Last month the Government announced that the country's 20 DHBs will be merged into one national health service and a Māori Health Authority established. This is of particular interest to the local government sector given that DHB elections are currently run concurrently with local body elections.
On 21 April 2021 the Government announced the high-level direction for the reform of the health sector. This has been identified as one of the most significant reforms since the 1980s.
You can find a 12-page overview of the reforms and a series of frequently asked questions here.
We are encouraged by the overall direction the reforms are taking. Crises such as the pandemic, and regulatory failures (such as in drinking water) show why the health system needs stronger system leadership. Further, there are health access problems for provincial areas. Deprived communities and Māori health outcomes are significantly worse than other New Zealanders’ outcomes. The current system is not delivering equitable services for everyone and well-being outcomes could be improved.
We have some concerns about the means that local communities will have for having a say in the design of services ‘on the ground’. We will ensure that these concerns are fed into both the legislation and the Future for Local Government review discussed in our last update. We are also concerned that the process for board appointments may lead to overt politicisation of Health New Zealand.
The initial announcements were not completely clear about the future role of District Health Boards (DHBs). Subsequent media reporting and an explicit clarification from the Minister of Health’s office make it clear that Health New Zealand will assume all the strategic planning and commissioning roles the DHBs presently undertake. DHBs will cease operation on and from 30 June 2022, and therefore 2019 marked the last triennial DHB elections (it’s not clear at this point whether by-elections will proceed).
Taituarā told the last Justice Committee on elections that:
“…it is past time that central government takes responsibility administering the election of District Health Board (DHB) elections. We also note that there is a legitimate question as to the appropriateness of the current governance arrangements given central government is the sole owner of most DHB assets, appoints the Chair and three other members, supplies the majority of the funding and sets the standards.”
We are not opposed to the abolition of DHBs. There are some immediate implications for the local electoral process. The first is that with no DHB elections to run, there will be no contribution from the DHBs to the common costs of running local elections. A quick sample of territorial authorities reveals that, in some cases, as much as a third of the common cost was met by the DHBs.
We are in discussions with the Department of Internal Affairs about the implications of this. It provides further impetus for calls to transform the way elections are delivered. In the meantime, we strongly advise local authorities to ensure that additional budget is factored into LTPs. In most instances you would start with the cost apportionment templates from the 2019 elections (check with Electoral Officer in the first instance).
If you have questions about this please contact Raymond Horan, our Chief Advisor.