From The Minister's Desk

DHB Performance Expectation Framework

Transitional Accountability for DHBs

Consultation Framework for DHBs

I am aware that there has not been an issue of Health Moves recently. There has, however, been a great deal of policy work going on, all of which will culminate in the passing of the New Zealand Public Health and Disability Bill, which is expected to happen early in December.

Also in early December I am releasing the definitive New Zealand Health Strategy. This culminates an extensive year's work with significant input from the health and disability sector, for which I thank you.

I will provide you with an update on the move towards District Health Boards (DHBs) in the near future.

In the meantime, I have recently released three Cabinet papers that I believe will increase public understanding of the way the sector will operate in the future.

This issue of Health Moves summarises the three Cabinet papers, which are also available on the website: www.executive.govt.nz/minister/king

The public release of the papers reflects the Government's intention that the new public health service should be as open and accountable as possible.

Hon Annette King
Minister of Health

The Cabinet has approved a framework for encouraging DHBs to meet the Government's expectations, and to intervene to help DHBs improve performance where they fall short of expectations.

The framework will be applied only to DHB management of risks over which DHBs have an ability to respond. (The focus is on improving health and disability outcomes for a DHB's population.)

Performance expectations will be based on the priorities in the New Zealand Health Strategy and New Zealand Disability Strategy, the closing the gaps policies and the statutory functions and responsibilities of DHBs.

The types of rewards that may be used include:

• greater autonomy for the DHB
• reappointment of board members
• public recognition of good performance and being the benchmark for other DHBs
• less onerous requirements for monitoring
• ability to use surplus funds for local initiatives
• access to funding for pilot initiatives.

Interventions for DHBs that are not meeting expectations include:

• less autonomy
• appointment of a commissioner
• dismissal of poorly performing board members
• removal of a board chair
• appointment of a board monitor
• ministerial direction
• public scrutiny of poor performance compared with benchmark DHBs
• more detailed and more frequent monitoring
• submission of surplus funds
• removal of a function.

The Cabinet has approved accountability arrangements for DHBs during the transition period to fully functioning DHBs. There are four key transitional phases.

Phase A: the planning period, which began in March 2000 and continues till legislation commences:

Hospital and Health Services have started to engage with their local populations and service providers and have now submitted plans for the establishment of the DHB for their locality.

Phase B: from the commencement of legislation until 30 June 2001:

The DHBs will be focused on building capability and capacity for 2001/02. They will start planning but will not yet have any responsibility for funding services.

DHBs will be responsible for managing their hospitals and for delivering the services specified in the 2000/01 HFA contracts. The Ministry of Health will take over responsibility for the HFA's funding agreement.

Phase C: 1 July 2001 to 30 June 2002:

This phase will see DHBs demonstrate the necessary capability for planning and administering the funding of those services devolved to them. The detailed timetable is part of a separate report to Cabinet in December. The Ministry of Health will continue to fund the remaining services. Board elections will take place during this phase.

Phase D: By 1 July 2002:

DHBs will be expected to have attained the capability necessary to enable them to take on full responsibility for planning and administering the funding of those services that the Government has decided to devolve to them.

The Ministry of Health will continue to fund some services on an ongoing basis, and will provide the national service frameworks and policy rules that all DHBs have to comply with.

DHBs must consult with their communities on the development of their strategic plan, as required in the New Zealand Public Health and Disability Bill.

The Minister of Health will establish the consultation principles and obligations. This will clarify what the DHBs must consult on, who they consult with and how they conduct the consultation process.

The consultation principles will include general requirements to consult on:

• initiating new policies, services or plans
• making changes to existing policies, services or plans
• establishing priorities
• making significant changes to the range or type of, or access to, services
• proposing changes in methods of contracting.

Any such changes will have to comply with the national framework and policy rules developed and maintained by the Ministry of Health. In the interim, until DHBs have developed full capacity and have a track-record of high performance, DHBs will have to seek the Minister's permission to make changes in these areas.

The DHBs must, as a minimum, consult with affected parties and with Mäori.

These consultation principles will be included in the operational policy framework for DHBs.

To respond to this newsletter, receive it, or have your name taken off the mailing list, please e-mail: healthmoves@moh.govt.nz or write to: Annette King, Minister of Health, Health Moves, Parliament Buildings, Wellington.