After all, this is our second-largest DHB in terms of population and area.
In recent weeks, seven out of the 11-strong executive leadership team have resigned. It seems some may have new jobs to go to, but most do not. Consternation over the resignations has led to a staff demonstration and concerns voiced about the adversarial nature of the relationship between the leadership team and the board and crown monitor Lester Levy.
Among those who have resigned is chief executive David Meates, who, in earlier years was feted for leading work to achieve much better integration between community and hospital services, moves which helped keep patients out of hospitals.
In a 2016 Otago Daily Times interview he said initially what he had to deal with were "old fractious fighting tribes" — GPs, hospital doctors, pharmacists, all who had traditionally blamed each other for whatever was going wrong.
It was work which was not easy but which stood the region in good stead when the devastating earthquakes struck.
The relationship between the board and the Ministry of Health has been festering for years, but the crunch came over this year’s expected $180million deficit, the biggest in the country. Management, under pressure to reduce this, produced a plan to save nearly $57million, but this is creating further controversy over the expected effects of staff cuts and reduced funding to services.
Dr Levy, brought in last year, says management has failed to reduce significant overspending and this has resulted in a deficit that has grown out of control.
Management’s stance is that it has been a revenue issue, and the deficit was caused by unfair funding which underestimated the population growth after the earthquake, capital charges imposed for new buildings and the cost of paying for private surgery while the board waits for a new hospital.
Dr Levy does not see the situation as a crisis, but the Prime Minister has said the Government wants to play a constructive role and needs to move quickly. This week, Director-general of health Ashley Bloomfield flew in for talks with the various parties, taking time to reassure demonstrators en route.
What might happen next is unclear, but there must be a better way to deal with this than what has been done to date which seems to have only created ill feeling and fears about service cuts.
Any hands-off approach by the Government would be disingenuous when it has known about the board’s situation all along and presumably hoped the new board and input from Dr Levy would fix it. Board members who might disagree with the direction being promoted now are in a difficult position too — under law all board members, whether elected or appointed, are directly responsible to the Minister of Health.
In the South we know all too well the damaging impact of ongoing DHB battles over deficits with the Ministry of Health and the ministry.
It is hard to see whether the move to between eight and 12 DHBs as proposed in the recent review of the health and disability system would improve these situations or exacerbate them .
The review panel wants Health NZ, the new body which would oversee DHBs, not to be an organisation which will just tell DHBs what to do. Rather, it would be designed to work with all parts of the system to ensure it is operating effectively, fairly and sustainably.
As the panel pointed out, effective leadership is as much about the culture of the sector as it is about the structure.
The Canterbury situation highlights both the need for that more collaborative model between DHBs and their masters and how much culture change will be required.
