Editorial: Elected boards an unhealthy hybrid

Annette King's proposed constitution for elected district health boards sounds a clang of warning of their democratic limits. The Health Minister will have the right to sack not just the entire board but any individual members - virtually at will.

The right of government to dismiss an elected body that spends taxpayers' funds cannot be denied. It is the Government that must collect the revenue that the newly elected health boards will be spending and the Government is ultimately accountable for the use of the money. But the right to dismiss an entire board is quite different from the power to pick off elected members piecemeal, even if the Government must cite what it considers "just cause."

Aucklanders well remember when the present Prime Minister, as Minister of Health in March 1989, sacked the Auckland Hospital Board and installed a commissioner, Harold Titter. It was a brave move, not least because Helen Clark's husband, Peter Davis, was among those she dismissed. The public could only admire her decisiveness and she probably helped, unintentionally, to prepare the way for boards fully appointed by the next Government which wanted hospitals and related services run along commercial lines.

Now Labour is about to abandon commercial methods of accountability and reinstate direct elections to district boards. But the right to dismiss a board for poor performance will always be needed and the public accepts that. Witness the Rodney District Council. When the cabinet considers that council's fate today the Minister of Local Government, Sandra Lee, will surely install a commissioner until new elections can be held.

The new health boards are going to be a hybrid, neither entirely democratic nor completely subservient to Government direction. Despite four lengthy briefing papers, it is still not clear which way the hybrid will tilt. Mrs King has not yet said either how many people will sit on boards or what proportion of them will be elected rather than appointed. The papers say only that elected members will form a majority and that the first elections will be held in conjunction with local authority elections in October 2001.

By then some of the appointed members will have been sitting for more than a year, setting the direction - and tone - for the way Mrs King wishes them to operate. And possibly elected members will fall into the desired culture, "feeling a dual accountability," she says, "to both ministers and the community which elected them."

"Dual accountability" presents a dilemma. Are they primarily to press for maximum funding in the interests of those who elect them? Or are they supposed to reassure their community that the best use is being made of the necessarily limited funds the Government can provide? The power to dismiss individuals raises the prospect that it will be used to discourage those who take the populist course of pressing constantly for more money. Their position will be tenuous.

The minister might reserve the power to veto people who win at election in "exceptional circumstances." She will be able to step in and sack any members she considers are not acting "with reasonable care and skill in carrying out their functions and powers." It begins to suggest the Government's talk of democratic health boards is more rhetoric than substance.

Even when Helen Clark was Health Minister she was inclined to relegate the democratic element of area health boards to subsidiary committees. In 1989 she returned from a trip to the World Health Assembly in Geneva talking of appointed boards with elected committees for the community influence. Maybe, that would still be a better idea than constituting boards with both Government functionaries and community voices.

Certainly a fully appointed board and an elected committee of local representatives would be more honest than this half-baked hybrid that might satisfy no one.