The chief executive of one of the country's largest district health boards has hit back at calls to cut the number of DHBs, saying they are "big, complex organisations" that, despite the expenses scandal at Waikato last year, take the responsibility to provide safe, quality care seriously.

And Canterbury District Health Board chief executive David Meates said because of the concerns raised over spending irregularities by former Waikato DHB chief Dr Nigel Murray, board members at Canterbury have requested an internal audit review of both board and executive expenses.

It was to ensure "all of the right checks and balances are in place", Meates said in his monthly chief executive update to 10,000 staff, ministers, other DHBs and unions.

Meates, who is also chief executive at West Coast DHB, said it was disappointing to see high profile examples in other parts of the country of senior health leaders behaving in ways that erode public confidence in the leadership of New Zealand's health system.

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"Abuse of public funds that should be supporting better care for communities is never okay."

He said the poor behaviour had cast a spotlight on New Zealand's 20 DHBs and whether there were too many, and the costs associated with boards and executive teams.

On Saturday the Weekend Herald revealed it cost about $66 million per year for just 444 chief executives, senior executives and board members to run the country's DHBs.

That amount did not include the hundreds of thousands of staff, or the senior executive and board members' spending.

Meates said DHBs, often the biggest employers in their region, were unlike other businesses for several reasons;

• DHBs can't close their doors - health is a 24/7 operation

• They can't put up prices or generate more revenue

• Demand always outstrips the ability to deliver.

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Canterbury and West Coast DHBs served a population of 600,000 with a budget of $1.8 billion.

Compared to some of New Zealand's biggest businesses in terms of employees, the DHB was 11th largest behind Fletcher Construction with 18,600; Progressive Enterprises, 18,500; Fonterra, 18,000; Defence, 13,930; The Warehouse, 12,000; NZ Police, 11,980; K-Mart, 11,000; Air New Zealand, 11,000; Oji Fibre (Carter Holt), 10,500; and Spotless, 10,000.

"In anyone's terms, we are big. The nature of what we do is complex too. Ours is the business of caring.

"This is why it is critical that we have the right governance and leadership arrangements in place and robust systems underpinning what we do."

He said every one of the DHB's systems was subject to extensive external audits, credentialing and certification and health and safety audits, and that board committees played a critical role in monitoring performance.

"Sometimes health is challenged regarding a lack of collaboration across DHBs and other providers," Meates said.

Canterbury though had a history of organised primary care and strong relationships between primary and community services and secondary care, he said.

At the same time the South Island Alliance had enabled a shared electronic health record to now cover one million people in the South Island.

Meates pointed out that before DHBs there were 23 hospitals and health services, one Health Funding Authority and the Ministry of Health.

That was preceded by 23 Crown Health Enterprises, four Regional Health Authorities and the MoH.

Before that there were 14 Area Health Boards and even further back there were 30 Health Boards.

The Canterbury board will hear the results of its expenses audit at a meeting in mid-February.

In December the Weekend Herald revealed that chief executives spent $1.2m in three years on travel and training.

Meates was the fourth highest spender on $112,838 between July 2014 and June 2017, though that figure was for both DHBs he heads.

On Saturday Waikato District Health Board member Mary Anne Gill called for DHBs to be cut from 20 to five, even if it meant losing her seat, to free up what she calls wasted money on duplicated services.

Canterbury DHB by the numbers in 2017

$1.8 billion budget

600,000 people in DHB catchment area

10,769 fulltime staff employed

21,456 elective surgeries performed

672,348 outpatient appointments

1.3 million GP visits

102,767 people accessed urgent care at Christchurch and Ashburton hospitals

2.8 million lab tests completed

6540 received up to five free counselling sessions

115,300 admitted to Christchurch Hospital

34,000 avoided hospital thanks to community care

3.2 million prescriptions dispensed

4500 elderly people funded for care

6000 babies born.