Political Challenges to the DHB System
The DHBs system is very complex in terms of the political challenges it faces. The table below identifies the challenges experienced by the DHB system and the effect they then have on the system.
Political challenges of the DHB system and the effect they have.
| Challenge |
Effect |
| DHBNZ [1] |
- Set up to facilitate cooperation and integration between multiple DHBs (DHBNZ 2010).
- Insufficiently funded (Gauld 2009).
- Tension between DHBs, Government and DHBNZ (Gauld 2009).
|
| DHBs |
- Accountability measured without regard for capacity (Gauld 2009).
- Lines of accountability blurred as accountability is on DHBs, without regard for role of Ministry (Ashton 2009).
- Lack of agreed direction for principles or process.
- Does not facilitate for political challenges.
|
| Clinicians |
- More communication between clinicians and planners required.
- Lack of clinical awareness of bigger DHB system and the effects their decisions make (Ashton 2002).
- DHB practices can increase clinician workloads (Gauld 2009).
|
| Public Administrators |
- Lack of planning put into reform resulting in loss of confidence in the system (Gauld 2009).
- Lost institutional knowledge from previous systems as administrators (Gauld 2009).
|
| External challenges |
- Widespread belief that 21 DHBs too many and not sustainable (Devlin, Maynard, and Mays 2001).
- Current cost of system is not sustainable (Ministerial Review Group 2009).
- Quality of boards governing DHBs questionable in terms of quality and representation (Gauld 2009).
|
[1] District Heath Boards New Zealand (DHBNZ) is the body created in response to a need for greater integration between multiple organisations. DHBNZ works as a body to represent all DHBs on certain issues and facilitates discussion between them and the Ministry of Health. However, is limited in the way it can function due to restrictions imposed by the Ministry of Health and insufficient funding. For further detail see Gauld 2009 and DHBNZ 2010.
