DISTRICT HEALTH BOARD ACCOUNTABILITY ARRANGEMENTS
   

MEMORANDUM TO CABINET SOCIAL POLICY AND HEALTH COMMITTEE

DISTRICT HEALTH BOARD ACCOUNTABILITY ARRANGEMENTS



PROPOSED ACCOUNTABILITY ARRANGEMENTS

  1. Cabinet has decided that DHBs will be accountable to the Minister of Health [CAB (00) M 2/4 recommendation j]. The Minister of Health will be the Vote and Responsible Minister for DHBs. The Minister will have responsibility for managing the interface with other Ministers whose portfolios contribute to health and disability outcomes [CAB (00) M 11/1A(3) nnn v refers].

  2. The health and disability support sector, and in particular the publicly owned hospitals, present an area of potential significant fiscal risk to the Crown. It would be expected that the Minister of Finance would continue to have a key role in the sector [CAB (00) M 11/1A(3) nnn v refers]. This may include having joint decision-making rights with the Minister of Health over some aspects of the DHBs' operations (for example hospital investment decisions) and/or the right to be consulted over certain aspects of the DHB's operations. Officials recommend that further work is done to determine the role of the Minister of Finance in respect of DHBs. Officials will report to Ministers on this by 30 April 2000, including on any provisions to be set out in the enabling legislation.

    Strategic Settings

  3. In addition to the Government's overarching Goals to Guide the Public Sector, the Government will communicate its desired outcomes for health and disability through the New Zealand Health Strategy and the New Zealand Disability Strategy. These strategies will provide the overarching policy framework within which the health and disability sector will be expected to operate. These strategies will establish specific nationwide health and disability outcome goals, objectives and targets, and sector performance standards.

  4. The Minister of Health will be responsible for determining and communicating the Government's desired outcomes for the health and disability sector, to DHBs, through these strategies. DHBs will be responsible for developing accountability documentation that details how will they give effect to these strategies at a local level. DHBs will be also be accountable, through appropriate contractual arrangements, for selecting, funding and providing the most appropriate mix and level of services to achieve these specific outcomes and performance standards.

    Annual Planning Information

  5. In addition to the overarching strategies, Officials recommend that prior to the commencement of the DHB accountability cycle the Minister of Health provides each DHB with specific planning information including:

    1. any changes to the Government's policy settings
    2. funding (budget) information
    3. any specific purchase or ownership expectations for the DHB in relation to past and future performance expectations
    4. the degree of autonomy afforded to it.

  6. The process being recommended by Officials is flexible enough to allow for variations in timing of Government's Budget process. Indicative funding information will be made available to inform DHB planning. Each year DHBs will be advised of Government's specific timeframes for confirming DHB funding levels. Performance Specification/Delineation

  7. DHBs will be accountable for funding health and disability services on behalf of their defined community, and for the governance and management of their provider arm (formerly HHSs). Each DHB will be required to ensure that all accountability documentation clearly and separately defines the performance to be delivered as a funder of health and disability support services and as hospital owner and service provider. The key dimensions of performance to be accounted for, including in the DHB's financial statements, are:

    1. funding health and disability services through appropriate contractual mechanisms
    2. governance and management of the DHB, including management of the core budget and the delivery of outputs (needs analysis, consultation, contracting and monitoring the delivery of contracts)
    3. governance and management of hospital and health services owned by the DHB with a focus on organisational health and sustainability.

  8. From a financial perspective DHBs will receive both revenue and capital from the Crown and will be required to account separately for these funding streams. The DHB will be allocated revenue via a population-based funding formula. Within this the DHB will be required to account for both the use of funds to enter into service agreements with providers (for example with primary care providers, disability support services providers and with the DHB's provider arm), DHB operating funds, governance and operational management of the DHB's hospital and associated services.

 
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