THE PRESS FRIDAY, SEPT. 23, 1983. Change to health services

Press, 23 September 1983, Page 16

THE PRESS FRIDAY, SEPT. 23, 1983. Change to health services

The hospital boards that are elected in next month’s local body elections will be faced with the choice posed by legislation that is now before Parliament. The Area Health Boards Bill has yet to be passed, but no obstacles to its eventual adoption are readily apparent. Given the years of inquiry and consultation before the legislation was drafted, and given the general agreement of members on both sides of the House to the main aims of the bill, a change in the law along the lines proposed by the bill will take effect on April 1, next year. Hospital boards will then be able to request their own abolition and replacement. On doing so, they will be replaced by area health boards. These new bodies will combine the functions performed now by the Department of Health district offices and the hospital board or boards in the area. The bill has the potential for great change in the structure of the State health service, possibly the greatest change since the reorganisation that took place in 1920. The potential, however, is subject to the views and opinions of the hospital boards. The change cannot be imposed. The boards will have sole discretion to take the step. The attitudes of hospital board candidates to the integration of public sector health agencies, therefore, have an added importance in this election. Proposals in the bill stem largely from the work of three committees. The chief among these was the Special Advisory Committee on Health Services Organisation, which made its report in December, last year, after more than six years of investigation. The need to reorganise New Zealand’s health services has been recognised for longer than this. The last Labour Government produced a White Paper on the subject and various consultative committees and research bodies have compiled plans for reorganisation since the early 19405. The concept in the bill has been on trial in Wellington and in Northland and a discussion document was sent to hospital boards, voluntary health organisations, and others in the health community early this year. The development of the bill to this stage has been a process running over many years, subject at several points to the scrutiny and submissions of the organisations directly affected. Interested parties have a further opportunity to voice their opinions now that the bill is before a Parliamentary select committee. So far, only one submission has reached the committee. The Minister of Health,

Mr Malcolm, says that, through the process of discussion and consultation over the years, the concept of the proposals has received a wide measure of support. He says that disagreement, when it has occurred, has been mainly with the detail or the pace of reorganisation rather than with its principles. Nevertheless, the members of the hospital boards that helped to bring these proposals together will not necessarily be on the boards that will have to live with the results.

The effect of the bill can be negated, and any impetus for change arrested, if it does not draw a response from hospital boards. Nothing in the bill requires hospital boards to consider a change or come to a decision one way or another. Simply by ignoring the opportunity that the bill proposes, hospital boards could ensure that an Area Health Boards Act did nothing more than gather dust for the next three years at least. The health service is too important, and the need for reorganisation in some places is too important to permit a laissez-faire reaction to the proposals for reorganisation. The public will be poorly served—and electors poorly rewarded—by a board whose members preferred not to come to grips with the issue. Few would deny that the confused interrelationships and shared responsibilities of administration of the health service are capable of much-needed improvement. Some may well challenge the notion that the Government’s proposals will do the trick. The appearance of more local, consolidated control may be deceptive. Nevertheless, even if the concept of an area health board is rejected by a hospital board, the proposed legislation will have served a worth-while purpose if it prompts full consideration of the merits of change. If the rejection of an area health board is the result of a detailed study of the advantages and disadvantages of change, and if the reasons justifying the rejection are demonstrated, this in itself is a check on the adequacy of the administration of health services.

Wise management and foresight are needed from hospital boards as much as social concern and medical expertise. Voters in the forthcoming elections might well consider that the candidates most deserving of support are those who are prepared at least to debate the opportunities for change in the health service and who are prepared to keep that debate alive once elected.