The country’s 20 DHBs were scrapped last year as part of the government’s ongoing health reforms — ongoing, as in the health locality system touted as ensuring a greater local voice in decision-making on the provision of local health services is not actually properly up and running yet. That is a whole other story.
But why are DHBs back? Because every financial year taxpayer-funded ministries, agencies, organisations and boards are required to front up before members of Parliament — the taxpayer’s representatives — to answer any questions about just how they spent the public’s money.
The end of the DHB system came after the end of the previous financial year, hence DHBs — or what could be mustered of them — were required to return to Parliament for one last huzzah to discuss their final few months’ expenditure.
Given that the publicly-elected former guardians of the health system have since long-returned to civilian life, the "DHBs" in this circumstance amounted to Naomi Ferguson — the interim chairwoman of Te Whatu Ora Health New Zealand (HNZ) since the self-inflicted demise of Rob Campbell — and HNZ chief executive Margie Apa, plus whichever senior local health staff remain in their positions.
Last week the Southern DHB — previously the recipient of some arduous and high-profile grillings from the health select committee — went around the block one last time.
Although National Dunedin list MP Michael Woodhouse is not on the health select committee, local MPs can sub in for relevant discussions and he was a very interested spectator for last Wednesday’s review of the 2021-22 financial year.
Although that was the year of Delta and Omicron, it was also the year that details started to leak out about the long-running wrangle between clinicians and bean-counters about cost over-runs and cutbacks on the new Dunedin hospital project, something Mr Woodhouse — and this newspaper, which is campaigning against them — are keenly interested in.
Mr Woodhouse challenged the board on the assumptions behind the declining number of medical and surgical beds from those originally planned. When the detailed business case for the hospital was signed off, its capacity was predicated on a 15-20% reduction in both the rate of admission of patients and the length of their stay in hospital.
However, he said, there was still no guarantee that general practice could take up that slack, and patient stays were likely going to be longer because they were arriving with more acute complaints than was the case some years ago.
Mr Woodhouse went on to press HNZ on whether those factors meant that the new hospital, as recently scaled back, would actually be fit for purpose.
In reply HNZ Southern chief medical officer Dr David Gow cautiously acknowledged that the health system nationally, not just in Otago and Southland, was under unheralded pressure, which was causing issues with providing planned care and flow of patients through the hospital.
Dr Gow did concede that doctors would have "obviously" preferred the original design of the new hospital, before saying clinicians had been engaged with in a useful process to understand "what the realities of the changes are".
Spaces had been shelled to be built at a later date rather than deleted, which he said had allayed some concerns.
"We accept that the most important thing now is to see how we can make what we have been delivered functional."
And with that, the zombie was consigned back to its grave.
While many will claim not to lament that fact, you probably should. For all the imperfections of the DHB system — and there was plenty wrong with it — through agendas and reports it did allow the public some insight into what was happening within the hospitals, general practices and public health system it funds.
Moreover, as part of the annual review process boards had to provide hundreds of answers to written questions from MPs about the internal workings and performance of the organisation.
That is a level of transparency and public accountability which will be difficult for health localities, let alone HNZ, to match.
Despite its legion of communications staff, HNZ will likely not match the level of disclosure achieved by DHBs and scarce and hard-pressed local reporters are faced with the prospect of filing myriad Official Information Act requests to secure important information which was once routinely publicly provided.
And if — for example — what was once your district health board is embarking on the biggest hospital construction project in decades, and you really are not sure if it is progressing in such a way that appropriate health care services will be provided when it is finished — you really do want as much information about that as possible to be available to the public paying for it, and who will use it for decades to come.
Take a trip
The upwards trajectory of Southland National MP Joseph Mooney continues.
As noted in Southern Say earlier this year, his party’s portfolio reshuffle had seen him allocated a challenging set of responsibilities, and ones which indicated a great deal of faith in the abilities of the first-term backbencher.
His workload was added to last week — following former leader Todd Muller’s retirement announcement, a minor reallocation resulted in Mr Mooney adding tourism to his responsibilities.
That is a natural fit given Mr Mooney lives in the tourism hub of Queenstown, and an area he has already done considerable work in.