Key Points:

It's a safe bet that Heather Roy won't spend this weekend mulling over her ballot paper for the district health board elections.

The Act Party health spokeswoman says the 21 postal elections are "a complete waste of time and money" because the boards merely carry out orders from Wellington.

She claims the proof came in Parliament when Prime Minister Helen Clark's could not identify anything the 21 health boards can do without the approval of Health Minister Pete Hodgson or his ministry.

Helen Clark did, however, describe the role of district health boards: "[They] are elected to be responsive and accountable to their communities, and they work very closely with their communities."

The legislation defining their place is very specific.

"While most board members are elected by the public," the ministry says, "all board members are directly responsible and accountable to the Minister of Health. This is because DHBs are funded by the Government, using taxpayer dollars."

That is the big difference between health boards and local government democracy. Councils levy rates independently, so they can spend their money much more autonomously.

Some elected health board members have resigned noisily since the first DHB elections in 2001, citing excessive control from Wellington.

Others, like Auckland DHB member Chris Chambers, recognise and work within the limits.

"There's certainly a lot of direction from Wellington and the ministry," he says. "There's not a lot of autonomy in what we can do. I think in many respects we may not be able to change decisions, but we may be able to change the flavour of them."

Pat Snedden, elected to the Auckland board on a Labour-leaning ticket in 2001 and appointed chairman of the Counties Manukau board in 2004, fills in the gaps in Helen Clark's response. He says his board has made closer contact with communities through members' connections with specific parts of the community. He cites Pacific Islander Arthur Anae, a city councillor and elected board member who has chaired its Pacific committee.

Mr Snedden says board members with strong connections in the local community were instrumental in the decision to spend $10 million on the Let's Beat Diabetes programme, which has led to projects such as having only the sugar-free version of Sprite soft-drink in the district's McDonald's restaurants.

"That's because they brought with them experiences of their own families dying from this disease. That direct advocacy is a very important part in this process."

Counties Manukau's current board, like Waitemata's in north and west Auckland, has a sprinkling of local government elected members. More than a third of Counties DHB election candidates and about a quarter at Waitemata and Auckland are also standing for councils or community boards.

Policies for this year's polls are generally bland and similar, promising the likes of cost-effectiveness, a lean bureaucracy and community responsiveness. The 1Auckland ticket wants amalgamation of the funding arms of the three Auckland boards, an important policy question, but hardly one to ignite public enthusiasm.

Citizens & Ratepayers has recognised the significance of the emergency department crisis caused by poor patient flow, slow discharges and too few beds at some hospitals. This issue has prompted Gary Taylor to form the one-man Fix Emergency Department ticket for the Waitemata poll, although the health board says it is already addressing the problem.

C&R Auckland board candidate Kevin Hicks, a cancer researcher, blames difficulties recruiting and retaining senior doctors and nurses for emergency department problems, which he says must not be allowed to occur at Auckland City Hospital.

Reports obtained by National this year suggest declining hospital productivity in the region, but the findings were widely contested.

Auckland chairman Wayne Brown says his board has turned in a deficit of $10.7 million, 47 per cent smaller than forecast, while improving many services.