But in many DHBs, the split continued internally with what were unhelpfully called funder and provider arms. These operated at some distance from each other, with limited collaboration due to misplaced notions of commercial sensitivity and conflict of interest.
So-called funder arms did not see themselves as an integrated part of their DHB. It did not lend itself to sensible, integrated decision-making; quite the reverse.
Fortunately, over time, in many DHBs (including Canterbury), the practical functions of funding were merged into the rest of the DHB rather than being a virtual, separate entity within it.
Hawke’s Bay is interesting under its current chief executive, who commenced employment in 2009. Previously the chief executive of a primary care trust in the NHS in England, he had experience of the funder part of the funder–provider split system. He was sufficiently disabused of its merits that, when he settled into his Hawke’s Bay role, he disbanded the funder arm by integrating its relevant core functions into the rest of the DHB.
Metro Auckland, in contrast, is highly contractual and, consequently, more bureaucratic and transactional.
Dr Levy was appointed chair of Waitemata DHB in early 2009. As it happened, that DHB was one of those still rooted in the old funder-arm system that many DHBs, including Auckland and Counties Manukau, had shifted away from.
When he subsequently became chair of Auckland DHB, its funding roles were merged with Waitemata’s and ran along the same line as Waitemata’s.
Now that Counties Manukau is also tucked under his armpit, all the indications are that this third DHB will be forced back into the outmoded funder–provider split under a new virtual structure. The obvious risk is the likelihood of poorer allocative decisions and higher transaction costs.