DHBs past use-by date

September 26, 2019

If you were wanting the best performance from a very large and complex organisation who would you want running it?

Would you want people with the skills and experience best suited to the task or a random group chosen by people who know little, if anything, about the requirements and those they are backing?

Health boards need the former but the system gives us the latter.

Otago University pro vice chancellor and Dean of Business, Professor Robin Gauld says it is clear the elected boards are not fit for purpose. . .

Boards have oversight for budgets worth billions of dollars and make key executive appointments, but all too often do not have the right skills, he said.

People voted in tend to be those with a high profile, often ex-mayors, MPs or sportspeople, who have name recognition.

The skills necessary are complex – everything from understanding medical IT, to how to deliver primary care, and financial skills – and the reality is that most candidates are unqualified, he said.

He wants more doctors on boards, but added it was just as important that they have the right skills.

Gauld believes the best solution is to scrap boards altogether. . .

He is right.

Churchill said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.

That may be right for Government but it’s not for the governance of health boards which are well and truly past their use-by date.

 

 


Politically appointed, politically disappointed

November 6, 2017

New Health Minister David Clark is considering asking District Health Board chairs for resignation letters.

David Clark says resignations may be accepted if DHB chairs aren’t “on the same wave-length” as the new government.

Dr Clark said he was “very seriously considering” asking for resignation letters and would make a decision shortly.

“I want to be sure that the district health board chairs … are in agreement with the current government’s agenda and direction. I need them to be on board with where we’re heading.” . . 

New ministers will, sooner or later, look at appointments made by their predecessors.

They have the right, and the power, to let them continue in their roles, or to terminate their appointments.

Clark should consider whether or not he wants DHB chairs to continue but he’s made a mistake by musing about it in public.

He should be doing his considering in private and once he’s done it he should act by either confirming chairs will stay or asking them to go.

By musing publicly Clark looks like he’s pussy-footing.

He also risks chairs calling his bluff by not writing resignation letters which would then force him to sack them.

Everyone who accepts such appointments know that when they’re politically appointed they can be politically disappointed.

Public musing merely looks like ministerial vacillation.


Do directors have the skills?

November 18, 2009

A media release from Health Minister Tony Ryall on his expectation that District Health Boards will collaborate more includes this:

DHBs across the country have responsibility for overseeing budgets from $100 million to over $1 billion a year. They also have in total around $160 million of unfunded services (DHB deficits) inherited from the last Government.”

“The Ministry of Health advises that only around 10% of Board members have specific financial expertise.

Only around 10% of board members have specific financial expertise?

I wonder how that compares with other boards?

Financial expertise isn’t the only skill required of directors but it’s one of the most important.


Herceptin, health & politics

August 8, 2008

Was Pharmac’s decision to not fund 12 month courses of herceptin based on clinical evidence or financial necessity?

Women’s Health Action Trust director Jo Fitzpatrick accepts it was clinical: 

[she] “reluctantly” spoke out yesterday in support of the decision, “because of concern at the high level of public misunderstanding about the drug and its effects”.

“Herceptin is promoted as the magic bullet for early breast cancer treatment,” she said. “People used to think – and many still do – that Her-2 positive breast cancer can and will be cured by Herceptin.

“We wish that was true but the evidence just isn’t there and people need to know that. At its best, 87 women in every 100 taking Herceptin get no benefit from the drug at all and may be harmed by it.”

And:

District health boards’ spokesman Murray Georgel said the lack of convincing evidence for 12-month treatments meant the decision was one “DHBs can understand”.

“In that context, and given the ability of DHBs to improve health through other interventions, it would have been concerning if Pharmac had come to DHBs and asked that the 12-month treatment be funded.”

But:

Other groups were scathing of the decision. Breast Cancer Aotearoa Coalition chairwoman Libby Burgess called it “a cruel blow for women and their families”.

She said the drug was “life-saving”, and Pharmac’s decision was “shameful” and “simply inhumane”.

Comments on my previous post  on the issue are also divided with Ed Snack saying it is important to judge the issue on science not emotion and he points to this link as a starting point. However Macdoctor  evaluates clinical trials and concludes Pharmac’s decision was a budget one.

But then NZ Conservative and several comments at No Minister  back Pharmac.

I am not qualified to argue about the science so I’ll move to the politics and this from TVNZ:

Diane Edwards from Herceptin Heroines says “there’s not a woman in this country that can afford to vote for this government after today’s decision”.

However over at the Hand Mirror Stargazer points out:

… national are saying they will fund the full 12 month course but legally would not be allowed to do so. unless, of course, they change the law to allow political interference in medical decisions.

She is right, Pharmac is independent and there are good reasons why neither the the Minsiter of Health nor the government can intervene. But that will be lost on most people because emotion beats facts in politics. Pharmac is regarded as an arm of government so unpopular decisions from the former will rebound on the latter.

Furthermore, Keeping Stock  points out the only other OECD countries not to fund 12 month courses of the drug are Turkey and Mexico.

As any parent will tell you “nearly everyone else does it” is not a convincing argument. But if most other OECD countries fund the treatment because they can afford to, even if the science is not settled; and we don’t because we can’t afford to then regardless of Pharmac’s independence we are justified in holding the government to account.


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