THE DIVISION OF ROLES BETWEEN DISTRICT HEALTH BOARDS AND THE MINISTRY OF HEALTH
   

MEMORANDUM TO CABINET SOCIAL POLICY AND HEALTH COMMITTEE

THE DIVISION OF ROLES BETWEEN DISTRICT HEALTH BOARDS AND THE MINISTRY OF HEALTH



National Screening

  1. New Zealand currently has three national screening programmes: the National Cervical Screening Programme; Breastscreen Aotearoa; and new-born screening. Tight co-ordination, nationally consistent services, high quality standards and nationally consistent information collection and monitoring of quality are essential to maximise the benefits of national screening programmes.

  2. National co-ordination of screening programmes is important if they are to achieve their objectives of reducing mortality and morbidity. This can be achieved by specification of requirements or standards in funding agreements with DHBs (and DHBs coordinating their activities in line with such standards), and/or by setting up a single coordination unit. To ensure nationwide consistency, planning and funding for the three current, and any future, national screening programmes is best located in a single co-ordination unit.

  3. Such a unit can either be funded jointly by the DHBs (as a team in one DHB, or through a subsidiary organisation) or by the Ministry. The preference is for it to be closely aligned with DHBs, to maintain clear lines of accountability, and to ensure the coordination of funding of screening programmes with treatment services. Decisions on future arrangements for national screening programmes will be made at a later date, when it can be ascertained how this will be managed within the DHB environment and when the results of the Gisborne Cervical Screening Enquiry are known. In the interim the existing unit will transfer into the Ministry of Health.

    Public health legislative functions

  4. Public health and biosecurity legislative functions are undertaken by designated enforcement officers. These officers are accountable to, and subject to direction from, the Director-General of Health for the implementation and enforcement of legislation on environmental health, toxic substances, communicable disease control, food safety and biosecurity. When the need arises, these functions require a high level of co-ordination and consistency (for example, in the application of the law), as well as technical support from the Ministry of Health.

  5. Arrangements should recognise that designated enforcement officers of public health and biosecurity legislative functions, although funded by DHBs, will on occasion be directed by the Director-General of Health (under the Health Act 1954).

    TREASURY COMMENT

  6. Treasury agrees with the proposals that DHBs should be responsible for planning and funding all health and disability support services, with rare exceptions in compelling circumstances. However, in focusing upon the role of the Ministry of Health in the transition and in the longer term, the paper gives no impression of when DHBs will become fully responsible for purchasing. In addition, other potential options for the transition, such as setting up a central or regional DHB function during the transition, are not given sufficient consideration.

  7. The current paper proposes a transitional period of indeterminate length during which DHBs will not have responsibility for a wide range of health and disability support services' planning and procurement. The paper proposes that detailed decisions on which services DHBs should have responsibility for, and which not, will be able to be made on the basis of a November 2000 report back.

  8. There are a number of policy risks with this approach:

    1. once roles pass to the Ministry of Health, it will be difficult to shift them to the DHBs, particularly if the Ministry is handling issues capably

    2. unless the transition is time-limited, there is no pressure on either the Ministry or the sector more widely to move to the end-state set out in this paper. Treasury recommends that the transition be completed by the beginning of 2002/3 financial year

    3. a development strategy is required which will enable all DHBs to take on the required roles in a defined time. DHBs will find it impossible to demonstrate the capacity without being given the responsibility

    4. it is not clear that more evidence will be available in November 2000 to guide decisions on the allocation of roles between DHBs and the Ministry of Health. Instead, Ministers may be faced with competing proposals as to where in the system different services should be planned and procured.

  9. The current paper discusses the issue of how the Ministry of Health should be held accountable for its planning/procurement/funding role in respect of those services which it will be made responsible for during the transition to fully functioning DHBs and the narrower set for which it may have responsibility in the longer term. In practice, the Ministry will be acting as a twenty-third DHB and accountability arrangements should be designed to reflect this. The Ministry's 'DHB' functions must be separately identified and separately managed. It is particularly important that the functions are discharged entirely separately from the Ministry's funding and performance management functions in relation to the DHBs.

  10. The Treasury acknowledges the importance of a strong leadership and monitoring role for the Ministry of Health under the new DHB structures but also emphasises that this does not necessarily require that the Ministry of Health assume a strong funding role within the new structures.

    CONSULTATION

  11. The following agencies were consulted in preparation of this paper: the Health Funding Authority and Pharmac, Crown Company Monitoring Advisory Unit, Department of the Prime Minister and Cabinet, the Treasury, Te Puni Kokiri, the State Services Commission, and the Office of the Auditor-General.

    FINANCIAL IMPLICATIONS

  12. Officials will report back on the financial implications as part of the report back in May on the financial implications of the health sector changes.

    LEGISLATIVE IMPLICATIONS

  13. A number of the recommendations will inform the drafting of the New Zealand Public Health and Disability Services and Health Reforms (Transfer and Transitions Provisions) Bill.

    COMPLIANCE COSTS STATEMENT

  14. The proposals do not have compliance costs implications beyond those identified as part of financial implications above.

    REGULATORY IMPACT STATEMENT

  15. A Regulatory Impact Statement prepared in accordance with the requirements set out in CO (98) 5 is attached.

    HUMAN RIGHTS IMPLICATIONS

  16. The proposals do not have Human Rights Act 1993 implications.

    PUBLICITY

  17. Publicity on matters related to this paper is managed as part of the Communications Strategy that forms part of the wider work on health and disability change.


 
      PREVIOUS | CONTENTS | NEXT  

 
HOME PAGE | DOCUMENT DOWNLOAD