1. This paper proposes that both DHB Committees required by Cabinet (CAB (00) M2/4) are established in an advisory role subordinate to the DHB Board. The Health Improvement Advisory Committee is proposed to provide strategic advice on health gain, and the management of the interface between primary and secondary care. The Hospital Governance Committee is proposed to provide oversight of and monitor the performance of the hospital and to advise the DHB Board on performance accordingly.

EXECUTIVE SUMMARY

2. Cabinet has agreed that DHBs will be required to form, as a minimum, a Hospital Governance Committee and a Primary Care Advisory Committee (refer CAB(00)M2/4).

3. The Minister of Health has also clarified that there will be a single Chief Executive for each DHB who will be responsible for the management of all of the DHBs functions, including the delivery of services by publicly owned hospitals.

4. Within these parameters, Officials consider that both of the committees should be established as advisory committees to the DHB Board. The two advisory committees will allow:
   1. the DHB Board sufficient 'head-room' to focus on its governance responsibility without being involved in the day to day operations of the DHB
   2. internal mechanisms within the DHB structure to minimise the risk that either of the 'interest' in the DHB (in particular the management of the hospital) predominate over the DHB's overriding responsibility for improving the health of its population
   3. the distinct ownership and purchase interests within the DHB to be made explicit.

5. It is proposed that a committee known as the Health Improvement Advisory Committee provide advice to the DHB Board on issues related to the prioritisation of services in order to achieve health improvement for the DHB's population. This committee aims to mitigate the risk of hospital dominance in the DHB by taking an overarching view of health improvement, which by definition includes examining the role of primary care, disability support, public health and other more community focused services.

6. It is proposed that the Hospital Governance Committee be charged with advising the DHB Board on the performance of the hospital(s) and strategic issues related to the delivery of hospital-based services. This committee would not be involved in the day-to-day management of the hospital(s) as this is the job of the Chief Executive and the management structure below the Chief Executive.

7. The membership of the committees should be determined by the DHB Board who should have the ability to appoint whatever membership they consider to be required to achieve the task in hand. Officials envisage that this would include a majority of Board members and external expertise as required. The DHB Board maintains the overall responsibility for the form and function of the committees within the parameters set by legislation.