Today, the Herald begins a three-part series on the three agencies that run our healthcare system. We look at who is standing and what the issues are.
Some candidates for the Auckland District Health Board election want a super health board created to mirror the Super City.
The Government has parked the idea of forced amalgamations of DHBs during the current parliamentary term, although it is moving to enforce much greater co-operation between boards.
The common view
in Auckland health circles is that the region's three health boards are "organically" moving much closer together and that there is no enthusiasm for a formal amalgamation.
But within the centre-left City Vision grouping of sitting board members and candidates, there is a degree of support for a merger.
"I have been a supporter of it for a long time, particularly if it is going to get rid of the local politicking that goes on," said Dr Ian Scott, 67, who was first elected in 2001 but is not seeking a fourth term.
Auckland and its neighbour Waitemata have occasionally sparred over the access of the latter's patients to Auckland's high-tech services and other border issues.
City Vision candidate Robyn Northey - wife of Labour Auckland City councillor and Super City hopeful Richard Northey - is a cautious supporter of amalgamation.
"It's not policy, it's a personal view ... and only if that really local perspective is retained," said Mrs Northey, 70, who is among several candidates with a health sector pedigree reaching back decades.
Mrs Northey, one of 18 candidates contesting the board election, started her health career as a school dental nurse and was later a social worker.
She became a manager in the old Northern Regional Health Authority in the 1990s and subsequently ran a resthome/hospital, has done health consultancy work and has sat on government health committees.
An opponent of amalgamation is Lee Mathias, a candidate on the centre-right Citizens & Ratepayers ticket, who said the time was not right.
"I believe there are opportunities for regionalisation of a lot more support activities," said Dr Mathias, 59, a nurse who has had a long career in health management and governance.
She rose to prominence as one of the founders of the Birthcare maternity hospitals, which in Auckland prompted National Women's Hospital, during the era of competition, to offer a user-pays option for a better class of "hotel" services.
Dr Mathias was appointed to three crown health enterprise boards - forerunners of DHBs - and played a key role in the upheaval in Auckland's laboratory services.
She was a shareholder - with Dr Tony Bierre, who was a C&R member of the Auckland DHB - in Labtests, the company that controversially won the contract for the region's DHB-funded community laboratory services, squeezing out Diagnostic Medlab until DML was partly brought back last year after Labtests' start-up troubles.
She sold her stake in 2007 around the time DML began its ultimately unsuccessful court challenge against the contract. Dr Mathias said her roles in the setting up of Labtests included stakeholder relations.
Another C&R candidate with a long history in health, Judith Bassett, is undecided about returning Auckland to the kind of health board she ran 21 years ago, before the National Party sliced it in three.
"I don't know enough about it," she said. "I think there is certainly great merit in co-operation."
The wife of former Labour Party health minister Dr Michael Bassett, Mrs Bassett, 67, has been a member of the Auckland Regional Council since 2001 and is chairwoman of its port-owning holding company.
She served two terms as an elected member of the old Auckland Hospital Board in the 1980s.
Labour converted this into the Auckland Area Health Board, but, before its first elections, and because of its financial trauma, the health minister at the time, Helen Clark, disestablished it in April 1989.
Mrs Bassett, who chaired the area health board, recalls that "it is often said" that the board - of which Helen Clark's husband Dr Peter Davis was a member - was sacked by the minister.
"We had made an appointment to see her to say we could no longer continue. The central issue of funding was overwhelming," said Mrs Bassett.
Six of the Auckland DHB's seven elected members - the Government appoints up to four members to each of the 20 health boards - are seeking re-election.
C&R has fielded a full slate of seven. The ticket won two seats on the current board and Dr Chris Chambers, an Auckland City Hospital anaesthetist elected on the 1Auckland ticket, has reverted to C&R for this election.
City Vision, which holds three seats, has put up four candidates, including sitting member and former Labour deputy prime minister Bob Tizard, 86.
Independent board member Susan Buckland, a journalist, is seeking a second term.
Chairman Pat Snedden, an appointee, said the board had turned in its third break-even result in a row in the last financial year, a huge turnaround from the years of deficits.
He expects the merging of back-office functions - including payroll and human resources - by the three Auckland DHBs and Northland will produce financial savings.
But there is "no suggestion" of a complete amalgamation in Auckland.
He has an explanation why health boards - he has chaired two - are not really political organisations.
Candidates may be elected with a brand, but the size and complexity of a metropolitan health board force them to leave political ideology at the door.
"We have to give effect to government goals that are pretty prescriptive.
"Every board has particular local conditions they do a lot of work around satisfying. The first requirements are the government's goals."
Auckland DHB facts, figures and how to vote
Estimated population: 460,000 next year.
Annual turnover: $1.7 billion.
Staff: 9000.
Patient contacts: 2 million a year.
Board member annual pay: $26,000 base rate for ordinary members, up to $35,000 including committee fees.
Voting system
District health boards are elected on the single transferable vote (STV) system.
The three Auckland boards are each a single ward for voting purposes.
Voters are asked to rank candidates in order of preference, writing 1 beside their top preference, 2 beside their second preference and so on, ranking as many or as few candidates as they wish.
The series
Today: Auckland DHB.
Tomorrow: Waitemata.
Wednesday: Counties Manukau.
