District health board

Map showing district health board boundaries since 2010

District health boards (DHBs) in New Zealand are organisations established by the New Zealand Public Health and Disability Act 2000 under the Fifth Labour Government, responsible for ensuring the provision of health and disability services to populations within a defined geographical area. They have existed since 1 January 2001, when the Act came into force.[1] There are 20 DHBs (fifteen in the North Island and five in the South Island). Initially there were 21 DHBs, and this was reduced to the current 20 organisations in 2010. DHBs receive public funding from the Ministry of Health on behalf of the Crown, based on a formula which takes into account the total number, age, socio-economic status and ethnic mix of their population. DHBs are governed by boards, which are partially elected (as part of the triennial local elections) and partially appointed by the minister of Health.

In April 2021, the Labour government announced that the system of district health boards would be abolished and replaced by a single agency to be called Health New Zealand.[2] In addition, a new Māori Health Authority will be set up to regulate and provide health services to the Māori community.[3]

History

District health boards were first introduced as an idea in the 1970s in the Green and White Paper suggested by the then Labour government. This was part of a plan to nationalise primary health care as the Social Security Act of 1938 had originally intended. Labour subsequently lost the election to Robert Muldoon's National Party in the 1975 election. Muldoon's government chose however to slowly implement these reforms in trial "area health boards", which can be seen as early predecessors of the district health boards.

The more direct predecessors were the Crown health enterprises (CHEs) and subsequent Hospital and Health Services (HHS) management structures of the 1990s; these were responsible for managing the hospitals under business ethos, albeit, with the expectation that the former would return a profit to the shareholders (i.e. the government).

In the 1990s "regional health authorities" (RHAs) were formed. These RHAs were amalgamated in 1997 to form the Health Funding Authority (HFA). The election of the Labour-Alliance government in the 1999 election saw the New Zealand Public Health and Disability Act 2000 passed by parliament, this led to the merging of the HFA with the Ministry of Health and the establishment of 21 district health boards. The functions for the new DHBs were drawn partly from the HFA and also out of the hospital management elements of the Hospital and Health Services board.

From their creation until 1 May 2010, there were 21 DHBs. At that date, the Otago DHB and Southland DHB were amalgamated by the Government to form the new Southern District Health Board.[4]

On 21 April 2021, Minister of Health Andrew Little announced that DHBs will be abolished and replaced by a public health agency to be called Health New Zealand, which will be modelled after the British National Health Service. In addition, a new Māori Health Authority will be established to set up policies for Māori health and to decide and fund those who will deliver services. A Public Health Authority will also be established to centralise public health work.[2][3] The transition will occur over a three-year period with an interim Health New Zealand organisation being set up in late 2021. Legislation establishing the new organisation is expected to occur in mid-2022. The second phase from late 2022 will be the expansion and development over a two-to-three year period.[5]

Epidemiologist Michael Baker described the establishment of the district health board system as driven by neoliberalism and characterised it as an "absurd system". He welcomed the abolition of DHBs.[6]

Organisation

The DHBs operate healthcare facilities. The Canterbury DHB operates Christchurch Hospital (pictured).

The Ministry of Health gives district health boards a set of objectives; they have a degree of autonomy in how they choose to achieve these. In contrast to their predecessors, the regional health authorities, the DHBs are non-profit providers. The DHB Funding and Performance Directorate of the Ministry of Health[7] monitors the performance of individual DHBs. DHBs provide funding to primary health organisations (PHOs).

DHB activities are governed by boards, which consist of up to eleven members: seven elected by the public every three years, and up to four appointed by the Government's Minister of Health. From 1 January 2001 the boards comprised appointed members only. The first elected members were chosen in the 2001 local-body elections held on 13 October using the first-past-the-post voting system (FPP).[8] Since the 2004 local-body elections, the single transferable vote (STV, a proportional voting system) has been used.[9] The use of appointed Board members aims to balance the boards' expertise as deemed necessary.[10] As part of the appointment process, the Minister of Health appoints a chairperson and a deputy-chair; either from the appointed members or from elected members.

Voting for public-elected DHB board members occurs at the same time as local-body elections. Local-body elections take every three years on the second Saturday in October. As defined in the legislation, elected and appointed (if they get appointed in time) members start their term 58 days after the election (i.e. in early December) and the term of the previous board finishes that day.[11]

Health Boards have been replaced by unelected commissioners in Hawke's Bay in 2009, Southern in 2015 and Waikato in 2019.[12] The basis on which ministers have made such decisions have been questioned.[13][14][15]

Taranaki and Wairarapa District Health Boards maintain their own ambulance services, with St John and the Wellington Free Ambulance covering the rest of the country.[16][17]

On 1 May 2010 the Otago DHB and the Southland DHB merged to form a new Southern DHB, with elected members coming from two constituencies – Otago and Southland – and the remainder appointed by the Ministry of Health, with the change taking effect from the 2010 local-body elections. From 1 July 2010, a unified primary health organisation has covered the entire new Southern DHB region, with PHO centres in Alexandra, Dunedin and Invercargill with the mandate of providing PHO resources and services, replacing the previous nine PHOs.[4]

Locations

There are 20 DHBs, organised around geographical areas, of varying population sizes, though they are not coterminous with the Regions of New Zealand:

Name Acronym/short name Website Area covered Population[18]
Auckland ADHB www.adhb.health.nz Central Auckland 545,640
Bay of Plenty BOPDHB www.bopdhb.govt.nz Tauranga City, Western Bay of Plenty District, Whakatane District, Kawerau District, Opotiki District 265,000
Canterbury CDHB www.cdhb.health.nz Christchurch City, Kaikoura District, Hurunui District, Waimakariri District, Selwyn District, Ashburton District, Chatham Islands 567,870
Capital and Coast CCDHB www.ccdhb.org.nz Wellington City, Porirua City, Kapiti Coast District (excluding Otaki ward) 318,040
Counties Manukau CM Health www.countiesmanukau.health.nz Pre-amalgamation Manukau City, Papakura District, Franklin District 563,210
Hawke's Bay HBDHB hawkesbay.health.nz Wairoa District, Hastings District, Napier City, Central Hawke's Bay District 165,610
Hutt Valley Hutt Valley DHB www.huttvalleydhb.org.nz Upper Hutt City, Lower Hutt City 149,680
Lakes www.lakesdhb.govt.nz Rotorua Lakes, Taupo District 110,410
MidCentral MDHB www.midcentraldhb.govt.nz Manawatu District, Palmerston North City, Tararua District, Horowhenua District, Otaki ward of Kapiti Coast District 178,820
Nelson Marlborough NMDHB www.nmdhb.govt.nz Tasman District, Nelson City, Marlborough District 150,770
Northland NDHB www.northlanddhb.org.nz Far North District, Whangarei District, Kaipara District 179,370
South Canterbury SCDHB www.scdhb.health.nz Timaru District, Mackenzie District, Waimate District 60,220
Southern Southern DHB www.southernhealth.nz Waitaki District, Central Otago District, Queenstown Lakes District, Dunedin City, Clutha District, Gore District, Southland District, Invercargill City 329,890
Tairāwhiti Hauora Tairāwhiti www.hauoratairawhiti.org.nz Gisborne District 49,050
Taranaki TDHB www.tdhb.org.nz New Plymouth District, Stratford District, South Taranaki District 120,050
Waikato Waikato DHB www.waikatodhb.health.nz Hamilton City, Waikato District, Matamata Piako District, Thames Coromandel District, Hauraki District, Waipa District, South Waikato District, Otorohanga District, Waitomo District, Ruapehu District excluding Waimarino-Waiouru ward. 419,890
Wairarapa Wairarapa DHB www.wairarapa.dhb.org.nz Masterton District, Carterton District, South Wairarapa District 44,905
Waitematā Waitematā DHB www.waitematadhb.govt.nz Pre-amalgamation North Shore City, Waitakere City, Rodney District 628,970
West Coast WCDHB www.wcdhb.health.nz Buller District, Grey District, Westland District 32,410
Whanganui WDHB www.wdhb.org.nz Wanganui District, Rangitikei District, Waimarino-Waiouru ward of Ruapehu District 64,550

See also

  • List of chairpersons of district health boards
  • Association of Salaried Medical Specialists, a trade union that represents just over 4000 senior salaried doctors and dentists, most of whom are employed by DHBs
  • List of hospitals in New Zealand

References

  1. ↑ "District health boards". Ministry of Health. 12 February 2020. Retrieved 12 April 2020.
  2. 1 2 Manch, Thomas; Witton, Bridie (21 April 2021). "Government announces radical plan to centralise healthcare, will abolish DHBs". Stuff. Archived from the original on 20 April 2021. Retrieved 16 November 2021.
  3. 1 2 Quinn, Rowan (21 April 2021). "Major health sector shake-up: DHBs scrapped and new Māori Health Authority announced". Radio New Zealand. Archived from the original on 21 April 2021. Retrieved 16 November 2021.
  4. 1 2 "New Southern DHB roles announced". Beehive.govt.nz. New Zealand Government. 31 March 2010. Archived from the original on 8 September 2012. Retrieved 20 April 2021.
  5. ↑ Small, Zane (21 April 2021). "All 20 DHBs to be replaced by one national authority, Health New Zealand, in 'major reforms' of sector". Newshub. Archived from the original on 21 April 2021. Retrieved 21 April 2021.
  6. ↑ Langstone, Michelle (1 May 2021). "'I went off a cliff': Meeting Michael Baker – and the man who plays him". The Spinoff. Retrieved 1 May 2021.
  7. ↑ DHB Funding and Performance Archived December 31, 2005, at the Wayback Machine
  8. ↑ "Editorial: Elected boards an unhealthy hybrid". The New Zealand Herald. 30 June 2000. Retrieved 8 January 2017.
  9. ↑ Choosing Electoral Systems in Local Government in New Zealand (PDF). STV Taskforce. May 2002. p. 27. ISBN 0-578-09275-X. Retrieved 2 May 2020.{{cite book}}: CS1 maint: ignored ISBN errors (link)
  10. ↑ "District Health Board Elections". Ministry of Health. 30 May 2004. Archived from the original on 31 December 2005. Retrieved 20 April 2021.
  11. ↑ "New Zealand Public Health and Disability Act 2000 No 91 (as at 30 September 2020), Public Act 14 When elected members come into office – New Zealand Legislation". www.legislation.govt.nz. Parliamentary Counsel Office. Retrieved 17 November 2020.
  12. ↑ "Health Minister David Clark sacks Waikato DHB board". Stuff. 7 May 2019. Retrieved 14 November 2020.
  13. ↑ "For the People, by the Minister: Ministerial Interventions in Subnational Elected Bodies and a Principled Approach to their Future Use" (PDF). New Zealand Journal of Public and International Law. December 2015.
  14. ↑ "Southern District Health Board dismissed by Health Minister over deficits". Stuff. 17 June 2015. Retrieved 14 November 2020.
  15. ↑ Macpherson, Dave (7 May 2019). "Waikato DHB Board sacking confirmed". Scoop. Retrieved 14 November 2020.
  16. ↑ "Ambulance Service". tdhb.org.nz. Taranaki District Health Boards. 10 June 2019. Retrieved 9 September 2021.
  17. ↑ "After Hours and Emergency". wairarapa.dhb.org.nz. Wairarapa District Health Boards. Retrieved 9 September 2021.
  18. ↑ "Subnational population estimates at 30 June 2009: local government areas". Ministry of Health. Retrieved 10 June 2020.
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