The Waikato District Health Board may well have provided Health Minister Dr David Clark with the impetus to bring sweeping change to our health system. Should that be the case, then it would be a shiny lining to a tawdry time indeed.

Anyone still unconvinced of the need for change need look no further than these pages over past weeks as the spending by chief executive Dr Nigel Murray was exposed for all to see. The resignation by board chairman Bob Simcock has done little more than cauterise the wounds left by Murray's excessive expenditure. The flow of money may have been stemmed but the cost to the public — monetarily, yes, but particularly in trust — has yet to begin healing.

Our district health boards have operated as autonomous regimes for too long, handed the strings to an apparently bottomless purse to provide healthcare as deemed fit by a cartel of executives, barely troubled by elected board members to account for the cash. Ministers of health too have been conveniently unaccountable for any identified performance issues, airily dismissing any perceived or proven failure to the public as matters for the errant boards themselves to consider.

Attempts to monitor performance of district health boards have been around since at least 2007 with published "target" categories, such as length of stays in emergency departments, access to elective surgery and immunisation rates. These performance tables have only emphasised the disparities across our districts.

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By the latest figures, if you need emergency care, you would be dealt with quickest in West Coast; slowest in the aforementioned Waikato. Conversely, cancer treatment is performing best in Waitemata; worst in the West Coast.

Core healthcare should be more consistently delivered across the country. It seems unconscionable that a heart attack in Greymouth could be stabilised and settled into a treatment schedule so much faster than Hamilton.

In the most recently published performance tables, only four of our 20 district health boards were reaching the set target of 85 per cent of patients receiving their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer. That's for a situation where the agreed timeline is a need to be seen within two weeks.

For a chief executive to spend 183 days in a year on travel — leaving him a maximum of 182 days, including weekends, to do his job — one can only conclude his hands were truly off the wheel for too much of the time.

More disclosure; more accountability; more improvements in performance. These must be the priorities for our new Health Minister. It may be time to herd nationally accepted levels of care in core services into a nationwide health service and leave primary care to the districts. Primary care needs much more robust scrutiny too, and perhaps districts could at least deliver here if secondary care were a national concern.

The sooner Dr Clark moves to hold health boards to decent standards of care and fiscal prudence, the better for all of us.