The expenses run up by the former chief executive of the Waikato District Health Board are just the highest of all the heads of district health boards over the past three years. The figures we have published today show the 20 district chiefs spent $1.2 million in total on travel, training and meetings, not all of them within New Zealand. For some reason, some of them found the need to travel on business to places such as Paris, London, New York and Amsterdam.

And the expenses pale by comparison to the salaries boards are paying, which have raised the concern of the State Services Commission at a time the public hears health boards can not meet their budgets and services are stretched at times to meet patients' needs. Last month the Southern DHB was so far behind its schedule of cardiac surgery that one patient complained his heart operation had been postponed six times.

The board said it did not have the money to send its overdue cases to other hospitals. Yet its chief executives spent nearly $58,500 on travel and other expenses in the three years to June.

Northland's board chief spent twice that much in the same period as did the Lakes CEO, and Waikato's Nigel Murray spent nearly twice as much again, $218,000. At the other end of the scale, Wellington's Capital and Coast chief executive spent just $28,237 over the three years.

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Possibly many of the meeting all attended were in Wellington and their expenses would increase with distance from the capital, but that begs a deeper question about the need for all these district health administrators.

The boards are essentially branches of the Ministry of Health though the ministry also has local offices throughout the country. It has often been asked, does a population of 4.5 million need so many (or any) district health boards? New Zealand's population is smaller than many cities served by a single health administration. Does the distance between our population centres preclude a single national administrative structure here?

It is worth recalling how DHBs came into being less than 20 years ago. Before them, public health services were reformed along corporate, quasi-competitive lines. Each big hospital and its associated services were constituted a "crown health enterprise" which would bid to provide tax funded services, make more efficient use of public funds and prove it by showing a return on their capital.

All of that was anathema to the Labour Government elected in 1999 which decided to retain the decentralised management local hospitals and related services but make then answerable to locally elected boards rather than corporate financial discipline. The decentralised set up was supposed to reflect the varied character and health needs of different communities. But that remains a dubious justification.

Health needs do not vary much from one district to the next and the ministry has dictated most of what DHBs could do from the outset. Local autonomy is more apparent than real. Even the elected element is limited. The board chairs are appointed from Wellington as are some of their members. The elections are held in conjunction with those for other organs of local government and the health board ballot is an after-thought for most voters.

We certainly do not need 20 boards, we probably do not need any. The costs of so many executive salaries and expenses could be better used to provide more of the medical services people really need.