District health board
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. 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 will be abolished and replaced by a single agency to be called Health New Zealand. In addition, a new Māori Health Authority will be set up to regulate and provide health services to the Māori community.
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.
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. The transition will occur over a three-year period with an interim Health NZ 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.
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 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). Since the 2004 local-body elections, the single transferable vote (STV, a proportional voting system) has been used. The use of appointed Board members aims to balance the boards' expertise as deemed necessary. 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.
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.
There are 20 DHBs, organised around geographical areas, of varying population sizes, though they are not coterminous with the Regions of New Zealand:
- 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
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