A former Hawke's Bay DHB chairman strongly opposes the Government being handed the power to appoint all DHB members.
Elected DHB member Kevin Atkinson, who failed to gain reappointment as chair in 2019, would support an independent body appointing members, but not the Minister of Health.
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However, current DHB chairman Shayne Walker says the present system doesn't work and he supports the Government appointing a diverse, full board.
"The current system doesn't work in representing our community fully."
A controversial report, spearheaded by former Prime Minister Helen Clark's chief-of-staff Heather Simpson, recommends an overhaul of the country's DHB system and the creation of new health agencies.
• An end to DHB elections, with the Ministry of Health appointing all members
• Māori Health Authority to assess performance.
• New Zealand's 20 DHBs would be reduced to between eight and 12 within five years.
Atkinson believes Hawke's Bay's DHB would survive a nationwide cull and he applauds the diversity proposal.
However, he opposes some of what he terms the "too political" recommendations.
"We are in dangerous territory if the recommendations are taken as is, and the appointment of DHB reps by the Minister of Health is not something I can support," Atkinson said.
Atkinson, initially a Government-appointed board member, was the top-polling public elect at four consecutive elections, and has been chairman for 19 of his 20 years.
"In the last election not one of the board members appointed by the minister was interviewed," he said.
"You need to have a range of skills ...
"I am seriously opposed and can't lend my support to the recommendation [that] the Minister of Health makes the appointment. It becomes too political and I do not support the disestablishment of the process.
"But if an independent authority was to make the appointment then I would support it."
DHB chairman Walker, who replaced Atkinson, said an independent and objective view towards revamping the existing system provided an opportunity to find improvements.
"I think ultimately it will lead to improvements in the health system. So the effect will be a positive one."
His views, as an MOH appointee, differed from those of Atkinson regarding the election process.
"Lots of different people have differing opinions," he said.
"Ultimately, do I think the Government is in a good position to appoint the full board? I think yes. It provides opportunities to ensure we get good diversity across the board."
Atkinson said he didn't think Hawke's Bay was in danger of being wrapped into another DHB.
"Hawke's Bay population is the most isolated population from tertiary services region-wise," he said.
"My thinking is Hawke's Bay would expand to include Dannevirke and Wairarapa, which includes Ngati Kahungunu iwi and it would be good to include the entire iwi territory.
"I believe HB would remain as one of the DHBs moving forward."
Board member Heather Skipworth said the recommendations needed to address the "systemic racism" in more detail.
"The Government has an obligation under Te Tiriti o Waitangi, so although one could applaud the Government for taking this stance, it has taken them 180 years to acknowledge it."
Interim chief executive Craig Climo said the recommendations didn't change the DHB's focus on working to improve the health outcomes for the Hawke's Bay community.
And fellow board member Anna Lorck, speaking personally, also had qualms about the democratic process.
"In my experience democracy has not been a failure - what I have seen is the process of electing our DHBs at large has failed," she said.
"Because as I have seen in Hawke's Bay, our smaller areas like Wairoa and CHB don't get elected reps from their communities, nor indeed Napier. I am particularly mindful of those who do not have a local elected voice at the table."