Health Minister Tony Ryall says he has no plans to amalgamate Auckland and Waitemata district health boards, but "would not stand in the way" if such a marriage took place.
As a member of a Government dedicated to making bureaucracies more streamlined and cost-efficient, why is he dragging the anchor? Indeed, why isn't he adding the Counties-Manukau district health board to the merger?
Mr Ryall was reacting to reported speculation following the resignation of Auckland DHB chief executive Garry Smith and two of his senior staff in recent months, that the exodus was a precursor to such amalgamation.
The denial is disappointing. The establishment of 21 DHBs in 2001 to administer health services across the country was always a flawed system as far as the Auckland region was concerned.
As a gesture towards local governance, the public hospital and specialist services of 1.5 million Aucklanders was divided between three providers, a choice based according to whether you lived south of Otahuhu, north of the harbour bridge, west of Avondale or on the isthmus.
Funding is population-based, with weighting according to sex, age, socio-economic status and ethnicity. If we all lived and worked and played within our own health board enclaves, this model might have made some sense.
But as the transport planners could have told the health boffins, Aucklanders are a mobile lot. The result is someone from Devonport - a Waitemata DHB resident - might well have his heart attack at the Britomart train station and be rushed to Auckland City Hospital, or at his job at the airport in the Counties Manukau health district.
For the bureaucrats, such thoughtless behaviour by the patient is most inconvenient, and complicated and expensive systems have had to be created to cope with reconciling the resultant "inter-district flow".
Not only is the aim of the system to get "foreign" patients back to their home districts as quickly as possible, but there are also the countless hours wasted in costing the care provided to these cross-town "foreigners" and trying to rip each other off.
The Auckland DHB also provides many specialties its two neighbours do not, meaning a steady stream of seriously ill patients from the outer districts have to be referred to Auckland DHB facilities and the bill sent back to their home DHB. When I last wrote about this a couple of years back, half of Auckland DHB's total operating revenue came from its two neighbours.
On a national basis, 40 per cent of the "inter-district flows" were then between the three Auckland boards.
The Auckland district health board raised the issue in its submission to the Royal Commission on Auckland Governance in the run-up to the creation of the Super City. It noted how the DHB boundaries were related to the old local government boundaries, and argued that the "natural flow or movement of communities to access publicly funded healthcare ... is not aligned with the geographical boundaries of territorial authorities". Otahuhu was held up as "the most obvious example", being locked into the Auckland DHB area as part of the old Auckland City "but whose natural alignment for acute and other hospital services is with Middlemore Hospital, part of Counties-Manukau DHB".
Advising incoming Health Minister Mr Ryall in November 2008, the Crown Health Finance Agency suggested "a formal reduction of DHB sovereignty in favour of regional bodies and/or central agencies" as a way of saving costs and improving service provision. But the new Government, like its Labour predecessor, backed off preferring to make gains through greater co-operation.
Labour tried to bring the boards closer together by appointing Ross Keenan as deputy chairman of all three boards. Just over a year ago, National appointed the existing Waitemata chairman, Dr Lester Levy, to take on the same role at the Auckland DHB.
At the time, Mr Ryall noted that "Waitemata pays Auckland DHB a quarter of its budget each year for services ... each board needs the other to be successful".
In other words, the three Auckland DHBs are in a de facto menage a trois with Government blessing already. So why not make it legal and reduce the costs and added complications of having to maintain three complete households?
This Government insisted on creating a single city to govern the region, along with one water company, one transport authority and one Auckland Plan. So why persevere with three health boards?By Brian Rudman Email Brian