misleading statements about the health effects of PM10 so as to fuel public opposition to more stringent regulation. A public consultation period is now underway, with the public largely ignorant of the health implications. Where is the DHB’s forceful and public explanation of how serious the health hazard — and need to act — actually is?

2) The Regional and local councils have dragged their feet in responding to widespread concerns about water quality and health threats from water pollution, and more lately, even about the supply of safe drinking water. Where is the voice of concern from the DHB? Instead of leadership, again and again the DHB passively defers to local bodies who have zero health expertise, even on matters like erecting public warning signs on polluted streams.

3) Local residents in Whakatu complain repeatedly about health effects and risks from neighboring industrial operations, in the form of air emissions, water discharges and use of hazardous chemicals. Why doesn’t the DHB investigate the issues on their behalf?

4) When local citizens are concerned about losing much-needed community-based health care or addiction facilities of proven effectiveness (e.g., Springhill Centre in Napier), is the DHB friend or foe?

I fully appreciate that final authority to remedy these matters might lie elsewhere. But DHB must serve as the proactive authority in getting at the underlying facts as they affect public health, and insisting that those facts drive community understanding, as well as local body policy, regulation and enforcement activities.

I would like to see the DHB substantially step up its advocacy in such matters, and
I would like to know the Governance Board’s position on the advocacy role of the DHB going forward.

Which brings me to my second concern – who is accountable for what under this new regime?

This new “Governance Board” is still chaired by Commissioner Sir John Anderson, who, legally, still holds ultimate authority for the HBDHB, reporting to the Health Minister.

At the same time, the elected members have each returned with the understanding that they are to exercise all the responsibilities and authorities that they were originally elected to exercise.

I strongly sense that Hawke’s Bay residents think the elected Board is once again calling the shots, and that on health advocacy issues like the ones I’ve just cited, the views of the elected Board would determine the direction of the DHB.

I believe that public accountability requires that you, Mr Chairman, make a clear public statement – this morning would not be too soon, given today’s discussion of terms of reference – as to how this Governance Board will actually operate. In what spirit? Is this “re-instatement” merely cosmetic, or can we expect our elected Board members to exercise, on a fully informed and proactive basis, the responsibilities for which they were originally elected?

I, for one, would not expect the advocacy role I’ve urged this morning to be performed effectively by Commissioners who, with one exception, have virtually no local knowledge, involvement or presence in our community. If our elected Board members have no authority, just tell us that, so we do not hold the wrong people accountable for any continuing failures of public health leadership here in Hawke’s Bay.

Thank you.

The Chairman, Sir John, thanked me for my comments and moved on to the next agenda item. No questions. No discussion. Not surprising, really, when you consider how tightly controlled the Governance Board is.

Consider these two provisions from the Terms of Reference for the new Board:

“If a Governance Board member wishes to communicate with the media in regard to HBDHB matters, it should only be done with the consent of the Commissioner.”

Comically, this makes Sir John, who himself eschews media contact, the gatekeeper for any media contact by others. Hopefully this rule will be frequently broken.

Then, referring to Board members’ interaction with DHB staff:

“Any meetings or communications with management outside Board and Committee meetings should be with the consent of the Commissioner and Chief Executive.”

Talk about a short leash on elected Board members! This is what passes for “good governance” at the local level in New Zealand (similar “rules” are adopted by other local bodies). And we wonder by local body bureaucracies are so unresponsive and out of touch!

Tom Belford

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  1. I'd love to know what's going on with our Art Deco Trust. Dave Pipe resigns, John Cocking resigns, seem like others have and will. Heard today GEON and other sponsors may withdraw their support and reconsider their sponsorship – seems like like this new girl Minett is riding roughshod over lots of people. Heard that her response was that there are several other potential sponsors waiting in the wings…………..wow! Who are the Board members? Who owns Art Deco Trust? Some of the public (like me) don't know the full ins-and-outs. About time we did!

    Maybe some employees deserve to go, maybe not. Folk like those who've just resigned are deserving better? And at a time when the Art Deco weekend is upon us! NOT A GOOD IMAGE!

  2. I find Tom Belfords comments interesting. He really should really do his homework properly and get his facts right. It does'nt surprise me at all the Sir John has placed restrictions on the board – they were a dysfunctional bunch at the best of time. They regularly interfered with senior management and most certainly did not have the interest of the community at heart. Health care in HB suffered immensely under their tenure – just look at cancer services in the region.They were anything but publically accountable. David Cunnilife described them so aptly in parliament " self perpetuating ……….. e.t.c" I don't see much improvement in the future – in fact more likely a worsening of the situation. Hopefully a new CEO will bring some fresh air into the siuation but don't hold your breath ! This board certainly won't – more of the same old.

  3. Regardless of whether the Board members are actually the right people for the job, Tom's points are valid: a DHB has – or should have, as they empowered to – the ability to assess and advocate over a wider range of subjects/effects/impacts than they currently bother to look at. The preoccupation with primary care – symptoms, not causes – ultimately is an admission of failure, no matter who's in charge.

  4. Not arguing on those points. However you still need to make sure there is effective tertiary care and as elected board members that is just one of their many responsibilities. Unfortunately the damage has been done by poor environmental factors or whatever and someone has to clean up the mess – thats where teritary care comes into the picture. The cancer rates in HB are extremely high and service delivery is apalling. Nobody seems to be questioning why (I tried and failed miserably – reviews were buried, senior management were not prepared to stand up and be counted, and the board were so busy playing politics they had no wish to get involved). HB has lost a lot of very competent specialists over the past 5yrs – many leaving because of the lack of facilities, poor service delivery, in-house politics. Yet the issues are never addressed ! Local politicians choose to only listen to those who can "progress" their careers and the editor proclaims to have investigated all the issues behind the sacking of the board when sadly he has only just "skimmed the surface" literally.

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