Media release from Association of Medical Specialists

Bureaucracy creation by stealth: National Health Board

Previously we outlined our concerns about the proposal in the Horn Report for the creation of a new health bureaucracy, the National Health Board (NHB).

This new bureaucracy would be a crown entity rather than government department or ministry thereby being more arms length from normal government accountability.

Part of the justification is that the Horn Report wants its recommended bureaucracy not to be subjected to "lobbying" from "outside" organisations which, by implication, includes the ASMS, the medical colleges, and the NZ Nurses Organisation. This does not rest comfortably with the Government's policy on clinical leadership and engagement.

Sneaky move Legislation is required to create a new crown entity. This enables Parliament to scrutinise it as well as the public (including organisations and individuals with relevant expertise and experience) to make representations and for Parliament to consider them in its deliberations.

However, in what can only be described as a sneaky move the Horn Report proposes that the Crown Health Funding Agency be changed, without legislation and consequently without parliamentary scrutiny, into the much larger and fundamentally different National Health Board. This suggestion indicates contempt for parliamentary scrutiny. It suggests a misuse of power and against the intent of both the NZ Public Health and Disability Act and the Crown Entities Act.

The Crown Health Funding Agency (CHFA) was originally set up in 1993 as the Residual Management Unit for a previous restructuring and is listed as such in the Crown Entities Act 2004. Its purpose has been the financing of debt.

Chalk, cheese and risk of judicial review The peculiarity of the CHFA is that though it is a crown agent its functions are set by ministerial instruction without direct oversight by parliament.

The difference between the CHFA and the proposed NHB is 'chalk and cheese'. The CHFA is a small crown entity of around 20 staff which now has the narrow function of being the DHBs' 'bank' for debt management.

By converting it into the new NHB it would become a much larger body with far greater responsibilities and powers. There is some debate over the legality and appropriateness of this and it could be open to judicial review.

A Ministry of Health emboldened with the political authority to implement the national good is likely to be more able to implement government policy than a crown entity. Why create a new bureaucracy by questionable means when you could simply adapt and empower a more accountable existing structure (ie, Ministry of Health.

Ian Powell EXECUTIVE DIRECTOR The Association of Salaried Medical Specialists (ASMS) represents salaried senior doctors and dentists. The large majority of our members are employed by DHBs. Outside the College of GPs we are the largest organisation representing doctors in New Zealand. Central to our existence is to promote the right of equal access for all New Zealanders to high quality public health services.

The ASMS publishes the ASMS Parliamentary Briefing to provide considered advice to MPs of issues and concerns where we believe we have the experience and expertise.