1. Officials propose the following mechanisms to promote the representation of women, Pacific peoples, and people with disabilities on the boards of district health boards (DHBs):
   1. encouraging candidacy and voter participation in board elections
   2. judicious use of appointments to boards
   3. influencing the orientation of the boards.

Executive Summary

2. Sound governance by DHB boards, and their ability to achieve their objectives rests on ensuring the right membership, composition and conduct of boards. A number of factors need to be balanced in order to meet these objectives, including ensuring community voice, ensuring sufficient skill mix and recognising the partnership between the Crown and Mäori.

3. Cabinet has made a number of decisions regarding the composition and conduct of DHB boards which aim to support the objectives of sound governance and the achievement of DHBs' tasks. Both electoral and appointment processes provide an opportunity for women, Pacific people and people with disabilities to be members of DHB boards. In addition, Cabinet has agreed a range of other mechanisms to facilitate transparency of decision-making and community input to boards. These include, for example, the ability to establish committees, specific accountability arrangements, and consultation requirements.

4. A majority of DHB board members are to be elected using the Single Transferable Voting (STV) method . This system aims to promote the representation of minority groups. A number of mechanisms are proposed to encourage candidacy and voter participation to increase the opportunity for the representation of women, Pacific people and people with disabilities and other groups on DHB boards.

5. Appointments to DHB boards should be considered on a board-by-board basis, given the outcome of DHB elections. It is proposed that the protocols to be developed to guide appointments specifically include consideration of gender balance, the Pacific population within a DHB, and the need to ensure a voice for people with disabilities.

Background

6. On 20 June 2000, the Minister of Health was invited to bring a paper to the Social Policy and Health Committee (SPH), as soon as possible, exploring ways to achieve equitable representation of women, Pacific peoples and people with disabilities on District Health Boards [SPH (00) M 15/15 refers].

DHB board membership, composition and conduct

7. Four key objectives drive arrangements for the membership, composition and conduct of boards:
   1. ensuring community voice and participation in DHB board decision making

   2. ensuring an appropriate skill and knowledge mix on the DHB board commensurate with the non-financial and financial responsibilities of DHB boards

   3. ensuring transparency in DHB board decision making

   4. recognising the partnership between the Crown and Mäori.

8. Given the percentage of the population with disabilities, and the interface between disability and health services, an important contribution to DHB boards deliberations, regardless of their role in funding disability support services, will be consideration of how services meet the needs of people with disabilities. It will be necessary therefore to ensure that DHB board members have a collective understanding of disability as an access issue.

9. Cabinet has already made a number of decisions on the membership, composition and conduct of DHB Boards. These are:
   1. that a majority of DHB board members will be elected by the local community [CAB (00) M 2/4 refers]

   2. that elected members will be supplemented by a minority of members appointed by the Minister of Health [CAB (00) M 2/4 refers]

   3. that there will be proportional representation of Mäori (determined by the proportion of Mäori in each DHBs population) on DHB boards, with a minimum of two Mäori members [SPH (00) M 15/8 refers]

   4. that DHB board meetings will be open to the public [CAB (00) M 11/1A(3) refers]

   5. that DHBs will be required to develop strategic plans in consultation with the community [CAB (00) M 15/10 refers]

   6. that DHB planning and performance documents will be publicly available [CAB (00) M 15/10 refers]

   7. that DHB elections will be conducted using the STV voting method [decision anticipated by Cabinet on 3 July 2000]

   8. that DHB boards must set up a Hospital Governance Committee and a Health Improvement Advisory Committee whose meetings will be open to the public [CAB (00) M 15/8 refers]

   9. that DHB boards can set up other committees as necessary to ensure that they get all the required input from groups with different interests, needs and expertise [CAB (00) M 15/8 refers]

   10. that DHB boards may be required to establish a Disability Issues Advisory Committee [this issue is currently before Ministers for their consideration].

ACHIEVING EQUITABLE REPRESENTATION FOR WOMEN, PACIFIC PEOPLE AND PEOPLE WITH DISABILITIES

10. The objective of equitable representation is to have a fair and effective board which allows different community perspectives to be heard and gives interest groups an opportunity to participate in DHB decisions.

11. The two avenues to board membership are election or appointment. Each of these can be used to promote and facilitate the membership of women, Pacific people, and people with disabilities on DHB boards.

Elections

12. It has been decided that there will be seven locally elected members on each DHB [CAB (00) M19/14 refers]. These people will be elected using the STV voting method for the 2001 DHB elections [this decision has been made by SPH and is expected to be endorsed by Cabinet on 3 July 2000].

13. Local elections, in principle, reflect the local population's choice of representation. STV, in principle, provides a good opportunity for minority groups to gain membership on DHB boards. The effectiveness of elections in achieving these objectives is dependent on who stands for election and how people vote. STV, in particular, while advocated as a strong method of promoting minority representation, will only achieve this if minority candidates stand for election, and people choose to vote according to the 'ticket' that minority candidates represent (e.g. people with disabilities).

14. Encouraging people to participate in elections by standing and/or voting can be facilitated by:
    1. simple, open and accessible nomination, listing and voting procedures - provisions of the Local Elections and Polls Act 1976 apply

    2. publicity and education campaigns targeted at encouraging people to stand and vote - this will be part of the preparations for the first elections of DHB boards and will continue in subsequent elections

    3. limits on campaign expenditures to avoid groups without large financial means from being disadvantaged - this is covered in the accompanying report-back entitled Limits on Campaign Expenditure

    4. provision of information to potential candidates, on issues such as: how board members expenses are met, the flexibility to have family-friendly meeting times, access for people with disabilities, and training and induction provisions for board members.

Appointments

15. Cabinet has previously decided that the Minister of Health will be able to appoint up to four members to DHB boards. Appointments provide the Minister of Health (and subsequently the Cabinet Appointments and Honours Committee) an opportunity to fill any gaps in skills, expertise or knowledge after the election process. Appointments can be used, therefore, to ensure that a Board has the skills and expertise to manage its significant health and financial responsibilities, and to fill any gaps in the representation of specific groups.

16. The skill gaps left after elections (including those of women, Pacific people and people with disabilities) will vary across boards, and the Minister will need flexibility to fill those gaps according to the needs of individual boards. For example, in the event that no people with the knowledge of Pacific health issues are elected to those DHBs with a large Pacific population, the Minister is likely to use the appointments process to fill this gap. Similarly, the Minister could appoint people for their knowledge of disability issues or to ensure a gender balance.

Appointments: process and protocols

17. Protocols are currently in place to assist the Minister of Health in seeking nominations and appointing board members for Hospital and Health Services (HHSs).

18. These protocols will be reviewed, developed further, and submitted to the Minister of Health for approval before being used to guide future DHB appointments in the context of majority elected boards. The membership of women, Pacific people and people with disabilities on DHB boards should be actively included as part of the principles which guide appointments. Other principles that will need to be considered include, for example, a reflection of mental health service interests, financial skills, and strategic capability.

19. The appointments to each DHB board will be considered on a case-by-case basis according to these protocols, and appointments proposed accordingly.

20. The Cabinet Appointments and Honours Committee will consider the Minister's proposals for appointment. This provides an additional opportunity for Government to ensure that DHB boards have an appropriate composition for their individual population and responsibilities.

Designated places on DHB boards

21. As detailed in paragraph 9, Ministers have made a number of provisions which, in combination, aim to improve the ability of 'minority' groups to participate in DHB decision making and processes. Given these mechanisms, and for practical reasons it is not recommended that there be 'set places' on DHB boards for women, Pacific people, people with disabilities or any other specific group (apart from those already agreed for Mäori). The reasons are that:
    1. the Government may lose the flexibility to fill necessary technical or skills gaps needed by the Board e.g. financial skills

    2. any member (elected or appointed) may bring skills, knowledge or background in a number of areas and requiring the duplication of these attributes by prescribing designated positions would remove an opportunity to address other gaps

    3. the decision to have proportional representation of Mäori on DHB boards, with a minimum of two Mäori members means that reserving places for other groups such as women, Pacific people and people with disabilities may mean that, in the event that these targets are not met through the election process, the Minister of Health will be statutorily required to use appointments to fill Mäori vacancies on the board. Further constraining the appointments to boards may mean that this statutory requirement cannot be fulfilled.

Influencing the orientation of DHBs

22. Regardless of the final composition of a DHB board, Cabinet has already agreed to other provisions that can be used to ensure that different community or interest groups have an adequate voice and an opportunity to participate in DHB board decisions:
    1. Accountability arrangements: the Minister of Health can express performance expectations through the accountability arrangements, including a requirement, for example, that a DHB involves specific community or interest groups in an issue

    2. DHB Committees: DHB boards can establish committees for specific purposes, for example, a board may establish a committee to consider issues such as maternity services, carer support for people with disabilities, or improving immunisation rates of Pacific children.

    3. Consultation requirements: DHBs have a requirement to consult, so that community or interest groups do not have to be represented on the board itself to have input

    4. Board member training: board members will be required to undertake approved training which could include how best to consult with different communities, and education on the issues facing these communities.

23. Officials conclude that, taken together, the election of DHB board members using STV, opportunities to increase candidacy and voter participation, and judicious use of appointments provide sufficient mechanisms to promote representation of women, Pacific people, people with disabilities and other groups.

CONSULTATION

24. The following agencies were consulted in preparation of this paper: Crown Company Monitoring Advisory Unit, Department of the Prime Minister and Cabinet, Ministry of Pacific Island Affairs, The Treasury, Te Puni Kokiri, the State Services Commission, and the Ministry of Women's Affairs.

25. There are no financial implications over and above those identified in previous decisions about electing or appointing Board members.

LEGISLATIVE IMPLICATIONS

26. There are no legislative implications.

27. There are no compliance cost implications.

REGULATORY IMPACT STATEMENT

28. A regulatory impact statement is attached, in compliance with Cabinet Office requirements.

HUMAN RIGHTS IMPLICATIONS

29. The proposal does not have Human Rights Act 1993 implications.

30. Publicity on matters related to this paper is managed as part of the wider Health & Disability Sector Change Communications Strategy.

REGULATORY IMPACT STATEMENT

Objective

1. The policy objective is to ensure equitable representation of women, Pacific people, and people with disabilities on DHB boards, consistent with sound governance of DHBs and achievement of DHBs objectives.

2. The local election of seven DHB board members and the appointment of up to four members does not guarantee equitable representation of women, Pacific people, and people with disabilities on DHB boards.

Non-regulatory measures

3. The proposals canvassed in the paper fall within provisions already agreed by Cabinet for inclusion in the New Zealand Public Health and Disability Bill and do not require additional regulatory measures. The provisions already agreed are:
   1. that a majority of DHB board members will be elected by the local community [CAB (00) M2/4 refers]

   2. that elected members will be supplemented by a minority of members appointed by the Minister of Health [CAB (00) M2/4 refers]

   3. that there will be proportional representation of Mäori on DHB boards, or a minimum of two Mäori members which ever is the greater [SPH (00) M15/8]

   4. that DHB board meetings will be open to the public [CAB (00) M11/1A(3) refers]

   5. that DHBs are required to develop strategic plans in consultation with the community [CAB (00) M15/10 refers]

   6. that DHB planning and performance documents will be publicly available [CAB (00) M15/10 refers]

   7. that DHB elections will be conducted using the STV voting method [decision anticipated by Cabinet on 3 July 2000]

   8. that DHB boards must set up a Hospital Governance Committee and a Health Improvement Advisory Committee whose meetings will be open to the public [CAB (00) M15/8 refers]

   9. that DHB boards can set up other committees as necessary to ensure that they get all the required input from groups with different interests, needs and expertise [CAB (00) M15/8 refers]

   10. that DHB boards may be required to establish a Disability Issues Advisory Committee [this issue is currently before Ministers for their consideration]

Regulatory measures

4. There are no practical additional regulatory measures.

Statement of the net benefits of the proposals

5. The proposals present a wide and flexible range of methods for: local populations (through local elections) to elect their representatives, and for the Minister of Health to enhance the chance that the representation on boards is equitable.

6. The financial costs of the proposals, including those associated with the electoral processes, were included in the estimates recently considered by the Cabinet Social Policy and Health Committee.

Consultation

6. The following agencies were consulted in preparation of this paper: the Health Funding Authority, Crown Company Monitoring Advisory Unit, Department of the Prime Minister and Cabinet, Ministry of Pacific Island Affairs, The Treasury, Te Puni Kokiri, the State Services Commission, and the Ministry of Women's Affairs.

THE COMMITTEE, HAVING BEEN GIVEN POWER TO ACT BY CABINET ON 3 JULY 2000 [CAB (00) M 22/21 REFERS];

SPH (00) M 17/7

EQUITABLE REPRESENTATION OF WOMEN, PACIFIC PEOPLES, AND PEOPLE WITH DISABILITIES ON DISTRICT HEALTH BOARDS

1. agreed that, taken together, the election of District Health Board (DHB) board members using the Single Transferable Vote System (STV), opportunities to increase candidacy and voter participation, and judicious use of appointments will provide mechanisms to promote the representation of women, Pacific peoples, people with disabilities and other groups in DHB decision-making and processes;

2. noted that increasing candidacy and voter participation will be encouraged by: simple, open and accessible nomination, listing and voting procedures;

   publicity and education campaigns targeted at encouraging people to stand and to vote;

   limits on campaign expenditures to avoid groups without large financial means from being disadvantaged;

   providing information to potential candidates;

3. noted that the process for appointing up to four members to each DHB board to fill specific gaps in skills, expertise and knowledge will be made on a board-by-board basis guided by protocols approved by the Minister of Health, following consideration by the Cabinet Appointments and Honours Committee;

4. agreed that the protocols for appointments to DHB boards include consideration of gender balance, the DHB's Pacific population, and the need to ensure a voice for people with disabilities;

5. noted that participation in DHB board decision making by women, Pacific people and people with disabilities could also be promoted through:

   the Minister of Health setting performance expectations and putting requirements into accountability arrangements with DHBs that they involve specific communities or interest groups;

   the DHB boards establishing sub-committees to consider particular issues facing women, Pacific peoples or people with disabilities;

   requirements for DHBs to consult with communities;

   the training of DHB board members.