Behind closed boards – Health NZ’s controversial new approach | Denton

A Te Whatu Ora | Health NZ’s decision to hold board meetings behind closed doors has drawn heavy criticism from the National Party, health advocates and others. Keeping the public out goes against transparency and accountability, they say, and is a significant and damaging departure from the old District Health Board (DHB) system where DHBs met once a month, and anyone could follow and observe.

The Case of the Crown Entity Model

Rob Campbell, chairman of Health NZ, dismissed the concerns, noting the availability of minutes, his intention to hold a press conference after each meeting and pointing out that Crown entities all take a similar approach for good reason; Is the RNZ board opening its meeting to the public, he asked on Morning Report, knowing the answer was, of course, no.

Rob Campbell is correct about the other tips. Under the Crown entity model, councils meet in camera, releasing minutes subject to any information being withheld for Official Information Act withholding grounds. So should Health NZ work differently? Should the public be allowed to attend board meetings? The answer from a public and administrative law point of view must be no.

It is absolutely true that public health and the decisions made by Health NZ are public affairs. Every New Zealander is or will be affected by what the Council decides. But those who advocate “open house” meetings confuse two very different types of entities; the old DHBs no longer exist and the old system has no meaningful application or equivalent under the current Crown entity model. While public access to regional meetings involving elected officials may have been beneficial, the same benefit cannot be said to apply to Health NZ Board meetings.

On the contrary, the negative impact of public access on the administration of Health NZ would likely significantly outweigh any benefit gained. Further, the highly prescribed Crown Entity Model provides for transparent and accountable governance in a different and arguably more effective way than the old DHB system. It should also be noted that the Pae Ora law provides for the development of a series of health strategies and plans, including at the local level, with requirements for community engagement. It’s an apples and pears situation.

There is always a case for public engagement at the regional level of decision-making. The CEO of Health NZ has indicated that this will continue to happen under the new model. But arguing for open meetings at Council level is a muddled argument at best and mischievous at worst.

End the old, make way for the new

The 21-year-old New Zealand health structure was disbanded from July this year, with the functions of 20 DHBs merging with Health NZ, the single entity responsible for the day-to-day running of the country’s health system. After DHB proved “too complicated for a small nation,” the health system overhaul aims to improve services and achieve equitable health outcomes through a more efficient and streamlined model. A key objective for ensuring access to health care is a nationally standardized service. Notably, Te Aka Whai Ora | The Māori Health Authority will work alongside Health NZ to directly commission tailored health services for Māori.

Essentially, comparing Heath NZ to the DHBs of yore is like comparing the All Blacks to the Hurricanes – Health NZ are playing in a much bigger and different league. This larger playing field necessarily involves much higher levels of commercial sensitivity and the need to keep information confidential (for example, discussions may be about private personal information or sensitive issues such as sourcing strategies) . It is also important to allow some degree of free and frank discussion among Board members as ideas are debated and developed (this is widely recognized as necessary for effective administration).

Previously, DBHs held monthly public meetings with agendas and documents made available online ahead of the meeting. This was a legal requirement for DHBs, which emphasized openness and availability of information. This also reflects the fact that the DHBs were made up of elected members of the local community and that issues were concentrated at the local level.

Health NZ is not a democratically elected council. It is deliberately created and run as a Crown entity. In structural terms, this gives Health NZ operational independence from central government while ensuring that it is directly accountable to the relevant Minister (being, at present, Andrew Little). As examples, other Crown entities include the Accident Compensation Corporation (ACC), Waka Kotahi and Kāinga Ora, none of which publicly hold board meetings or face appeals public to do so.

Public liability of a public health entity

Minister Little supports Campbell’s decision, saying the Council’s status as a Crown entity means there is no requirement for it to meet in public rather than in private.

National Health Party spokesman Dr Shane Reti meanwhile accused the Health NZ Board of secrecy and said that current problems plaguing the health system, such as the shortage of midwives, painful wait times for medical care and inadequate, earthquake-prone buildings should be discussed in public at town hall meetings.

Other critics have argued that open meetings are essential to establishing and maintaining public confidence in the new system. The question of trust is interesting – trust in all public institutions is currently strained, in New Zealand and elsewhere. Those who engage in debates about New Zealand’s public institutions can influence public trust through the choice of drums they beat. Many critics of Health NZ fully understand the Crown entity governance model and the fact that other Crown entities hold council meetings without a public forum.

In conclusion

Skepticism about the new superstructure undermines the legitimate argument that no other equivalent entity of similar size holds public board meetings. Furthermore, the actual impact that holding meetings behind closed doors will have on transparency and accountability is questionable; agendas are provided in advance, summaries are given after board meetings, and Campbell and CEO Fepulea’i Margie Apa host a half-hour press conference after each meeting to outline what they talked about and answer questions. Minutes will also be made public in the month following each meeting. Rarely have DHB meetings been reported so comprehensively, showing that a new efficiency-focused approach is probably the best way forward for Health NZ.