The call for such examination comes from health policy academics Assistant Prof Miriam Laugesen (Columbia University, New York) and Prof Robin Gauld (University of Otago) in Democratic Governance & Health.
This slim fact-packed book explores the history of elected representation on hospital and health boards and questions the future of the existing system.
The authors say New Zealand is the only country in the world where elected boards have been a ''core and enduring feature'' of post-war health governance.
Laugesen and Gauld would like the public given the opportunity to review the existing model, possibly through a referendum. They accept people would need more information than they have now on which to evaluate the boards, including research on whether the existing boards make better decisions than appointed boards would.
They do not really discuss that one of the issues with the current setup and its mix of appointed and elected members may be it is poorly understood by the public. Many boards attract little media attention and, even if they do, much of their work is done beyond the public gaze. Also, it is possible many people perceive board members have more influence than they actually do.
Often, the only time people notice their boards is when services are threatened.
How many voters realise the primary accountability of board members, of whatever ilk, is to the minister of health and central government, rather than their own communities?The authors say it is not clear boards have been able to provide the all-important capacity expected of a governing board to drive innovation, monitor and question the performance of providers and act as a sounding board for the chief executive and other full-time employees, because they lack the expertise needed.
They say these gaps include finance and accounting, clinical governance, information technology, quality improvement and primary care.
I believe their suggestion the $16.9 million fraud of the then Otago District Health Board might have been avoided if there had been more IT savviness on the board is questionable however, considering the way in which that fraud was carried out. As I understand it, the size of the amounts siphoned off to a bogus company was unlikely to attract the attention of a governance body.
The authors acknowledge most boards have been focused on austerity. Could this, and complying with directions from the Government, have stifled some innovative tendencies, I wonder?
They suggest reducing the number of elected members from the existing seven to two or three and giving those members the specific role of consulting the public.
Clearly defined roles and responsibilities under law could reduce disagreements between such members and appointed members. While this sounds good, in practice could it still be a very lonely path for elected members, where it might be easy for community input to be sidelined or at least under-valued?
Such a reduction in numbers, they say, would require ''moving away from more sentimental notions of geography and locality''.
A related question was whether national decisions about such things as total funding for health were more important than local decisions about services.
The existing 20 boards could also be further reduced, they suggest.
As someone with a keen interest in health issues, including the convoluted politics, I would welcome a far-reaching debate on the issues raised by Laugesen and Gauld, but I'm not holding my breath.
- Elspeth McLean is a columnist and former ODT health reporter.
