Report of the

Wanganui Area Health Board Steering Committee

0 to the Minister of Health, the Hon. Dr. Michael Bassett

JULY 1985 WANGANUI AREA HEALTH BOARD STEERING COMMITTEE

P 0 BOX 287 WANGANUI

4 July 1985

Hon. Or M Bassett Minister of Health Parliament Buildings

Dear Or Bassett

The presentation of this report is the culmination of:

(1) three months intensive research and consultation by the Wanganui Area Health Board Steering Committee and its Advisory Group, (2) seven years interest and close study of Area Health Boards by members of the Wanganui Hospital Board, and, (3) . three years investigation and experimentation by the Wanganui Area Health Co-ordinating Committee (comprising representatives of the District Office of the Health Department, Wanganui United Council, Medical Association, Ministry of Works and Development, Lake Alice Hospital, and . the Wanganui Hospital Board) of the feasibility, of the concept of an Area Health Board for the Wanganui Region.

I would like to express my deep and sincere appreciation to all who have been associated with this exciting and challenging task, for their extremely hard work and enthusiastic dedication. The calibre and expertise of the members of the Steering Committee, the personal commitment and responsibility each has shown in their broad approach, attendance at meetings and the zealous manner in which they have carried out their Terms of Reference must be acknowledged with deep gratitude.

The encouragement and assistance provided by you as Minister of Health, the Director-General of Health, Or Ron Barker; Officials of the Department of Health; the Health Service Personnel Commission; and the active participation, invaluable input and advice provided initially by Dr Derek Taylor and then by Or Bryan Christmas, the Deputy Director- General of Health (Public Health), is a measure of and tribute to the support and co-operation we have received. Throughout the Steering Committees deliberations, the Advisory Committee (comprised of the Executive Staff of the District Office, Lake Alice Hospital, and the Wanganui Hospital Board, and the Hospital Boards Planning Officer) have been an invaluable resource and advisory group. Without their assistance, loyalty and application to the many tasks referred to them and to the objectives and philosophy of an Area Health Board, the task set for the Steering Committee would not have been possible to achieve.

For all of us, health care is a partnership between the traditional health people - those who work in the hospitals and those in the community. The important practical and successful expression of this with an Area Health Board is in the formation of Service Development Groups and Community Committees. The establishment of Service Development Groups ensures the practical involvement of professional people with intimate knowledge of special and particular health needs for the voluntary, private and public sectors in the planning and evaluation of services. The appointment of Community Committees will provide the important community link between their areas and the Area Health Board. This will intimately involve all in the achievement of a better organisation and improvement of our health services.

As Minister of Health you have given advice that you see the future of Lake Alice Hospital as being part of the proposed Wanganui Area Health Board. The bringing together of the two public funded hospital systems within the Wanganui Area Health Board District is a logical step in the formation of an Area Health Board with its emphasis on service development planning and the provision of comprehensive services. All State funded mental health services in the district will therefore come under the control of an Area Health Board, with participation from health professionals in service planning, oversight from the Health Department, and participation from Community Committees.

Grateful thanks must be extended to the members of the various professional groups, the voluntary organisations, the Trades Council, and the members of the general public, who have shared so honestly with us their viewpoints, the expression of which have been so important to the Steering Committee in their deliberations.

In conclusion I would like to record my personal thanks to all members of the Steering Committee and the Advisory Group - it has been a privilege and a pleasure to have worked so closely with each and every one of them.

Yours faithfully

L/L^ AU^ BETTY BOURKE Chairman Wanganui Area Health Board Steering Committee

CONTENTS

Page

LIST OF MEMBERS 1

LIST OF ADVISORY COMMITTEE MEMBERS 3

TERMS OF REFERENCE 5

1. RECOMMENDATIONS 7

2. INTRODUCTION 13

3. FACTORS AFFECTING REGIONAL RE-ORGANISATION 15

4. WANGANUI AREA HEALTH BOARD 19

1. The Board and its Management 19 Summary of Recommendations 33

Service Development 37 2. Summary of Recommendations 40

3. Communications and Community 43 Involvement

Summary of Recommendations 46

Finance 49 4. Summary of Recommendations 50

5. Personnel 53 Summary of Recommendations

5. FURTHER ACTION 59

APPENDIX

Steering Committee Meetings 63

Representation and Constituent Areas 64

Consultation and Communication 65

Funding Report 73

Personnel Matters 8.

Notes of Meeting with Director,

Dental Division 92

Ministerial Advice Concerning Lake Alice Hospital 94 Background Paper - Wanganui Area Health Board Steering Committee 95

Tasks for Steering Committee 104

Area Health Board Act - Division of Responsibility 107

List of Resource Material 110

Personal Statement by Mr G H Neill 113 -1-

WANGANIJI AREA HEALTH BOARD STEERING COMMITTEE MEMBERSHIP

Mrs B Bourke, OSM, JP, Chairman, Wanganui Hospital (Chairman) Board; Member Patea Hospital Management Committee, Patea.

Dr B W Christmas Deputy Director General of (from May 1985) Health (Public Health), Department of Health; Wellington.

Mr G H Neill Deputy Principal, Wanganui Regional Community College; Wanganui

Mrs L Noble Member, Wanganui Hospital Board; Chairman, Council for the Ageing; Wanganui.

Mr d E ONeill Wanganui County Councillor; President, Federation of NZ Ostomy Societies; Kakatahi.

Mrs R Rei, OSM, JP Member, Wanganui Regional Community College Council; former Community Officer with Department of Maori Affairs; Wanganui

Mr R G Russell, OSO Former Mayor, Wanganui City Council; Former Chairman Wanganui United Council Wanganui

Dr C N D Taylor Former Deputy Director General (until May 1985) of Health, (Public Health); .

Mr H D Treadwell, JP Former member, Rangitikei County Council; former member, Wanganui United Council; NZ Vice-President Royal Agricultural Society of New Zealand; Taihape.

Mr I C Webster Chairman, Wanganui Newspapers; Wanganui -3-

ADVISORY COMMITTEE

Miss D A Bowen Principal Public Health Nurse, Department of Health, Wanganui.

Mr J Boyack, JP Chief Executive, Wanganui Hospital Board, Wanganui

Mr D J Cairns Principal Inspector of Health, Department of Health, Wanganui

Dr R W England Medical Superintendent-in- Chief, Wanganui Hospital Board, Wanganui.

Mr P G Hales District Executive Officer, Department of Health, Wanganui.

Mr S F Jackson Advisory Officer, Department of (from May 1985) Health, Wanganui.

Mr J J B Moar Secretary, Lake Alice Hospital, Marton

Mr T Quinlan Principal Nurse, Lake Alice Hospital, Marton.

Mrs S J Smail Chief Nurse, Wanganui Hospital Board, Wanganui.

Dr K D B Thomson, O.B.E. Medical Officer of Health, Department of Health, Wanganui -5-

TERMS OF REFERENCE

i To ensure that there is adequate community support for the establishment of an Area Health Board. ii To complete the report to the Minister no later than 1 July 195. iii To establish as necessary working parties to consider and investigate specific areas for inclusion in any final report. iv To ensure that all administrative prerequisites are completed in readiness for the target date of 1 October 1985. v To investigate the procedures necessary to ensure the smooth transfer of the Wanganui Hospital Board and the Wanganui District Office of Health into an Area Health Board as set down by the Area Health Boards Act and the Health Service Personnel Act. vi To establish a system of communication through which organisations in the Wanganui Hospital Board Area can be kept informed of developments and have the opportunity to make submissions to the Steering Committee. vii To identify any matters as listed in the Area Health Boards Act 1983 and any other matters which require further clarification. -7-

SECTION 1

RECOMMENDATIONS

1.1 The Steering Committee recommends

Area Health Board

1.1.1 That a Wanganui Area Health Board be a new corporate body incorporating the District Office of the Department of Health, Lake Alice Hospital, and the Wanganui Hospital Board.

1.1.2 That the services provided by the Wanganui District Office of the Department of Health to the District continue to be provided by a Wanganui Area Health Board.

1.1.3 That the responsibility for the School Dental Service within the boundaries of the Wanganui Area Health Board be transferred from the Department of Health to the Wanganui Area Health Board.

1.1.4 That negotiations take place for the employment of the Principal Dental Officer attached to the Palmerston North District Office to be employed on a part-time basis by the Wanganui Area Health Board as its Principal Dental Officer.

1.1.5 That when a local authority is without an Inspector of Health the Wanganui Area Health Board may make an Inspector of Health available to the local authority to perform statutory health functions at an appropriate cost.

1.1.6 That a Wanganui Area Health Board not duplicate the traditional medical role of the General Practitioner, but in consultation with the NZ Medical Association may provide emergency cover to a community temporarily without services.

1.1.7 That a Wanganui Area Health Board establish a full and suitable working relationship involving regular consultation with the Wanganui Division of the NZ Medical Association as the official and recognised professional body of registered medical practitioners.

1.1.8 That the Wanganui Area Health Board grant direct access to duly appointed representatives of the Wanganui Division of the NZ Medical Association.

1.1.9 That the planning services of a Wanganui Area Health Board be responsible to the Head of Administrative Services for the Board with functional responsibilities to the Executive team.

1.1.10 That there be eleven elected members of a Wanganui Area Health Board and that there may be up to two appointed members.

1.1.11 That the constituent representation of a Wanganui Area Health Board be:

Patea County, Patea Borough, Waverley Town 1 Waitotara County and Wanganui County 1 Waimarino County, Raetihi and Boroughs 1 , Taihape Borough, Northern Rangitikei County 1 Southern Rangitikei County 1 Marton and 1 Wanganui City 5

1.1.12 That urgency be given to changing the Health Service Personnel Act, 1983, to allow for the inclusion of Lake Alice Hospital in an Area Health Board and, that in line with advice received from the Minister of Health, Lake Alice Hospital become part of the Wanganui Area Health Board on 1 April, 1986 provided an Area Health Board is in place on that date.

1.1.13 That following the establishment of a Wanganui Area Health Board therebe a transitional period for the transfer of the functions, duties, and powers of an Area Health Board, during which time all aspects of the organisations involved in the merger will be transferred to the new Area Health Board.

1.1.14 That, because of the multi-disciplinary nature of the Executive team, the Chairman should have a close working relationship with it.

1.1.15 That the Executive team consist of a head of nursing services, head of medical services, and head of administrative services, to advise the Area Health Board and administer those public sector health services which will be under the Boards control

1.1.16 That each member of the Executive team be individually responsible for the services, activities and programmes under his control

1.1.17 That the job descriptions and the conditions of employment of the Principal Officers of a Wanganui Area Health Board adequately reflect the requirement of these offices in assisting the Area Health Board to fulfil its objectives as an organisation involved in the promotion of health, the prevention of disease, and the treatment of illness, and be to the satisfaction of the Health Service Personnel Commission and the Area Health Board. Ma

1.1.18 That management groups comprising the Senior Nurse, Senior Medical Officer and Senior Administrator for an institution or service be responsible for the planning policy and day-to-day running of that institution or service within the policies and guidelines laid down by a Wanganui Area Health Board and its Executive.

1.1.19 That a Wanganui Area Health Board have the following Committees

Community and Environmental Health Hospital Services Finance Works and Buildings

1.1.2fl That the necessary negotiations take place to ensure the retention of the present District Office accommodation following the establishment of a Wanganui Area Health Board.

1.1.21 That the estimates for a Wanganui Area Health Board provide for separate rental accommodation for Area Health Board administrative services within two years of formation, and ultimately that there be provision of finance for the purchase or rental of a new building at a later stage.

1.1.22 That the Community and Environmental Health Service team be housed in the same building as the Area Health Board administrative services as soon as possible after the Board is established.

Service Development

1.1.23 That sufficient Service Development Groups be established to deal adequately with health promotion, primary health care, medicine, surgery, child health, health of the elderly, mental health, dental health, and health protection (with special emphasis on occupational health).

1.1.24 That elected or appointed members of a Wanganui Area Health Board may be eligible for membership of Service Development Groups.

1.1.25 That allowance be made for consumer representation on Service Development Groups.

1.1.26 That a convenor for each Service Development Group be appointed by the Board, and that the Chairman be appointed by the group from its members, and approved by the Board.

1.1.27 That the Wanganui Area Health Board provide adequate resources for the servicing of Service Development Groups.

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1.1.28 That attendance fees and travelling expenses he paid as appropriate to group members.

Communications and Community Involvement

1.1.29 That consideration be given to the adequate provision of an information and complaints system.

1.1.30 That Community Committees be established in appropriate areas based on communities of interest.

1.1.31 That secretarial services be provided from within each Community Committee and not by the Wanganui Area Health Board.

1.1.32 That an incoming Area Health Board strongly encourage the establishment of Community Commmittees as soon as possible to keep the public informed of progress made, and as an instrument to increase the understanding of people about Area Health Boards and their need for personal involvement.

Finance

1.1.33 That the funds and resources of the Wanganui Hospital Board be transferred to the Wanganui Area Health Board.

1.1.34 That the funding and resources of the District Office of the Department of Health with the addition of sufficient funds to fill vacant established staff positions be transferred to the Wanganui Area Health Board.

1.1.35 That the funding and resources of the School Dental Service of the Department of Health within the boundaries of the proposed Wanganui Area Health Board be transferred to the Wanganui Area Health Board.

1.1.36 That the funding and resources of the Lake Alice Hospital with the addition of sufficient funds to fill vacant established staff positions be transferred to the Wanganui Area Health Board.

1.1.37 That the services provided by government departments at no cost to the District Office of the Department of Health and Lake Alice Hospital continue to be provided without cost, or that sufficient funding to cover these costs be transferred to the Wanganui Area Health Board.

1.1.38 That a commitment be given by the Department of Health to provide finance at a later date for any unidentified services currently being provided by the District Office of the Department of Health, the School Dental Service and Lake Alice Hospital.

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1.1.39 That all assets and land owned by the Wanganui Hospital Board, the District Office of the Department of Health, the School Dental Service of the Department of Health (within the proposed Wanganui Area Health boundaries) and Lake Alice Hospital be transferred to the Wanganui Area Health Board.

1.1.40 That a supplementary grant be made to the Wanganui Area Health Board to cover transitional costs.

1.1.41 That the Population Based Funding formula continue to be used for the allocation of funding for inpatient hospital services, including Lake Alice Hospital, with provision for a supplementary grant for the Maximum Security Unit at Lake Alice Hospital

1.1.42 That the Wanganui Area Health Board assume responsibility for the payment of the accounts and salaries of the Wanganui Hospital Board, the District Office of the Department of Health, and the Wanganui regional School Dental Service at the time of its establishment.

1.1.43 That bridging finance be provided by the Department of Health for a period of three years to permit the employment of a planning officer primarily for mental health service development planning.

1.1.44 That seeding finance be sought to increase the health promotion and health protection programmes.

1.1.45 That the formation of an Area Health Board be subject to resolution of the matters contained in the funding report and as outlined in the other finance recommendations.

Personnel

1.1.46 That the concerns of employee organisations be resolved as matter of urgency and that it is desirable that the concerns be resolved prior to an Area Health Board being formed.

1.1.47 That the provisions of the Health Service Personnel Act be applied to all transferred employees, that good communication channels be established and maintained with staff, and that where jobs, duties, or status may change, the employees ffected be consulted.

1.1.48 That the executive management team be appointed as quickly as possible.

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SECTION 2

INTRODUCTION

2.1 The Wanganui Hospital Board first notified -the Minister of Health of its desire for an Area Health Board to be established in its region in January, 1981, when it wrote to the Honourable G F Gair informing him of a resolution of the Board passed at its meeting on 22 January 1981. This interest was confirmed in a letter to the Honourable A G Malcolm, Minister of Health, on 1 May, 1984, following enactment of the Area Health Boards Act, 1983.

2.2 In July, 1984, there was a change in government and, following a visit by the incoming Minister of Health, the Honourable Or M Bassett, in December of that year, the Board once again confirmed its request and sought approval for an Area Health Board to be established on 1 October, 1985, the date suggested by the Minister, The Board also asked for administrative responsibility for Lake Alice Hospital to be assumed by the Area Health Board on the same date.

2.3 Consequent to the Ministers visit the Wanganui Hospital Board decided to set up a Steering Committee to look at the feasibility of an Area Health Board for the Wanganui region. Members were appointed by the Wanganui Hospital Board with the approval of the Minister of Health and the first meeting was held on 29 March 1985.

2.4 The Steering Cornmmittee met on fourteen occasions. Eighteen public meetings were held throughout the region to inform the public and to listen to their concerns. In addition, members of the Steering Committee attended meetings of professional organisations, local bodies, and other groups as requested. Throughout its deliberations the Steering Committee was assisted by an Advisory Committee which included the executive staff of the District Office of the Department of Health, Lake Alice Hospital, and the Wanganui Hospital Board.

2.5 The work already undertaken in New Zealand by the Special Advisory Committee on Health Services Organisation, the Northland Health Services Advisory Committee, and the Wellington Health Services Advisory Committee was of considerable assistance to the Steering Committee.

2.6 In October, 1981, the Wanganui Area Health Co- ordinating Committee had been formed to look Into matters which could assist with the provision of an Area Health Board in the area. This committee functioned until November, 1984, and, In this time -14-

set up Shadow Service Development Groups and developed the Wanganui Health Data Handbook as well as considering many other matters related to an Area Health Board. The experiences of the committee, comprised of representatives of the Wanganui United Council, the Wanganui Hospital Board, the District Office of the Department of Health, the Wanganui Division of the New Zealand Medical Association, and the Ministry of Works and Development, was also of help to the Steering Committee.

2.7 Motivating factors behind the Wanganui Hospital Boards request for the establishment of a Wanganui Area Health Board include:

(a) the desire for a Service Development Group approach to planning involving closer liaison and co-operation among the private, voluntary and public sectors.

(b) the ever increasing demand for curative services and the ever increasing costs associated with those.

(c) the wish to change attitudes to health and prevent illness by increasing emphasis on health education, health promotion and disease prevention.

An Area Health Board, uniting the health promotion, disease prevention, and treatment services was seen as an appropriate way of addressing this.

2.8 It is the view of the Steering Committee that an Area Health Board is a feasible proposition for the Wanganui Region and that the opportunity it presents for the development of a health service special to the region makes its creation desirable provided that the concerns and issues raised in this report can be satisfactorily resolved.

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SECTION 3

FACTORS AFFECTING REGIONAL REORGANISATION

3.1 From the commencement of its deliberations the Steering Committee has been very much aware of the special factors that must be considered in the development of any health service reorganisation for the Wanganui region. These include such things as its demography and geography and any other aspects that distinguish it from other areas.

3.2 The Wanganui region is predominantly rural and 50% of the population live outside the city of Wanganui. Approximately half of these live in boroughs or towns scattered throughout which, like Wanganui, are geared to servicing the rural sector surrounding them.

3.3 The region includes both flat land, and mountainous terrain and extends from the coast to Mt Ruapehu. 75% of the land area is classified in the United Council Regional Plan as steep to very steep hill country. This topography makes access to some areas both tortuous and time consuming, with a consequent sense of isolation for many people. These factors pose special problems for the delivery of health services which need to be recognised.

3.4 The presence of the Lake Alice Psychiatric Hospital must be taken into account. The hospital is a major provider of health care in the region and is currently the direct responsibility of the Head Office of the Department of Health. The Steering Committee considers that its continued operation divorced from the services administered by a Wanganui Area Health Board would make the co- ordination of public sector services both incomplete, uneconomic, and unnecessarily unwieldy. The Minister of Health has indicated his belief that transfer of the hospital to the Wanganui Area Health Board should take place on 1 April, 1986 provided an Area Health Board is in place on that date.

3.5 The Wanganui Hospital Board is a user rather than a provider of regional or national services to other hospital boards and it would seem appropriate for this to continue in the future. The inclusion of Lake Alice Hospital in an Area Health Board would result in the addition of a regional psychiatric Intensive care service and a national forensic psychiatry unit. The Steering Committee can see no reason why the presence of these services should in any way affect the administrative responsibility for Lake Alice Hospital being assumed by a Wanganui Area Health Board.

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WANGANUI AREA HEALTH BOARD BOUNDARIES

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3.6 The Steering Committee agrees with the Wellington Health Services Advisory Committee (WHSAC) and "believes that a regional health system designed to meet local needs must emanate from the region itself". It also believes that there is opportunity for this to happen in an Area Health Board through the presence of Service Development Groups and Community Committees.

Boundaries

3.7 The Steering Committee recommends that the boundaries of a Wanganui Area Health Board should be those of the Wanganui Hospital Board. This area can be seen on the accompanying map.

3.8 While the area recommended is exactly the same as that of the Wanganui Hospital Board it is different from that of the District Office of the Department of Health which also includes the area covered by the Taumarunui Hospital Board.

3.9 This boundary differs from that of the Wanganui United Council which excludes the area north west of the Waitotara River, i.e. Patea Borough, Patea County and Waverley Town. Recently the Taranaki Hospital Board has suggested an extension to its boundary, as far as the Whenuakura River, between Patea and Waverley. The Wanganui Hospital Board has indicated that it does not wish to change its north western boundary and there is a strong feeling amongst the people of the area that they want to be part of the Wanganui region for health related matters.

3.10 Some of the peripheral areas expressed reservations about possible loss of access to alternative services. Assurances were given that people living within a Wanganui Area Health Board region would retain their right of access to health services beyond that region.

Consultation with neighbouring Hospital Boards

3.11 The Wanganui Hospital Board has advised its neighbouring Hospital Boards of its intention to become an Area Health Board, and details of the Steering Committee which was established to report to the Minister of Health on the feasibility of an Area Health Board.

3.12 The Taumarunui Hospital Board has not replied to the Board, although discussions have been held between the Boards Chairmen. The Taumarunui Hospital Board has no desire to be part of an enlarged Wanganui Hospital Board. -is-

3.13 The Palmerston North Hospital Board has, in acknowledging this advice, made no other comment but discussions with the Boards Chairman and media comment, indicate that the Board is not interested in changing territorial boundaries or assuming responsibility for Lake Alice Hospital.

3.14 The Taranaki Hospital Board has sought a change in the boundaries, with the boundary line being moved south to the Whenuakura River. At a public meeting held in Patea on 12 June, 1985, attended by 53 people, the very strong view expressed by those present was that they wished to continue to be associated with health services provided from Wanganui, and favoured the proposal for there to be a Wanganui Area Health Board including within its boundaries Patea Borough and Patea County. The Steering Committee accordingly can report that the strong wish of the people in Patea Borough and Patea County is to be part of a Wanganui Area Health Board.

RECOMMENDATION

That the boundaries of a Wanganui Area Health Board be those of the Wanganui Hospital Board incorporating all public health services within those boundaries. -19-.

SECTION •4

WANGANUI AREA HEALTH BOARD

1. THE BOARD AND ITS MANAGEMENT

4.1.1 An Area Health Board is not a hospital board, neither is it a district office of the Department of Health. It is a new concept that is more than just a merger of these two organisations and Lake Alice Hospital. All must appreciate this - those within the Area Health Board and those without. The sooner this is achieved the quicker the new Board can hope to move realistically towards attaining its objectives and gaining participation from the communities it serves. Such is the importance of this that the Steering Committee recommends that a Wanganui Area Health Board must be seen to be an entirely new organisation.

Objectives

4.1.2 The primary objectives of an Area Health Board are laid down in the Area Health Boards Act, 1983. The Steering Committee concurs with these and readily accepts them for an Area Health Board in Wanganui. It places particular emphasis on health promotion, health protection, and health education, seeing these as the key to improving the health of New Zealanders in the future.

4.1.3 Section 9 of the Act states -

The primary objectives of an Area Health Board in its district shall be as follows:

a. To promote, protect, and conserve the public health, and to provide health services; b. To provide for the effective co- ordination of the planning, provision, and evaluation of health services between the public, private, and voluntary sectors. C. To establish and maintain an appropriate balance in the provision and use of resources for health protection, health promotion, health education, and treatment services.

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Functions, Duties And Powers

4.1.4 The Steering Committee is in agreement with the functions, duties, and powers of a Board as set out in the Act. It acknowledges the importance of, and the valuable work undertaken by the voluntary agencies in particular and believes that much of the success of an Area Health Board will be dependent upon its ability to incorporate them, along with representatives of the community, into the planning framework of the Board. The place of the private sector is recognised, as is the significant contribution that the Steering Committee believes this sector makes towards the provision of health services for the community.

4.1.5 Section 10 of the Act states -

1. The functions of an Area Health Board shall be as follows:

a. Generally to promote and protect the health of the residents of its district, and, towards that end, to consult and co- operate with individuals and organisations (including voluntary agencies, private agencies, departments of State, and territorial authorities) concerned with the promotion and maintenance of health:

b. To investigate and assess health needs in its district:

C. To plan future development of health services in its district, and, towards that end, -

i To consult as appropriate, with any regional or united council in the district; and ii To support, encourage, and facilitate the organisation of community involvement in the planning of such services:

d. To set objectives and determine priori- ties within the scope of its functions, duties, and powers:

e. Such of the functions of the Minister and the Department as may from time to time be delegated to the Board in accordance with Section 36 of this Act:

f. As and to the extent that the Minister from time to time directs pursuant to his functions under this Act, - i To provide and at all times maintain health services; and

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ii To provide relief in accordance with this Act; and iii To provide services for Government departments, hospital boards, and other area health boards:

g. To manage all institutions and health services for the time being vested in or controlled by it:

h. At the discretion of the board but subject to section 84 of this Act, to grant financial or other assistance to any individual or organisation involved within its district in -

i Setting up programmes for health services and maintaining health services; or ii Training volunteers engaged in any such programmes or services;

i. To make available to the public reports, information, and advice concerning the public health and the health services available within its district.

2. An area health board shall have such other functions, duties, and powers as are conferred or imposed on it by this or any other Act.

Relationship With Current Health District

4.1.6 The health district of the Wanganui District Office of the Department of Health includes the area covered by both the Wanganui and Taumarunui Hospital Boards. Implementation of the Steering Committees recommendation concerning the boundaries of a Wanganui Area Health Board will result in arrangements being made in one way or another for the continued provision of public health services to the Taumarunui area.

4.1.7 Two options for the provision of this service are available and contact was made with the Taumarunui Hospital Board and the territorial local authorities i.e. Taumarunui Borough Council and Taumarunui County Council, to ascertain their preference. The options are for the service to be provided by the Waikato or Rotorua District Office of the Department of Health, or for it to continue to be provided from Wanganui by the Area Health Board probably under contract to the Department of Health. Although expressing satisfaction with the service currently provided by the Wanganui District Office each local authority has indicated that they are giving consideration to the possibility of the service being provided by the Waikato District Office should an Area Health Board be

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established. The Steering Committee believes that the present satisfactory service could still be provided and recommends that the services provided by the Wanganui District Office of the Department of Health to the Taumarunui District should continue to be provided by a Wanganui Area Health Board.

4.1.8 School dental services throughout the Wanganui Health District are not administered by the Wanganui District Office. Those in the eastern sector of the district form part of the Palmerston North dental district while the rest, including those in Wanganui, come into the New Plymouth district. There are 28 school dental nurses in the area which would constitute the Wanganui Area Health Board. The Wanganui Health District does not have its own Principal Dental Officer.

4.1.9 School dental nurses are very actively involved in health promotion and health protection. They are currently employed by the Department of Health and have an integral part to play if the Area Health Board concept is to be realised. To this end the Steering Committee recommends that the responsibility for the school dental nurses employed within the boundaries of the Wanganui Area Health Board should be transferred from the Department of Health to the Wanganui Area Health Board. At the same time recognition is given to the work that must still be done before such a transfer occurs, particularly in relation to personnel matters and the purchase of stores and specially designed and manufactured capital equipment(See Appendix).

4.1.10 Section 39(c) of the Area Health Boards Act 1983 requires an Area Health Board to appoint a Principal Dental officer. The Steering Committee is aware of the need for such an appointee to be a specialist in community dentistry. They have also been told that there are no dentists with these attributes in Wanganui at present and that there would be insufficient work within the area covered by a Wanganui Area Health Board to employ a Principal Dental Officer on a full-time basis. Accordingly, the Steering Committee recommends that negotiations take place for the employment of the Principal Dental Officer attached to the Palmerston North District Office on a part-time basis by the Wanganui Area Health Board as its Principal Dental Officer. The Steering Committee have been assured that this is a workable arrangement and that the extra workload resulting from the school dental nurses currently administered from New Plymouth would not be too great for the Principal Dental Officer. Neither would it reduce the workload of the New Plymouth Principal Dental Officer to an unacceptable level

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4.1.11 Health inspection services within a district are provided by the territorial local authorities and the Department of Health. Each group is responsible for specific tasks. Where a local authority is temporarily without a health inspector or is unable to obtain the services of a suitable person, the local authority seeks the services of a Departmental Officer and pays for the service on a per capita basis. The Steering Committee recommends that when a local authority is without an inspector the Area Health Board may make an Inspector of Health available to the local authority to perform statutory health functions at an appropriate cost.

Relationship With Private Sector

4.1.12 For an Area Health Board to properly fulfil its role in co-ordination and planning it must have the support and co-operation of those working in the private sector. The importance of the contribution of the private sector in the provision of health services is acknowledged as is the part they have to play in making the Area Health Board concept work.

4.1.13 The Steering Committee met with three professional organisations representing private practitioners - the Wanganui Division of the NZ Medical Association, the Wanganui Branch of the NZ Nurses Association, and the Wanganui Branch of the NZ Dental Association. Persons in private practice from these organisations, as well as others attended the public meetings too. A number of concerns were expressed.

4.1.14 Members of the medical profession were concerned that the creation of an Area Health Board was the first step towards complete nationalisation of the health services. Some private sector workers saw the reference to co-ordination of health services as meaning control of the private sector by a Board. Assurances have been given that neither of these apply and that the aim of an Area Health Board is to work with those in the private sector in a spirit of co-operation to prevent unnecessary duplication of services and to plan together for the provision of services in the region.

4.1.15 Some private practitioners involved in treatment services expressed a concern that these may not receive sufficient priority under an Area Health Board while others were anxious to ensure that health protection and promotion were given proper emphasis. The Steering Committee believes that the wording of the Act is such that it ensures that an Area Health Board will fulfil its obligations towards all of these areas in accordance with the priorities that are identified for the Wanganui Region.

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4.1.16 The possibility of an Area Health Board taking over some areas that are currently the role of the general practitioner was raised by the NZ Medical Association. Coupled with thiswas a fear that a Board might even provide general practitioner services. These matters were considered in detail by the Steering Committee which recommended that the Wanganui Area Health Board not duplicate the traditional medical role of the general practitioner, but in consultation with the NZ Medical Association may provide emergency cover to a community temporarily without services.

4.1.17 The NZ Medical Association also expressed the concern of their members that there was not direct access to the Board for the Association. The Steering Committee recognises the unique and vital role played by the medical profession in private practice and urges the future Wanganui Area Health Board to establish a full and suitable working relationship involving regular consultation with the Wanganui Division of the NZ Medical Association, which is the official and recognised professional body. To this end it is recommended that the Area Health Board grant direct access to duly appointed representatives of the Wanganui Division of the NZ Medical Association.

4.1.18 The Steering Committee believes that general practitioners play a key role in the health service in terms of health promotion and protection, and in the treatment of ill health. It also believes that they, along with others involved in the private sector, must be represented in the membership of Service Development Groups and Community Committees.

Relationship With Voluntary Sector

4.1.19 The Steering Committee regards the contribution of the voluntary organisations to the health services as being of inestimable value. It considers the involvement of the voluntary sector as being essential to the success of Service Development Groups and Community Committees.

4.1.20 A number of voluntary organisations are funded, or subsidised, by the government through the Departments of Health and Social Welfare in Wellington. At the various public meetings they asked if this funding was to be channelled through an Area Health Board. If this were to happen they thought that the funding might not be guaranteed. This was coupled often with a fear that their organisation would come under the control of the Area Health Board or be taken over by it. The Steering Committee was able to assure them that

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funding would continue as at present and not be directed through the Area Health Board and that voluntary organisations would retain their autonomy and independence.

Co-ordination And Planning

4.1.21 One of the primary objectives of Area Health Boards as laid down in Section 9 of the Act provides for "the effective co-ordination of the planning, provision, and evaluation of health services between the public, private, and voluntary sectors."

4.1.22 The WHSAC Report describes Area Health Boards as providing

"a structure that will allow co-ordination of the public, private and voluntary sectors through improved planning mechanisms and procedures. Through their association with these mechanisms there would be a means whereby the views of the private and voluntary sectors would be assured of effective and systematic consideration. This "broad model" would allow a comprehensive overview of health services within the region."

4.1.23 The Steering Committee believe that this mechanism is provided through the Service Development Groups and Community Committees of an Area Health Board. It particularly stresses the importance of these, and the need for effective planning to co-ordinate the work of these groups.

4.1.24 Area Health Board planners will be associated with all of the Boards services as well as maintaining an active liaison with the private and voluntary sectors and other planning agencies. The Steering Committee recommends that the planning services of a Wanganui Area Health Board be responsible to the head of administrative services for the Board with functional responsibilities to the executive team.

Membership

4.1.25 The Steering Committee recommends that there be eleven elected members of a Wanganui Area Health Board and that there may be up to two appointed members. The Steering Committee believes that appointed members can add a balance of knowledge and skills.

4.1.26 The Steering Committee further recognises the importance of having a Maori voice in the affairs of an Area Health Board and recommends that the Area Health Board encourages Maori participation.

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4.1.27 Representation is recommended on the following basis:

Patea County, Patea Borough, Waverley Town 1

Waitotara County and Wanganui County 1

Waimarino County, Raetihi Borough, Ohakune Borough

Waiouru, Taihape Borough, and Northern Rangitikei County (Ruanui, Erewhon, Awarua, and Te Kapua Ridings including ) 1

Southern Rangitikel County (including Bulls) 1

Marton and Hunterville 1

Wanganui City 5

4.1.28 The Steering Committee considered the matter of the date for the establishment, of a Wanganui Area Health Board. This had been raised from time-to- time in meetings with the public and with some professional groups. Section 14 of the Area Health Boards Act, 1983, states:

(1) "Where, in respect of a new area health district, the operative date is within the period of 12 months preceding the date of the next triennial general election of members of territorial authorities as prescribed by section 4 of the Local Elections and Polls Act 1976, the Governor-General shall specify in the Order in Council establishing the district a date for the first election of members of the area health board for that district.

(2) Except in a case to which subsection (1) of this section applies, on the establishment of a new area health district, the persons who, immediately before the operative date, were members of the initiating hospital board shall, subject to subsection (3) of this section, be deemed to have been elected to the area health board.

(3) Where the number of persons deemed by subsection (2) of this section to have been elected to an area health board exceeds the number of elected members prescribed in respect of that board by Order in Council under section 8 of this Act, a sufficient

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number of those persons shall retire from the office as soon as practicable after the operative date so that the number of elected members may conform to the order.

(4) The persons who are to retire from office under subsection (3) of this section shall be determined by agreement between all the members of the initiating hospital board or, failing such agreement, by lot in such manner as that board shall direct.

4.1.29 The Minister of Health, when visiting Wanganui in December 1984, suggested 1 October 1985 for the establishment of an Area Health Board in Wanganui. If the translation to an Area Health Board takes place on this date, it will mean that the present members of the Wanganui Hospital Board will become the members of the Wanganui Area Health Board until the ordinary triennial local body elections in October 1986. Although it was the general view that, in accordance with democratic principles, the new Board ought ideally to be an elected Board, in the interests of the 1,600 staff involved it was accepted that continued administration by the members of the present Hospital Board would offer a more stable and appropriate period for the transitional process and that it would be less upsetting for the staff. The Board would act as an interim agency. The Area Health Board must be seen as a new concept, and not simply the former Board under a new name. In twelve months time the community would elect a new Board

Legislation

4.1.30 The Health Services Personnel Act, 1983, provides for the Staff of the District Office of the Department of Health and the Wanganui Hospital Board in an Area Health Board but does not make the same provision for the staff of Lake Alice Hospital

4.1.32 The Steering Committee recommends that urgency be given to changing the Health Services Personnel Act, 1983, and that in line with advice received from the Minister of Health Lake Alice Hospital become part of the Wanganui Area Health Board on 1 April 1986 provided an Area Health Board is in place on that date. AREA HEALTH BOARD

EXECUTIVE TEAM Head of Administrative Services Head of Nursing Services c-J Head of Medical Services

LAKE ALICE HOSPITAL MANAGEMENT WANGANUI HOSPITAL MANAGEMENT COMMUNITY AND ENVIRONMENTAL TEAM TEAM HEALTH SERVICES MANAGEMENT TEAM Senior Administrative Officer Senior Administrative Officer Senior Administrative Officer Principal Nurse Principal Nurse Head of Community Nursing Services Medical superintendent Medical Superintendent Director of Community Health Principal Dental Officer Princioal Insiector of Health

WANGANUI AREA HEALTH BOARD MANAGEMENT STRUCTURE

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Transitional Period

4.1.33 The Steering Committee recommends that following the establishment of a Wanganui Area Health Board there be a transitional period for the transfer of the functions, duties, and powers of an Area Health Board during which time all aspects of the organisations involved in the merger will be transferred to the new Area Health Board.

4.1.34 This transitional period would allow for the appointment of the Boards executive team and the implementation of the management structure. At the same time the accounting systems must be standardised and the funds transferred to the new organisation. Trust documents will also need to be transferred and various functions of the District Office will require gazetting upon transfer to an Area Health Board. Title deeds for land and buildings will also require transferring.

Chairman

4.1.35 The Chairman of the Board should be elected as is provided for in Section 23 of the Area Health Boards Act, 1983. The Chairman will be an elected member of the Board as he/she is elected at the first meeting after the election of the Board. It is not until the same meeting that the Board can decide whether or not to have appointed members on the Board.

4.1.36 The Area Health Board, through its Chairman will be responsible to the Minister of Health for the performance of its statutory powers and duties.

4.1.37 The Steering Committee recommends that, because of the multidisciplinary nature of the executive team,

the Chairman should have a close working relationship with it.

Management Structure

4.1.38 The Steering Committee recommends the appointment of a triumvirate executive team responsible to a Wanganui Area Health Board. This team would be composed of a head of nursing services, head of medical services, and head of administrative services and would advise the Board and administer those public sector services which will be under the Boards control. Support for this recommendation has been expressed by the Wanganui Branch of the NZ Nurses Association, and the Wanganui Branch of the NZ Institute of Health Administrators.

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4.1.39 The Steering Committee further recommends that each member of the executive team be individually responsible for the services under his control, consensus decision making to operate when more than one service is affected and when recommendations are made to the Board.

4.1.40 The three members of the executive team are to be made clearly accountable to the Board for effectively implementing Area Health Board policies and programmes.

4.1.41 At the next level there should be management groups responsible for their own particular service. There would be a management group for Lake Alice Hospital, another for Wanganui Hospital, and another for the Community and Environmental Health Service. The management group should consist of the senior medical officer, the senior nurse, and the senior administrator for that service, and in the Community and Environmental Health Service, the Principal Inspector of Health is also a member of the management group. It is envisaged that the Medical Officer of Health would be the Director of Community and Environmental Health.

4.1.42 The Principal Dental Officer will be responsible to the Head of Medical Services and act as an advisor

to the Community and Environmental Health Committee.

4.1.43 The executive team would be heavily involved in board-wide planning and policy making. The management groups would be responsible for the planning, policy, and day to day running of their own institution or service within the policies and guidelines laid down by the Wanganui Area Health Board and its executive.

4.1.44 It is of the utmost importance for the Area Health Board to have executive principal officers whose qualifications include or embrace the appropriate and specialised management skills, and who are able to exercise a responsibility for the total service provided by the Board, and not just community health or treatment oriented services.

4.1.45 The Steering Committee recommends that the job descriptions and the conditions of employment of the principal officers of a Wanganui Area Health Board adequately reflect the requirements of these offices in assisting the Area Health Board to fulfil its objectives as an organisation involved in the promotion of health, the prevention of disease, and the treatment of illness, and be to the satisfaction of the Health Service Personnel Commission and the Area Health Board.

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Organisational Structure

4.1.46 The Steering Committee recommends that a Wanganui Area Health Board should have the following committees - Community and Environmental Health, Hospital Services, Finance, and Works and Buildings. Each committee would have advisors who would be Board Officers.

4.1.47 The advisors to the Community and Environmental Health Committee would be the Community and Environmental Health Service management group.

4.1.48 Members of the management groups from the Lake Alice and Wanganui Hospitals would be the advisors to the Hospital Services Committee. The Director of Finance would be advisor to the Finance Committee and the Chief Engineer to the Works and Buildings Committee.

4.1.49 The advisors to the Area Health Board would be the executive team with the Medical Officer of Health having the right to attend Area Health Board meetings.

4.1.50 Committees of the Board would undertake detailed consideration of matters concerning their area of responsibility and have the power to make recommendations for adoption by the Board.

4.1.51 Service Development Groups and Community Committees should be an integral part of a Wanganui Area Health Board and their place in the organisational structure is illustrated in the diagram.

Accommodation

4.1.52 The Steering Committee sees the philosophy behind the establishment of an Area Health Board as integration of services and believes that the community health team should be housed in the same building as the Boards administrative staff as soon as possible. However, the lack of availability of suitable buildings which will necessitate separation of the two in the short term is acknowledged.

4.1.53 It will be necessary to continue to make use of the present District Office accommodation initially at least and the Steering Committee recommends that the necessary negotiations take place to ensure the retention of this. SERVICE DIEVELOP-1 COMMUNITY MENT GROUPS COMMITTEES

AREA HEALTH BOARD

H PITAL SERVICES FINANCE BUILDING AND COMMUNITY AND ENVIRON- COMMITTEE COMMITTEE^ WORKS COMMITTEE , MENTAL SERVICES COMMITTEE OS -

EXECUTIVE TEAM ------

WANGANUI AREA HEALTH BOARD ORGANISATIONAL STRUCTURE -33-

4.1.54 The Steering Committee also recommends that the estimates for a Wanganui Area Health Board provide for separate rental accommodation for Area Health Board administrative services within two years of formation, and ultimately that there be provision for finance to purchase or rent a new building at a later stage. Tied in with this is a further recommendation that the Community and Environmental Health Services team is housed in the same building as the Area Health Board administrative services as soon as possible after the Board is established.

RECOMMENDATIONS

That the services provided by the Wanganui District Office of the Department of Health to the Taumarunul district should continue to be provided by a Wanganui Area Health Board.

That the responsibility for the school dental nurses employed within the boundaries of the Wanganui Area Health Board should be transferred from the Department of Health to the Wanganui Area Health Board.

That negotiations take place for the employment of the Principal Dental Officer attached to the Palmerston North District Office on a part-time basis by the Wanganui Area Health Board as its Principal Dental Officer.

That when a local authority is without an Inspector of Health, the Wanganui Area Health Board may make an Inspector of Health available to the local authority to perform statutory health functions at an appropriate cost.

That a Wanganui Area Health Board not duplicate the traditional medical role of the general practitioner, but in consultation with the NZ Medical Association may provide emergency cover to a community temporarily without services.

That a Wanganui Area Health Board establish a full and suitable working relationship with the Wanganui Division of the NZ Medical Association which is the offical and recognised professional body.

That the Wanganui Area Health Board grant direct access to duly appointed represen- tatives of the Wanganui Division of the NZ Medical Association. -34-

That the planning services of a Wanganui Area Health Board be responsible to the head of administrative services for the Board with functional responsibilities to the executive team.

That there be eleven elected members of a Wanganui Area Health Board and that there may be up to two appointed members.

That the constituent representation of a Wanganui Area Health Board be -

Patea County, Patea Borough, Waverley Town 1 Waitotara County and Wanganui County 1 Waimarino County, Raetihi & Ohakune Boroughs 1 Walouru, Taihape Borough, Nthn Rangitikei County 1 Southern Rangitikei County 1 Marton and Hunterville 1 Wanganui City 5

That urgency be given to changing the Health Services Personnel Act, 1983, and that in line with advice received from the Minister of Health Lake Alice Hospital become part of the Wanganui Area Health Board on 1 April 1986 providing that an Area Health Board is in place on that date.

That following the establishment of a Wanganui Area Health Board there be a transitional period for the transfer of the functions, duties, and powers of an Area Health Board during which time all aspects of the organisations involved in the merger will be transferred to the new Area Health Board.

That, because of the multidisciplinary nature of the executive team, the Chairman should have a close working relationship with it.

That the executive team consist of a head of nursing services, head of medical services, and head of administrative services to advise the Area Health Board and administer those public sector health services which will be under the Boards control.

That each member of the executive team be individually responsible for the services, activities, and programmes under his control. -35.-

That the job descriptions and the conditions of employment of the principal officers of a Wanganui Area Health Board adequately reflect the requirements of these offices in assisting the Area Health Board to fulfil its objectives as an organisation involved in the promotion of health, the prevention of disease, and the treatment of illness, and be to the satisfaction of the Health Service Personnel Commission and the Area Health Board.

That management groups composed of the senior nurse, senior medical officer, and senior administrator for an institution or service be responsible for the planning, policy, and day to day running of that institution or service within the policies and guidelines laid down by a Wanganui Area Health Board and its executive.

That a Wanganui Area Health Board should have the following committees - Community and Environmental Health, Hospital Services, Finance, and Works and Buildings.

That the necessary negotiations take place to ensure the retention of the present District Office accommodation following the establishment of a Wanganui Area Health Board.

That the estimates for a Wanganui Area Health Board provide for separate rental accom- modation for Area Health Board administrative services within two years of formation and ultimately that there be provision of finance for the purchase or rental of a new building at a later stage.

That the Community and Environmental Health Services team is housed in the same building as the Area Health Board administrative services as soon as possible after the Board is established.

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2. SERVICE DEVELOPMENT

Preamble

4.2.1 Service development is a relatively new concept to the health services. In the past services tended to develop in a haphazard manner according to the needs of the moment, the skills of the providers, and the availability of money. The introduction of the Population Based Funding Formula for allocating funds to hospital boards and the high cost of providing treatment services has forced boards to undertake service development planning.

4.2.2 The establishment of Area Health Boards widens the planning horizons, enabling health workers and consumer representatives to plan for service provision for an area as a whole. The Area Health Board Act, 1983, requires the formation of Service Development Groups for this purpose.

4.2.3 Service Development Groups are a means of participatory planning and co-ordinating of health services involving representatives from the public, private, and voluntary sectors.

4.2.4 In 1981 the Wanganui Area Health Co-ordinating Committee set up Shadow Service Development Groups (SSDG) to test the concept. Membership of the groups included representatives from the public, private, and voluntary sectors. The absence of an Area Health Board as a parent body limited the success of some of the groups while the Health of the Elderly SSDG proved the concept to be both workable and worthwhile. 1984 saw the spontaneous re-establishment of a Mental Health SSDG which continues to meet regularly.

Objectives

4.2.5 Section 29 of the Act states that Service Development Groups will be appointed "to advise the Board, in accordance with any policy directives prescribed by the Board on the full range of health services in the public, private, and voluntary sectors relevant to its district."

4.2.6 The Steering Committee sees another objective being forward planning for the development of the relevant service throughout the area within the Boards boundaries. -38-

Range of Groups

4.2.7 The Steering Committee concurs with the range of groups laid down in Section 29 of the Act and recommends that sufficient Service Development Groups be established to deal adequately with health promotion, primary health care, medicine, surgery, child health, health of the elderly, mental health, dental health and health protection (with special emphasis on occupational health).

Membership

4.2.8 For Service Development Groups to be able to achieve the objectives set down it is imperative that their membership should be drawn from the public, private, and voluntary sectors, and be as representative of the service as possible.

4.2.9 The inclusion of consumer representatives on Service Development Groups is also considered to be important to ensure that the viewpoint of the consumer is considered as part of the planning process. Accordingly the Steering Committee recommends that allowance be made for consumer, representation on Service Development Groups.

4.2.10 The Steering Committee considered the comments in the Reports of both the Northland and Wellington Health Services Advisory Committees, regarding the eligibility of Board members to be members of Service Development Groups. It can see no reason for Board members to be ineligible and recommends that elected or appointed members of a Wanganui Area Health Board may be eligible for membership of Service Development Groups.

4.2.11 Members would be appointed in accordance with Section 29 of the Act and would be discharged at the end of the Boards term of office.

Criteria For Membership

4.2.12 The Steering Committee is in agreement with the comments in the Report of the Northland Health Services Advisory Committee (NHSAC) that -

"it is considered essential for an effective planning team that a wide range of disciplines relevant to each field of health are represented. It is also crucial that personal qualities and individual expertise are carefully considered."

4.2.13 The large proportion of rural dwellers within the boundaries of a Wanganui Area Health Board makes it necessary to ensure that there is rural as well as urban representation. Minority ethnic groups should not be overlooked either.

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Size Of Group

4.2.14 The Steering Committee did not wish to limit any Service Development Group by enunciating a strict recommendation on the size of a group. The Health of the Elderly SSDG was a large but effective group with 17 members. However, ten to twelve members is generally seen as a good workable size.

Chairman

4.2.15 The Steering Committee recommends that a convenor for each Service Development Group should be appointed by the Board and that the Chairman be appointed by the group from its members and approved by the Board.

Planning Mechanism

4.2.16 Service Development Groups are advisory planning groups who submit proposals concerning public sector services to the Area Health Board for consideration. The groups must give consideration to the needs of the service in the whole of the district served by the Board.

4.2.17 As stated in the WHSAC Report,

"Bringing together the public, private, and the voluntary sectors for planning on service lines will:

enable a comprehensive overview of the health services of the region; provide a forum for a consideration of the plans and aspirations of the private and voluntary sectors, and the means by which consumers views can be given recognition; establish a process for arriving at planning proposals agreed upon by all sectors; provide the scope for focusing upon and developing a particular service with the co- operation and involvement of all sectors; provide a mechanism for identifying the needs of the region and the formulation of options for the setting of policies and priorities by the Board, based on local conditions; and a base for the regional planning process"

Lines Of Communication

4.2.18 The Act requires Service Development Groups to submit an annual report to the Board and, on the expiry of its appointment, to submit a report to the Board on whether or not it should be reappointed. These reports should be tabled and received at a Board meeting, and at the same time referred to the executive team for comment and -40-

referral to the various Area Health Board committees for consideration if appropriate.

4.2.19 Should matters arise which Service Development Groups wish to direct to the Board, they should have the opportunity to do this in the same manner as for an annual report.

4.2.20 In most cases however, the day to day management issues which Service Development Groups may be interested in will be matters which can be handled directly by the executive team of the Area Health Board.

Servicing

4.2.21 The Steering Committee recommends that the Wanganui Area Health Board provide adequate resources for the servicing of Service Development Groups.

4.2.22 As most of the work of these groups will be of a planning nature it would be most appropriate for them to be serviced by the Planning Section of the Board.

Remuneration

4.2.23 It was generally felt that it was necessary for people to receive attendance and travelling expenses as outlined in Section 86 of the Act.

4.2.24 Recognition was also given to the fact that Board staff will also be members of Service Development Groups and it was not seen as appropriate for them to receive extra remuneration for attending meetings held during their normal hours of duty.

4.2.25 The Steering Committee recommends that attendance fees and travelling expenses should be paid as appropriate to group members.

RECOMMENDATIONS

That sufficient Service Development Groups be established to deal adequately with health promotion, primary health care, medicine, surgery, child health, health of the elderly, mental health, dental health, and health protection with special emphasis on occupational health.

That elected or appointed members of a Wanganui Area Health Board may be eligible for membership of Service Development Groups.

That allowance be made for consumer representation on Service Development Groups. -41-

That a convenor for each Service Development Group be appointed by the Board and that the chairman be appointed by the group from its members and approved by the Board.

That the Wanganui Area Health Board provide adequate resources for the servicing of Service Development Groups.

That attendance fees and travelling expenses be paid as appropriate to group members.

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3. COMMUNICATIONS AND COMMUNITY INVOLVEMENT

Steering Committee Communications

4.3.1 The terms of reference given the Steering Committee charged it with establishing "a system of communication through which organisations in the Wanganui Hospital Board area can be kept informed of developments and have the opportunity to make submissions to the Steering Committee." The Steering Committee saw this communication as essential if it was "to ensure that there is adequate community support for the establishment of a Wanganui Area Health Board."

4.3.2 A variety of means of communication were used by the Steering Committee in its endeavour to make contact, not only with organisations in the area, but with members of the public as well. These included the printing of pamphlets, one of which went to every household in the area, with the other available through chemist shops, a feature article in the Wanganui newspapers, a radio interview, meetings with professional organisations, Trades Council representatives, territorial local authorities, and other groups as requested, and eighteen public meetings. As well, information was sent to almost 250 persons and groups. At all times written submissions were encouraged.

4.3.3 A total of 450 people attended the public meetings. Two rounds of meetings were held, with five weeks between them. This proved to be a very useful method of informing those present and at the end of the second round of meetings there was generally a feeling of "cautious acceptance" of the proposal that a Wanganui Area Health Board should be established. The meetings, both with the public and other groups, were very helpful to the Steering Committee in informing them of the questions and concerns of those in the community.

4.3.4 Twenty-one submissions were received and considered by the Steering Committee for their consideration.

4.3.5 The communication process used is covered in detail in the appendix to this report.

Area Health Board Communications

4.3.6 The success of the Area Health Board concept is dependent upon community involvement. For this reason it is important for a Wanganui Area Health Board to establish an effective system of communication with organisations and the public in general. As well, there must be good internal communications within the Board itself.

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4.3.7 A means of communication will need to be established with professional groups (e.g. NZ Medical Association, NZ Nurses Association, Chemists Guild, NZ Dental Association, School Dental Nurses Institute), with health related voluntary organisations, with union organisations, and with territorial local authorities, and appropriate access to the Board made possible.

4.3.8 Provision should be made for dissemination of information and the processing of complaints. The Steering Committee recommends that consideration be given to the adequate provision of an information and complaints system.

COMMUNITY COMMITTEES

4.3.9 The Steering Committee endorses the concept of Community Committees and sees them as a valuable adjunct to an Area Health Board. They provide opportunity for communication between the Board and communities and for local community input to influence Board policy on matters relating to their particular community. Through them active participation in the promotion of health in their own community, in their own way, is encouraged.

Objectives

4.3.10 The primary purpose of the Community Committees is seen as being to assist in local health perspectives, to determine the needs of the local area, to bring any matters of concern to the attention of the Area Health Board, and to. assist the Service Development Groups.

Range Of Groups

4.3.11 Much consideration was given to the locations for Community Committees. Some of the options were - wherever a defineable community exists and where they wish to have a committee; according to general practice catchment areas; or according to constituent areas. It was agreed that there must be a desire on the part of the community to have one if it is to fulfill its purpose.

4.3.12 The Steering Committee encountered strong support for the establishment of Community Committees and therefore recommends very strongly that Community Committees be established in appropriate areas based on communities of interest.

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Membership

4.3.13 Membership should consist of consumers and representatives of the voluntary, private, and public health sectors. The local general practitioner is seen to be an integral part of this committee where available. Area Health Board members and staff should be eligible for membership.

4.3.14 The Steering Committee sees the active participation of the Community through the Community Committees as vital to the success of an Area Health Board. Members would be nominated by a community and appointed by the Board.

Criteria For Membership

4.3.15 The main criteria for membership of a Community Committee would be involvement and/or interest in the health of the community.

Size Of Committee

4.3.16 Large groups may be widely representative but are generally unwieldy and slower to progress once they get beyond a certain size. The Steering Committee believes that these should be kept to a workable size.

Chairman

4.3.17 The Chairman of a Community Committee should be appointed by the committee from its members.

Lines Of Communication

4.3.18 Reports from Community Committees should be submitted to the Area Health Board. At the same time a copy should be submitted to the Boards executive team for comment and for referral to the relevant committee of the Board as appropriate.

4,3,19 Should matters arise which Community Committees wish to direct to the Board, they should have the opportunity to do this in the same manner as for their reports.

4.3.20 In most cases, however, the day to day management issues which Community Committees may be interested in will he matters which can he handled directly by the executive officers of the Area Health Board.

4.3.21 A link should also exist between the Community Committees and the Area Health Board so that the Board communicates and consults with them on matters affecting their area. -46-

Liaison

4.3.22 Section 31 (4) of the Act mentions the role of a Community Committee in providing a liaison between the various community groups working in the health field and the Area Health Board. The Steering Committee sees it as important for Community Committees to liaise with the Board, and the Board institutions and services in the area, as well as with the community as a whole.

4.3.23 For a Community Committee to achieve its stated objective of assisting the Service Development Groups, liaison will need to be set up through the planning service.

Servicing

4.3.24 The Steering Committee recommends that the secretarial services should be provided from within each Community Committee and not by the Area Health Board.

4.3.25 Since committee members would be appointed by the Board, reasonable expenses incurred for postage, stationery etc. should be reimbursed.

Remuneration

4.3.26 Section 86 of the Act states that an Area Health Board may pay members of Community Committees attendance fees and travelling allowances for attendances at meetings of that committee. However, Community Committee members are seen by the Steering Committee as persons serving voluntarily for the benefit of their community. Consequently it does not propose that they should receive attendance fees or reimbursement of travelling expenses.

Patea

4.3.27 In 1968 the Patea Hospital Board was amalgamated with that of the Wanganui Hospital Board. Section 31 (2) of the Act requires a Wanganui Area Health Board to appoint a Community Committee for Patea.

RECOMMENDATIONS

That consideration be given to the adequate provision of an information and complaints system.

That Community Committees be established in appropriate areas based on communities of interest.

That secretarial services should be provided from within each Community Committee and not by the Wanganui Area Health Board. -47-

That an incoming Area Health Board strongly encourage the establishment of Community Committees as soon as possible to keep the public informed of progress made, and as an instrument to increase the understanding of people about Area Health Boards and their need for personal involvement. -49-

4. FINANCE

4.4.1 The funding allocation for a Wanganui Area Health Board would be a combination of that presently received by the Wanganui District Office of the Department of Health, Lake Alice Hospital, and the Wanganui Hospital Board. It would include funds currently expended by the New Plymouth and Palmerston North District Offices on the School Dental Service within the boundaries of the Area Health Board.

4.4.2 The allocation for the Wanganui Hospital Board is calculated using the Population Based Funding formula. Both the District Office and Lake Alice Hospital operate on budgets approved by the Department of Health. Neither is funded according to the Population Based Funding formula.

4.4.3 A report on the funding of a Wanganui Area Health Board (Appendix) was prepared for the Steering Committee. This report outlines the known financial factors associated with the three organisations and attempts to list those requiring clarification and/or negotiation before the establishment of an Area Health Board. It is the result of an exhaustive exercise conducted by the Funding Sub-Committee of the Steering Committee, both, on its own and with the co-operation of the Department of Health.

4.4.4. The Steering Committee believes that more information on the funding of Lake Alice Hospital is needed before its incorporation into a Wanganui Area Health Board and that a commitment is required from the Department of Health that the Area Health Board would not be financially disadvantaged if all financial matters are not identified before any such incorporation.

4.4.5 Provision needs to b made to cover building maintenance and/or any remodelling and refurbishing agreed to be necessary at the time of transfer of Lake Alice Hospital.

4.4.6 The importance of service planning in the provision of health services has been mentioned elsewhere in this report. Lake Alice Hospital is a large institution with its own specific needs for service planning. The Steering Committee recommends that bridging finance be provided by the Department of Health for a period of three years to permit the employment of a planning officer primarily for Mental Health service development planning.

4.4.7 When the funding for Lake Alice Hospital is incorporated in the Population Based Funding Formula in time, it will be necessary for a Wanganui Area Health Board to receive a -50-

supplementary grant to cover the funding for the Maximum Security Unit.

4.4.8 The establishment of an Area Health Board will result in some extra one off-costs. These would particularly relate to such things as the legal costs involved in having the Title Deeds changed for land and buildings. The Steering Committee recommends that a supplementary grant be made to the Wanganui Area Health Board to cover transitional costs.

4.4.9 The Steering Committee is aware of the personnel and other financial constraints which have been applied to the public health activities of the Department of Health and the effect of these upon the work of the District Office. While appreciating that the allocation of an Area Health Board is the combination of its constituent bodies, the Steering Committee recommends that some seeding finance will be necessary to increase further health promotion and health protection programmes. It believes additional funding for health promotion and health protection programmes will in time pay for itself through reduced treatment costs. Accordingly seeding finance provided immediately will assist a greater injection of funds into the health promotion and health protection areas. If seeding funds are not available the switch in resources will take some considerable period of time because an Area Health Board would be hard pressed to initiate these programmes in the period immediately after establishment while having to maintain existing services.

4.4. in As with Lake Alice Hospital there are some aspects of the District Office financial situation still to be clarified and/or identified. The Steering Committee believes that a commitment is required from the Department of Health that a Wanganui Area Health Board would not be financially disadvantaged if all financial matters are not identified before the Board is established.

RECOMMENDATIONS

That the funds and resources of the Wanganui Hospital Board be transferred to the Wanganui Area Health Board.

That the funding and resources of the District Office of the Department of Health with the addition of sufficient funds to fill vacant established staff positions be transferred to the Wanganui Area Health Board(See Appendix for Funding Report). -51-

.That the funding and resources of the School Dental Service of the Department of Health within the boundaries of the proposed Wanganui Area Health Board be transferred to the Wanganui Area Health Board.

That the funding and resources of the Lake Alice Hospital with the addition of sufficient funds to fill vacant established staff positions he transferred to the Wanganui Area Health Board.

That the services provided by government departments at no cost to the District Office of the Department of Health and Lake Alice Hospital continue to be provided without cost or that sufficient funding to cover these costs be transferred to the Wanganui Area Health Board.

That a commitment be given by the Department of Health to provide finance at a later date for any unidentified services currently being provided by the District Office of the Department of Health, the School Dental Service and Lake Alice Hospital.

That all assets and land owned by the Wanganui Hospital Board, the District Office of the Department of Health, the School Dental Service of the Department of Health (within the proposed Wanganui Area Health boundaries) and Lake Alice Hospital be transferred to the Wanganui Area Health Board.

That a supplementary grant be made to the Wanganui Area Health Board to cover transitional costs.

That the Population Based Funding formula continue to be used for the allocation of funding for inpatient hospital services, including Lake Alice Hospital, with provision for a supplementary grant for the Maximum Security Unit at Lake Alice Hospital.

That the Wanganui Area Health Board assume responsibility for the payment of the accounts and salaries of the Wanganui Hospital Board, the District Office of the Department of Health, and the Wanganui region School Dental Service at the time of its establishment.

That bridging finance be provided by the Department of Health for a period of three years to permit the employment of a planning officer primarily for mental health service development planning. -52-

That seeding finance be sought to increase the health promotion and health protection programmes.

That the formation of an Area Health Board be subject to resolution of the matters contained in the funding report and as outlined in the other finance recommendations. -53-

5. PERSONNEL

4.5.1 An Area Health Board encompassing the present geographical area of the Wanganui Hospital Board, and including Lake Alice Hospital will bring together the staff of the current Wanganui Hospital Board, the District Office of the Department of Health, and Lake Alice Hospital.

4.5.2 Legislation exists for the formation of an Area Health Board as outlined, except the Health Service Personnel Act makes no reference to the staff employed at Lake Alice Hospital. The Minister of Health, Or M Bassett, has conveyed advice to the Chairman of the Wanganui Hospital Board on this matter as follows:

"I would also mention that the necessary action is being taken to amend the Health Service Personnel Commission Act to allow the transfer of Lake Alice Hospital staff."

4.5.3 The Health Service Personnel Act makes specific reference to the transfer of staff:

"47(1) - On the date of transfer, every person employed by the initiating Hospital Board or by the Crown in the affected area shall cease to be employed by the Board or the Crown, as the case may be and shall become an employee of the Area Health Board.

47(2) - Every person who, on the date of transfer, becomes an employee of the Area Health Board by virtue of sub-section (1) of the section shall, as from that date have the same functions, duties and powers as he had immediately before that date unless and until the Area Health Board otherwise determines."

4.5.4 Specific reference is made in the legislation under Section 48 regarding employees transferred from District Offices. These employees have the right to apply within 12 months after the date of transfer in writing to resume employment in the public service. This provision applies to full time employees and the details and rights of employees regarding transfer are outlined further in Section 48 of the Act.

4.5.5 Reference is made in the legislation to the conditions of employment of transferred employees: -54-

"49 - Every transferred employee -

(a) Whose conditions of employment, immediately before the date of transfer were prescribed by:

(i) A determination issued under the State Services Conditions of Employment Act 1977; or (ii) An award or collective agreement issued under the Industrial Relations Act 1973; or (iii) An apprenticeship order made under the Apprentices Act 1948; and

(b) Whose position in the employment of the Area Health Board on the date of transfer is the same in terms of responsibility and function as that which he occupied immediately before that date, -

shall continue to be employed on the same conditions until a new determination affecting his conditions of employment is issued by the Commission pursuant to the State Services Conditions of Employment Act 1977."

The Act in essence protects the employment and conditions of employees at the time of transfer. The transferred employees continue on the same conditions and salary until a new determination is issued by the Health Service Personnel Commission, pursuant to the State Services Conditions of Employment Act 1977.

4.5.6 Unions currently party to awards or collective agreements issued under the Industrial Relations Act 1973 oppose the issuing of new determinations (for staff currently represented by them) by the Health Service Personnel Commission pursuant to the State Services Conditions of Employment Act 1977. They are seeking changes to the current legislation. The number of workers who are associated with awards or collective agreements is 395 which is 32.9% of the total number of staff employed by the Wanganui Hospital Board, or 24.6% of the total number of staff collectively employed by the Wanganui District Office of the Department of Health, the Lake Alice Hospital, and the Wanganui Hospital Board. 807 Hospital Board workers, and all staff at the Department of Health District Office and Lake Alice Hospital are currently employed under determinations issued pursuant to the State Services Conditions of Employment Act 1977.

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4.5.7 The Steering Committee has sought advice from the Health Service Personnel Commission on the concern of unions. The advice it has received is that new determinations will be negotiated following the advent of an Area Health Board (Section 49, Health Service Personnel Act). The Steering Committee has considered how it should comment on the issue of awards being subject to either the State Services Conditions of Employment Act or the Industrial Relations Act. It is considered that it is outside the scope of the Steering Committee to make comments about the appropriateness of industrial law. However, the Steering Committee urges further on-going consultation take place between the Health Service Personnel Commission as the appropriate government agency and the Federation of Labour to find a satisfactory solution. In any event, it is noted that the bulk of Hospital Board staff (807) work under determinations issued by the Health Service Personnel Commission pursuant to the State Services Conditions of Employment Act, and that no representation has been made on behalf of these staff to seek changes to the law in regard to coverage under the Industrial Relations Act. The Steering Committee considers its primary brief is to examine the delivery of health care under an Area Health Board, adequately funded. The Steering Committee considers it is beyond its jurisprudence to comment on the complexities of industrial law, and is hopeful the unions involved can resolve the matter with the Health Service Personnel Commission and the Government.

4.5.8 The Area Health Board will be legally obliged to ensure that the provisions of the Health Service Personnel Act are complied with for all employees. In time, should there be changes to job descriptions, duties or status of employees, adequate consultation should be undertaken with the employees affected.

4.5.9 It is recognised that when organisations experience major change such as is proposed for the District Office of the Department of Health, the Lake Alice Hospital and the Wanganui Hospital Board, there is likely to be concern amongst workers of how they are to be affected. The clauses referring to the rights of transferred employees in the Health Service Personnel Act give protection in terms of existing salaries and conditions. District Office staff are also able to transfer back to the Public Service as outlined under the Health Service Personnel Act.

4.5.10 The management structure has already been outlined elsewhere in the report regarding the executive officers responsible to the Board, and the management structures at the general hospital, Lake Alice Hospital and environmental and community -56-

health level. Once the job descriptions for the executive officers of the Area Health Board have been agreed upon between the Area Health Board and the Health Service Personnel Commission, advertising should commence. The Area Health Board makes the appointments in accordance with Clause 20 of the Health Service Personnel Act.

4.5.11 To reduce uncertainty amongst staff it is recommended that adequate lines of communication be established and maintained with staffing groups, and that the executive management team be appointed as quickly as possible.

4.5.12 The Wanganui Branch of the New Zealand Nurses Association commented in its submissions that support for an Area Health Board has been adequately demonstrated by professional groups, but questioned whether the general public is any more aware of the issues involved than it was in February 1985. The Branch comments on two industrial matters. One is that the Health Service Personnel Act 1983 part 4 Section 47 (2) be amended to provide a phrase that protects the rights of the employees. The Branch comments "that it believes that consultation at all levels is imperative prior to any proposed reduction of services, or change in job description". The Steering Committee agrees that consultation prior to change is necessary and recommends this to the future Area Health Board. The Steering Committee notes that change is constantly occurring and organisations are having to review the duties and responsibilities of senior employees and their organisation structures to meet the demands of change.

4.5.13 The Branch recommended that "any proposed change to career structure or job description within the nursing profession be studied by both national and regional offices of the New Zealand Nurses Association so that negotiations can be commenced at the earliest possible time", and "that the Wanganui Hospital Board consult with employee organisations to establish a facility for resolving disputes relating to changes in role, function and status before the formation of an Area Health Board."

4.5.14 At present the Hospital Board and the Department of Health (as employer of the staff at Lake Alice and the District Office), have the right to change job descriptions of staff. It would not be proper for the Steering Committee to recommend that the Area Health Board and the senior management lose the right to reorganise the management structure and duties of staff from time-to-time. The Branch recommended that "the Wanganui Hospital Board consult with employee organisations to establish a facility for resolving disputes relating to changes

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in role function and status before the formation of an Area Health Board". The Steering Committee can not agree with this recommendation. The Wanganui Area Health Board and its appointed executive officers should not have decisions made for it by the Wanganui Hospital Board or by the senior Hospital Board management. The Steering Committee acknowledges that for some senior positions there may be changes in job content and it agrees that consultation prior to change is desirable.

4.5.15 The Steering Committee has received a submission from the Local Bodies Officers Union, the Engineers Union, the Wellington District Hotel Hospital Restaurant and Related Trades Employees Union, the New Zealand Labourers Union (Central Branch), and the Wanganui Drivers Union. The combined union group comment that their support for a Wanganui Area Health Board is conditional upon the satisfactory resolution of industrial matters and seek the deferral of the 1 October 1985 date on the basis of three areas.

1. The removal of workers from union coverage under the Industrial Relations Act into the State Services Conditions of Employment Act. They are concerned there would be lessening of the workers present conditions and do not believe that the State structure places much emphasis on the welfare of "unskilled" workers.

2. The ongoing representation of members by their existing unions. Under an Area Health Board there is no guarantee that union members will continue under the present union coverage. Workers may be left without union coverage for some time and the unions are not prepared to accept this situation.

3. The right of workers in the health services to direct bargaining with their employers - a faceless bureaucracy would not understand local concerns.

4.5.16 In regard to the three specific areas of concern it is noted that items numbered 1 and 2 are matters which can only be determined or changed by the Government. The Steering Committee has been advised by the Health Service Personnel Commission that workers will not be left without union coverage as claimed by the combined union group. The right of the workers in the health service to direct bargain with their employers is again a matter of Government policy and is beyond the Steering Committees brief. -58-

4.5.17 The predominant consideration in the determination of union coverage under the State Service Conditions of Employment Act is the wishes of the employees. The usual practice is to determine this by means of a ballot supervised by the Department of Labour.

RECOMMENDATIONS

That the concerns of employee organisations be resolved as a matter of urgency and that it is desirable that this be done prior to an Area Health Board being formed.

That the provisions of the Health Service Personnel Act be applied to all transferred employees, that good communication channels be established and maintained with staff, and where jobs, duties, or status may change, the employees affected be consulted.

That the executive management team be appointed as quickly as possible. -59-

SECTION 5

FURTHER ACTION

5.1 There are a number of issues that require further attention if a Wanganui Area Health Board is to be established. For this reason it is important for the Advisory Committee that assisted the Steering Committee to remain in existence to follow these matters through. Some issues will be capable of resolution prior to the establishment of a Board while others may take longer.

Communication

5.2 Now that a system of communication has been set up efforts must be made to ensure that communication is maintained with the public at large and with the various professional groups, voluntary organisations, and trade unions. There is a need for them to be informed of progress being made in the preparatory period.

Legislation

5.3 Steps must be taken to ensure that the necessary changes to legislation are enacted to enable Lake Alice Hospital to become part of a Wanganui Area Health Board.

Finance

5.4 Further work is needed to clarify and identify a number of financial issues related to the District Office of the Department of Health and Lake Alice Hospital. As well, an arrangement needs to be entered into with the Department of Health to ensure that a Wanganui Area Health Board is not financially disadvantaged if all financial aspects relating to the District Office and Lake Alice Hospital are not identified prior to their incorporation in the Board.

5.5 Discussions should continue on the funding of Lake Alice Hospital and particularly the need for a supplementary grant for the operation of the Maximum Security Unit.

Personnel

5.6 Communication with staff and unions will need to continue, ensuring that they are kept informed throughout the preparatory period.

5.7 Work on the resolution of personnel issues should be commenced as soon as possible and every effort made to reach a satisfactory conclusion prior to the establishment of the Board. -60-

5.8 Steps should be taken to obtain written assurances from the Minister of Health and the Health Service Personnel Commission in line with the Health Service Personnel Act safeguarding staff conditions and salaries.

Accommodation

5.9 Any options for the accommodation of an Area Health Boards administrative staff and community health team should be investigated.

Lake Alice Hospital

5.10 Further clarification is needed on a number of issues that have been identified in relation to Lake Alice Hospital. This work should continue so that the incorporation of the hospital into an Area Health Board can proceed smoothly.

School Dental Service

5.11 Various matters relating to the School Dental Service are still to be finalised with the Department of Health. -61-

APPENDIX

CONTENTS

Steering Committee Meetings

Representation and Constituent Areas

Consultation and Communication

Funding Report

Personnel Matters

Notes of Meeting with Director, Dental Division

Ministerial Advice concerning Lake Alice Hospital

Background Paper - Wanganui Area Health Board Steering Committee

Tasks for Steering Committee

Area Health Board Act - Division of Responsibility

List of Resource Material

Personal Statement by Mr G H Neill -63-

STEERING COMMITTEE MEETINGS

The Steering Committee met weekly for fourteen weeks with meetings lasting from 3.5 hours to 8 hours. All Steering Committee members gave much time attending these meetings as well as public meetings and meetings with professional organisations, service clubs and other groups.

The following list demonstrates the commitment made by members: Steering Public Other Committee Meetings(17) Meetings Meetings (14)

14 17 6 Mrs B Bourke Dr B W Christmas 7 8 2 4 5 Mr G H Neill 10 Mrs L Noble 10 17 S Mr J E ONeill 12 17 7 Mrs R Rei 12 17 6 13 17 6 Mr R G Russell Or C N D Taylor 5 7 1 17 6 Mr H D Treadwell 12 Mr I C Webster 14 13 8

Discussion at meetings of the Steering Committee was detailed and wide ranging. In addition to the assistance given by the Advisory Committee, who were present at all meetings, help and advice was available from senior officers of the Department of Health, the Health Service Personnel Commission, and Messrs J Crompton and I Murphy of Northland. -64-

REPRESENTATION AND CONSTITUENT AREAS

District Pop.81 No.of Reps Electors per Board Member

Patea County, Patea Borough Waverley Town 5,772 1 5,772

Waitotara County and Wanganui County 6,195 1 6,195

Waimarino County, Raetihi Borough and Ohakune Borough 4,137 1 4,137

Waiouru, Taihape and Northern Rangitikei County (Ruanui, Erewhon, Awarua and Te Kapua Ridings including Mangaweka) 8,214 1 8,214

Southern Rangitikei County (Including Bulls) 7,761 1 7,761

Marton and Hunterville 5,422 1 5,422

Wanganui City 36,687 5 7,336

TOTAL 11 -65-

CONSULTATION AND COMMUNICATION

Much effort was put into consulting and communicating with as many people as possible.

A householder pamphlet "The Good Health Board Guide" was distributed to every household in the area between 29 April and 3 May, 1985.

A further pamphlet "An Area Health Board for Wanganui" was sent to all those on the mailing list (approximately 250 organisations and individuals), made available through chemist shops throughout the area, and handed out at any meeting attended after 3 June.

A full page article appeared in "Time Out", the magazine section of the Wanganui Chronicle and Wanganui Herald, on Friday, 3 May. Questions about an Area Health Board and answers from the Steering Committee Members were published in both papers.

A number of members of the Steering Committee were interviewed by reporters and the Chairman, Mrs Bourke, was interviewed by the local radio station, 2ZW, on Tuesday, 30 April.

Copies of two articles "Area Health Board for Wanganui - a Proposed New Approach to Health Care", and "Background to the Establishment of a Wanganui Area Health Board and the Establishment of the Wanganui Area Health Board Steering Committee" were sent to all those on the mailing list and to others on request.

Written submissions and questions were encouraged at all times. 21 were received and considered, coming from the Wanganui Branch, Plunket Society; Wanganui Branch, NZ Nurses Association; Wanganui Trades Council; GROW, Wanganui; Wanganui County Council; Combined Union Group; Wanganui Branch, NZ Institute of Health Administrators; Wanganui Womens Network; Wanganui Branch, NZ Dental Association; Wellington District Hotel, Hospital, Restaurant and Related Trades Employees Industrial Union of Workers; Medical Staff Committee, Wanganui Hospital; Waitotara County Council; Waverley and District Maternity Home Service; Central Districts Regional Office, NZPSA; Wanganui Division, NZ Medical Association; Mosston Institute, NZ Country Womens Institutes, Wanganui; Mrs M J Lilburn, Hunterville; Mr A J Daley, Marton; A.R.T. Davenport, Wanganui; and Mrs N Hanna, Marton; Mrs E Higgie, Wanganui

Two members of the Steering Committee attended a meeting of Wanganui Hospital Board staff at which Mr H Smith, Chief Executive, Health Service Personnel Commission was present. The same members were also present at a meeting of District Office staff with Mr Smith. Meetings with staff at all Wanganui Hospital Board institutions were held by the Hospital Board representatives on the Steering Committee and Board executive staff. -66-

The full Steering Committee, or representatives of it, attended the following meetings:

Wanganui Division, New Zealand Medical Association - two meetings Wanganui Branch, New Zealand Nurses Association Wanganui Branch, New Zealand Dental Association Wanganui United Council, Planning Committee Wanganui County Council Waitotara County Council Maori Elders Wanganui Branch, National Council of Women Wanganui Trades Council representatives Taihape Rotary Club Patea and District Lions Club Association of Anglican Women

A meeting was held with 20 representatives of selected professional and voluntary organisations on 2 May.

LOCAL GOVERNMENT

The Wanganui United Council representing all elements of local government within the region was addressed by two members of the Steering Committee. Discussions followed and at a later date the Steering Committee was advised of their support. The following recommendation was moved by the Regional Planning Committee and adopted by the Council:

That the report from the Steering Committee on the Area Health Board be received and the outcome of its investigation awaited with interest,

and that this Council endorse in principle the proposal to form an Area Health Board.

Individual territorial local authorities were not canvassed but members of the Steering Committee took opportunity to discuss the formation of an Area Health Board with the Wanganui and Waitotara Counties who subsequently forwarded the following resolutions:

Wanganui County Council

Members were unanimous in their support of the proposed Area Health Board.

Waitotara County Council

Council has resolved to support in principle the concept of such a Board in the belief that it will result in overall improvement to the health services in the Wanganui region.

It should be noted that all territorial local government Chairmen or Mayors at some stage took part in meetings.

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PUBLIC MEETINGS

On the 8th and 9th May the first round of public meetings were held:

Date Time Location Public Attendance

8.5.85 1000 hours Patea 40

8.5.85 1330 hours Brunswick 15

8.5.85 1745 hours Raeti hi 6

8.5.85 2000 hours Ohakune 9

9.5.85 1000 hours Tai hape 9

9.5.85 1330 hours Marton 11

9.5.85 1730 hours Wanganui 70

Invitations were sent to those on the mailing list notifying them of the nearest meeting. Advertisements were placed in the Wanganui, Taranaki, and Manawatu daily newspapers.

The second round of public meetings were held from the 10th to 12th dune:

Date Time Location Chairman Public Attendance 10.6.85 1000 hrs Raetihi Mr G Workman 12 Mayor 10.6.85 1300 hrs Ohakune Mr W Taylor 15 Mayor 10.6.85 1530 hrs Walouru Col. B Meidrum 11 Camp Commandant 10.6.85 1930 hrs Taihape Mr N Byford 21 Mayor 11.6.85 1000 hrs Hunterville Mr G Agnew(Chair- 24 man Com. Council) 11.6.85 1330 hrs Bulls Dr 0 Haylock (Chair- 8 man Com. Council) 11.6.85 1700 hrs Marton Mr C Hunt (Marton 30 Borough Council) 12.6.85 1030 hrs Waverley Mr R Dallison 42 Mayor 12.6.85 1530 hrs Patea Mr N McKay 53 Mayor 12.6.85 1930 hrs Wanganui Mr D Turney 58 Mayor

Invitations were sent to those on the mailing list as previous. Advertisements were placed in the daily newspapers as before and also in the smaller district publications. -68-

LEVEL OF SUPPORT FOR AREA HEALTH BOARD CONCEPT

Raetihi Supported in principle with no negative responses, though one person had reservations about rural interests having enough representation.

Ohakune Supported in principle. Several people indicated that the meeting had changed their views.

Waiouru Supported the concept.

Tai hape Concept was accepted with caution on some points.

Hunterville Agreed with concept, but some still had a feeling of there being too much rush and pressure.

Bulls Supported the concept, but one person had reservations regarding the number of committees proposed. Concern expressed about losing traditional access to Palmerston North.

Marton Representative feeling not obtained.

Waverley Concept supported, though with reservations on some details.

Patea Motion (Adams/Wills) passed unanimously (although some provisos were noted): "That the citizens of Patea support the Area Health Board proposal in principle as put forward by the Steering Committee."

Wanganui Representative feeling not obtained.

Maori Elders Supported the concept. Particularly interested in Community Committees and representation on Board.

QUESTIONS ASKED

The Area Health Board concept

Why does New Zealand need Area Health Boards? What deficiencies are there in the present system? What is new about Area Health Boards? Why cant hospital boards do these things now? Where did the Area Health Board concept come from originally? It seems such a good idea, surely there must be some problems associated with it? Management Structure

Where does the District Office fit in? Does the Area Health Board itself contain District Office Staff? What is different about an Area Health Board; what can it do that a hospital board cant? Doesnt an Area Health Board, like any amalgamation, imply a bigger bureaucracy? And therefore wont communication be poorer with the new structure? Is an Area Health Board another tier on top of the Wanganui Hospital Board and the District Office? What is the reporting mechanism for SDGs and community committees? Arent there a lot of new committees? Will there be extra positions, and what would these cost?

Service Development Groups

Why are SDG5 necessary and what will they do? What is the difference between SDGs and community committees? How will the memberships of SDGs and community committees compare? Do SDGs imply any influence by the Area Health Board on the private and voluntary sectors? What is the reporting structure to the Area Health Board? What rights of access to the Board do SDG5 have? Will members receive any payment? Will the groups be based in Wanganui; what input will rural areas have?

Community Committees

How many community committees will there be? Who decides where the committees are to be located? Who is eligible for membership? Who decides the final membership? Will the number of committees relate to the number of Area Health Board members? Will Area Health Board members be eligible for community committee membership? Will committees be funded? How much control does an Area Health Board have over them? What access do they have to the Board? How do they link up with SDGs? Are community committees mandatory? If the intention is more community participation, does this mean that the Area Health Board will shift a burden of responsibility for improving health and health services onto community committees? What will happen to the Patea Hospital Management Committee? How will committees be decided for Wanganui City? -70-

The voluntary and private sectors

Will central funding be affected? Can an Area Health Board control or direct people and organisations in these sectors? If they take part in the SDGs, does this imply any direction by an Area Health Board or commitment to board policies? Will an area Health Board mean a greater workload for voluntary groups? Who will practice nurses (who are funded by government) be responsible to? Why are the "18 Wanganui doctors" seemingly so opposed?

Personnel Matters

Will any staff bemade redundant? Will their salaries or conditions of employment be altered? Will the Area Health Board be able to negotiate locally over personnel issues?

Services

What will be the effect on existing services, both Hospital Board and District Office? In particular, if the intention is to increase prevention and health promotion, what is the future for hospital services? Will there be new opportunities for using hospital buildings? Will rural services be "further downgraded"?

Finance

How is funding determined for the Area Health Board? Will an Area Health Board be financially advantageous or disadvantageous to the Wanganui region? If there are going to be savings, where will these come from and how much will they be? Will there be extra money for health promotion? How much autonomy will an Area Health Board have, given that all funding will come from Government? Will the SDGs and community committees entail extra costs, and how much would these be?

The Date

Why October 1 - why the rush? Shouldnt the date be delayed intentionally to allow an election? Isnt it just a Hospital Board takeover? Hasnt the decision to establish an Area Health Board already been taken? -71-

Lake Alice Hospital

Why hasnt the Steering Committee met with Lake Alice staff? Is Lake Alice definitely to be included? Is its inclusion essential, and if so, why? Why are the staff at Lake Alice unhappy? Will Lake Alice services suffer? Will Lake Alice retain the Maximum Security Unit? What are the financial implications of including Lake Alice? Does the Hospital Board currently lose funds because of Lake Alice?

Elected Area Health Board Members

Why 11 instead of 14? Where do these 11 come from; what criteria were used for choosing the areas to be represented on the Board? Why do some areas lose representatives? Can 11 cope with the workload of the new organisation? Is the recommendation of 11 final? How are the 3 who opt out chosen?

Appointed Area Health Board Members

Why are appointed members necessary? Are they mandatory? How many would be appointed? Who decides, and how, who is to be appointed? Since the Minister makes the appointments, do they therefore come from the Department of Health? Do they have the same rights as elected members? Could the 2 appointments u )set the rural/urban balance on the Board?

Boundaries/Amalgamation

Are Area Health Boards just the thin end of the wedge with regard to local authority amalgamations? (With reference to the Local Government Commission.) Will there be any reduction in the present 29 hospital boards as area health boards are formed? What likelihood is there of Wanganui amalgamating with Palmerston North and/or Taranaki districts? Wouldnt a bigger board be able to offer a better range of services? Would the establishment of a Wanganui Area Health Board affect access to services in other areas? (Especially regarding Waimarino people going to Taumarunui and those in Southern Rangitikei going to Palmerston North) Is there any chance of parts of the Wanganui region (especially Southern Rangitikei and Patea) being hived off to adjacent districts? -72-

Public Opinion

How can the Steering Committee be sure it is gauging public feeling accurately when so few people attend public meetings? How well publicised were the public meetings? How far has the Steering Committee gone in trying to acquaint the public with its thoughts? If Area Health Boards have received extensive publicity for a number of years, why do people seem to know so little? Is this meeting the last chance for the public to have a say? How much power does the public have in the decision to become an Area Health Board? Arent public meetings just a matter of going through the motions of consultation? Wouldnt a delay from 1 October allow for more indepth public consultation? Will there be a further series of public meetings?

Miscellaneous

If Area Health Boards are such a good idea, why has Northland taken so long? What are other regions doing about Area Health Boards (why is Wanganui so keen)? Wont the establishment of Area Health Boards on top of hospital boards and district offices create a more complex system of health organisation? Are Area Health Boards the first step towards a nationalised health service such as the U.K. has? Why should an Area Health Board be any better a performer than the Wanganui Hospital Board? What opportunities will the new structure present for the Maori people? How will the following fit in: Pharmaceutical Pricing Office, Taumarunui, local authority health inspectors, education services? -73-

REPORT ON THE FUNDING OF A WANGANUI AREA HEALTh BOARD

This report is the result of discussions held with members of the Sub-Committee for Funding set up by the Wanganui Area Health Board Steering Committee. The Funding Sub-Committee members are:

Chief Executive Wanganui Hospital Board Director of Finance Wanganui Hospital Board Secretary Lake Alice Hospital District Executive Offficer Department of Health, Wanganui Director of Finance Health Department Head Office

Meetings were held with local members on various occasions but because of the time frame allowed to draft this report, negotiations with the Department of Health Head Office will take place at a later date. The content of this report has therefore been limited to the local scene and I would point out that full co-operation has been received from both the District Executive Officer of the Department of Health and the Secretary of Lake Alice Hospital. Discussions have also been held with the District Office of the Ministry of Works and Development.

First of all this report summarises the known finances of the Wanganui Hospital Board, Lake Alice Hospital and the Department of Health Local Office. This report is also based on the resolution of the Steering Committee that the Wanganui Area Health Board boundaries would remain the same as that of the Wanganui Hospital Board. Included in these summaries of expenditure are items which are presently not funded through the accounting systems of either Lake Alice Hospital or the District Office but were easily identified as to their cost. The other items which were known but for which costs could not be assessed are outlined in this report at a later stage. These items are open to negotiation but funds will either have to be provided to an Area Health Board to cover them or they will have to be continued to be provided at no cost to the Board. The operating funds of the Wanganui Hospital Board however are all known and are included in total in this report. Supplementary grants provided to the Wanganui Hospital Board however, apart from loan servicing, are listed as a separate item for further clarification. The actual expenditure for the 1984/85 year is known but it was considered that it is more appropriate to show the proposed expenditure for the 1985/86 year. It should also be noted that the expenditure of the Wanganui Hospital Board is funded from its operating allocation as well as from revenue received by the Board which will be outlined later. Revenue collected by the District Office and Lake Alice Hospital is not apportioned back to fund operating expenses but is in fact presently paid into the consolidated account. The estimated known expenditure for the three organisations is as follows:

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a) Wanganui Hospital Board proposed operating expenditure for 1985/86 (excludes funds carried forward from the previous year amounting to $152,990.00).

$ Treatment salaries 10,909,955 Domiciliary salaries 695,263 Diagnostic salaries 914,488 Housekeeping salaries 2,677,164 Engineering & Maintenance salaries 842,882 Administration salaries (includes ACC premium and Superannuation payments) 1,473,104 17,512,856

Treatment expenses 1,564,870 Domiciliary expenses 7,050 Diagnostic expenses 256,000 Housekeeping expenses 875,670 Engineering & Maintenance expenses 842,362 Administration expenses (includes other expenditure: see note below) 1,078,180 Reserve for advance stabilisation 171,874 Capital equipment 270,960 5,066,966

Total Operating Expenditure $22,579,822

Note: Administration expenses includes grants to Waverley and Whare Ora Hospital, transport expenses, ambulance expenses, insurance, advertising, gratuities, staff training, Board members expenses and many other expenses apart from Administration/Office expenses.

b) Lake Alice Hospital proposed operating expenditure 1985/86 year.

Salaries and Wages 6,893,640 Operating expenses 1,732,749 Capital equipment expenditure 156,555

Payments charged to Lake Alice Hospital 8,782,944

Plus other services not paid for by Lake Alice but able to be estimated:

Vehicle replacement costs 58,000

Total known costs 8,840,944 -75-

c) Department of Health District Office proposed operating expenditure 1985/86. (Excludes three Taumarunui nurses and related expenses as well as a portion of Health Inspectors work carried out also in Taumarunui)

S Salaries and Wages 629,401 Operating expenses 96,956 Capital ,equipment 39,460

Priority Area Programme 5 S

Salary and Wages 43,350 Expenses 11,250 Capital Expenditure (includes replacement vehicles) 9,500

Total Costs Charged to District Office 829,917

Other services not paid through Local Office but able to be estimated

0.50 Principal Dental Officers salary 21,000 Dental Nursing salaries (incl. Supervisor 507,963 Dental ClinicPayments to Education Board, Technident & Others 69,906 Vehicle replacement (Capital Expenditure) 87,000 Fringe Benefit Tax, (11 vehicles) 37,000 Rental & Rates on Office (State Insurance Building) 26,581 Marton Clinic Rental & Rates 1,821 Office cleaning 2,770 754,041

Total known costs District Office Department of Health 1,583,958

NOTE The priority area programme has been set up to cater for what is classified as at risk areas and these funds will be built into the Health Departments budget at the end of this year. They have therefore been included in the above proposed expenditure. -

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Summary of Costs for the three organisations: (not including the 7% General State Adjustment)

Operating costs $ Wanganui Hospital Board 22,579,822 Lake Alice Hospital 8,840,944 Department of Health District Office 1,583,958

Total known costs 33,004,7 24

Supplementary ongoing costs (Currently met by special grant) Interest & Principal on loan repay- ments re Wanganui Hospital Board 2,731,490

Total known payments 1985/86 35,736,214

As can be seen from the above figures, the known total estimate for the Area Health Board, based on 1985/86 estimates amounts to $35,736,214. This figure does not include increases in salary and wages expected this year which it is estimated would total around $2,000,000. The figures also do not include the latest 7% GSA. It also does not include other supplementary grants such as grants under resource management and paramedical pool scheme that are currently available to the Wanganui Hospital Board. Such grants are mentioned below under the other items requiring further clarification. It is assumed however that salary increases will be claimed as supplementary grant for all the above organisations and that these will be stabilised at the beginning of the following year. This area will, of course, require further discussion with the Department of Health, Head Office.

The above figures do not include many items that are funded externally and some of these would need to be assessed by the Department of Health, Head Office. The items that the Committee has so far isolated but cannot as yet assess the cost of are listed below. These would have to be included on top of the expenditure previously shown otherwise agreement would need to be reached that they would continue to be provided at no cost to the Area Health Board. The lists the items that require further clarification followin q and will need to be ne iated with the Department o ea

1. Maintenance and major work carried out by the Ministry of Works at Lake Alice

Some painting and reroofing was carried out by the Ministry of Works last financial year which was not charged. This included the reroofing of Villas 13 and 15 at a cost of $164,033 and painting of 8 small villas at a cost of $27,461. The Ministry of Works also provides a service for Lake Alice Hospital where it arranges contracts for work to be done. Such contracts consist of fixed price quotes and although the contract price is charged to Lake -77-

Alice, the supervision provided by Ministry of Works personnel is not. This is currently under review and it appears that this will become a charge to Lake Alice Hospital in the near future. An allowance would have to be considered within Lake Alice Hospital expenditure to allow for the increased supervision costs. Other maintenance work provided by Ministry of Works staff themselves are usually of the emergency type and are charged to Lake Alice Hospital with a built in rate to include overhead costs.

Verbal assurances have also been given regarding funding required of Maintenance at Lake Alice in line with the Departmental Report. It is also considered that fire access requires upgrading in some of the villas.

2. Treasury Forms and Stationery

At the present time accounts are approved for payment in both the District Office and at Lake Alice but are sent to the Treasury Offices in Palmerston North for payment. This involves use of various Treasury forms and these are supplied free of charge to these organisations. Extra stationery costs will therefore accrue as a result of the withdrawal of the Treasury service.

3. Transitional Costs

It is envisaged that extra one-off costs will accrue at the time the Area Health Board is set up. Solicitors fees would be incurred because of legal costs involved in changing over the land and buildings and having the Title Deeds changed. It is also considered that bridging finance for a Planning Officer for Mental Health Services should be provided.

4. Accountin q Services

Some accounting services are provided by Treasury for both of these organisations and this would also be an extra cost to the Board.

5. Computer/Payroll Processing Costs

These are also processed externally by the Government and it is assumed that such computer/payroll processing would fall back on the Area Health Board. This cost also needs to be assessed. -78-

District Office Imprest Account

An imprest account of $4,000 is currently held by the District Office which is not shown as a proposed payment during the year. If an imprest account of this nature did continue a one-off payment would be required to set it up.

7. Transfer and Removal Expenses

It appears that some transfer and removal expenses are paid by the Head Office of the Department and are not charged to the individual organisation. This includes dental nurses on initial appointment. It has also been questioned as to whether the two year provision regarding house purchase for persons on transfer would continue over if an Area Health Board was set up.

8. Dental Clinic Costs

Dental nurses salaries and payments for clinic costs have been estimated and shown in the costs for the local, office but we are unable at this stage to ascertain the cost of the related on-going expenses for repairs and maintenance on dental equipment. It is believed that such costs could he extremely high and this is another area that will need to be closely looked at by the Department of Health. At the present time dental nurses salaries are paid by both the Palmerston North office and the New Plymouth office.

9. Dental Equipment Capital Costs

This is another area that requires clarification as the costs of new and replacement capital equipment can be extremely high.

10. Mobile X-Ray

Use is made of the Mobile X-Ray Unit in Wanganui on various occasions and it would have to be confirmed that this would either be provided at no cost to the Area Health Board as before, or it would have to be funded.

11. Dental Refresher School Costs

Dental nurses returning to service are currently given a month training at a refresher school. This is not currently charged to the Department locally.

12. Vaccines

It appears that BCG Vaccine is also distributed through the local office of the Department at no charge. -79-

13. Library Service

At present the local office of the Health Department can use the services of the Library at Head Office. It needs to be ascertained if this service will continue to be provided to an Area Health Board.

14. Health Education Services Including Equipment and Literature

Some education equipment as well as a multitude of health pamphlets and education material is provided to the District Office of the Department of Health and is not reflected in their expenditure. It would have to be determined whether this would continue to be funded externally. Also whether the support from the Head Office for Health Education Services would continue to be provided at no cost.

15. Seaview Stores Supplies

Supplies from this store which includes consumables, hand pieces, clothing etc, is currently provided free of charge to dental clinics and would also have to be funded. This cost could also be considerable.

16. Buildin g s and Vehicles Insurance

Insurance on vehicles and buildings are handled differently by the various organisations at present. Vehicles are not insured by the local office of the Department of Health. Insurance on vehicles would increase costs.

17. Funding of Service Development Groups and Community Committees

Meeting costs and associated travelling costs with the various committees set up under an Area Health Board would also require consideration of extra funding and this is a topic that needs further clarification from the Department.

18. Effects of Government Policy

Some policy decisions may effect the funding of an Area Health Board,i.e. the providing of Impedance Audiometers to Public Health Nurses. Would extra funding be provided for such policy changes.

19. Relieving Expenses for Dental Nurses

Expenses are paid to dental nurses who operate outside of their own base (i.e. sub bases and other clinics). These are not shown in the expenditure listed earlier in this report and this would also need further consideration.

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20. DSIR Analysis

This service is also used at no cost to the local Health Department.

21. National Health Institute

This is another service also used on occasions and not charged for.

22. National Environmental Chemistry and Accoustics Services and others

Presently the services of NECAL are not charged to the Department of Health, local office. Services are also provided free by the Regional Air Pollution Control body and the National Radiation Laboratory.

23. Regional Staff

Some regional staff visit the district and this is not reflected in the Department of Healths expenditure. These consist of a visiting Regional Medical Officer of Health and a Regional Health Education Advisor provided from Head Office. A District Advisory Pharmacist is also provided from Palmerston North.

24. Funding for Pilot Schemes

The Act refers to the granting of assistance to individuals or organisations for

(i) Setting up programmes for Health Services

(ii) Training volunteers engaged in such services.

Some provision will therefore be required in the funding for the setting up of pilot schemes.

25. Legal Fees incurred in Prosecutions

Expenses incurred in taking legal action against those persons prosecuted for violating Health regulations can be considerable. It is considered these costs should be met by special grant as they can vary greatly from year-to-year.

26. Study Leave - Internal and Overseas

This is another area which is not charged to either Lake Alice or the District Office. -81-

27. Organisational Structure

It is envisaged changes will be made to accommodate the new Area Health Board and the effect of these on finance would also need further discussion.

28. Accommodation

The question of the funding of accommodation for the central offices of an Area Health Board requires further clarification. The Steering Committee has resolved that the, estimates for a Wanganui Area Health Board should provide for separate rental accommodation for Area Health Board administrative services within two years formation, and ultimately that there should be provision of capital finance for a new building at a later stage.

29. Courses and Conferences

Internal courses and conferences are currently paid by the Health Department, Head Office and not charged locally. This includes Dental Nurses. Also an allowance must ben made for sufficient funds for courses and conferences other than those provided centrally for Dental Nurses.

30. Goods and Services Tax

It is assumed that increased expenditure caused by the proposed goods and services tax would be met by way of an additional supplementary grant. This needs confirmation.

31. Salary Rates

It is as yet still unclear if staff salary rates would be adjusted in the future up to State rates. If this does occur a stabilisation payment would be required to fund this. It is also considered that an Area Health Board should be funded for "Salary Creep" which amounts to a considerable sum, this occurs when an employee moves through an automatic scale in an award or determination.

32. Freezer space rental

The question of renting of freezer space to hold contaminated food seized by health inspectors also needs further discussion. -82--

33. Community Health Initiatives Funding Scheme

Two requests have been received so far through District Office and passed through to Head Office. Some clarification is needed as to whether this would affect the funding of an Area Health Board.

34. Other Supplementary Grants

Supplementary grants such as resource management grants, service development grants and grants under the paramedical pool scheme etc. are currently being used by the Wanganui Hospital Board. These have not been included in the figures provided earlier in this report and clarification is needed as to whether use can be still made by an Area Health Board of the same facilities as offered under the Wanganui Hospital Board. The Board is currently using a number of these which provide funds for the year ended 31 March 1986 totalling $63,000.

As I have mentioned before the items listed above that we need further clarification on could amount to a substantial sum and a number of these items can only be costed by having access to or information supplied through the Head Office of the Department of Health or Treasury. The other areas that affect funding and need further consideration are as follows:

Revenue All revenue received by the Wanganui Hospital Board is allowed to be retained by the Board and is applied towards part payment of the Boards operating costs. The balance is met by the Boards allocation of health funds.

Estimated receipts for the Wanganui Hospital Board for the 1985/86 year are as follows:

Hospital fees, sundry sales and other miscellaneous receipts 554,000 Board and lodgings 160,000 Capital Sales 42,000 756,000

The revenue received by Lake Alice based on the previous financial year is as follows:

Board and lodgings 38,529 Miscellaneous recoveries 1,329 Trading operations, Occupational Therapy etc 15,610 Sales of stores 104 House rental 38,058 Miscellaneous 909 Capital sales 10 94,549 -83-

Not included in the above revenue for Lake Alice is an amount of $7,282 from hospital industries and an amount of $20,566 from Occupational Therapy which is apportioned to the Hospital Trust Recreation Account. This equates to 10% of the Hospital Industry revenue and 50% of Occupational Therapy revenue.

Estimated revenue for the Department of Health District Office is as follows, (based on last financial year):

Registration of firms 1,395 Fees paid under Health Act 3,902

Miscellaneous 9 Local Body Contributions 2,717 Sales of stores 2

4,364 Rentals Sale of Capital Assets 21,714 34,103

The above revenue also includes the sale of a house under capital assets which amounted to the full figure of $21,714, which means that an average years revenue would probably to equate to around $13,000. Other expenditure which is not currently charged out by the local office is as follows:

1. Tea Lady Services

This position is provided by the Department of Health and is used by other departments within the State Insurance building. It is not presently charged to these other departments and this would have to be done if an Area Health Board was set up.

2. Photocopying Services

The use of the photocopier is provided to other departments within the State Insurance building but is not charged to them.

3. Switchboard Services

The services of a switchboard operator are provided by the Department of Health and this service is used by the other departments but is also not charged.

It is. therefore necessary to establish with the Department of Health as to what revenue will be required to go back to the consolidated fund and what revenue will be allowed to be retained to offset running costs, or in the case of Lake Alice to be allocated back to the Trust Account. Consideration should be given to the retention of some of this revenue which may in fact be able to be used to offset some of the costs that require further discussion with the Department of Health. Another area of revenue not currently retained by the District Office or Lake Alice is that of the sale of motor vehicles. It is assumed that the revenue from the sale of vehicles would be allowed to be retained by the Area Health Board. Further clarification is needed on the -84-

items of revenue listed above which can be retained and at this stage it is assumed that the only items that may need to be paid back to the consolidated account are for the registration of firms and for fees paid under the Health Act.

Trust Funds

Trust funds are held by both the Wanganui Hospital Board and Lake Alice Hospital. It is assumed that both these funds would continue to be used in the same manner as before. The balances in the trust accounts as at 31 March 1985 are as follows:

Wanganui Hospital Board $

Patients deposits and unclaimed salaries 69,559 Contractors deposits 250 Special trust funds 470,864 540,673

Lake Alice

Rehabilitation Fund 61 Hospital Industries Account 576 Occupational Therapy Account 2,084 Recreation Account 147,202 Patients deposits 105,197 255,120

Buildings and Major Capital Equipment

At present the Wanganui Hospital Board raises loan funds for major building works, alterations and major equipment purchases.

Loan funds on hand at 31 March 1985 by the Wanganui Hospital Board totalled $2,803,197. A further $3,000,000 is proposed to be raised this financial year, of which the major portion will be used to fund the continued building of the Wanganui Ward and Administration Block. It is assumed that major building works and equipment would continue to be funded by the raising of loans, however, this would have to he further discussed with the Department of Health, Head Office.

Staffing Numbers

This year the Wanganui Hospital Board is budgeting for a staffing level of 942.82 full time equivalents (FTE). The Wanganui Hospital Board now regards this figure as both the establishment and the financial ceiling as it is of course not possible to fund any higher than finance will allow.

The Department of Health District Office has a staff ceiling of 36.38 FTE (including 0.38 Tea Assistant) while the establishment is 39.75 FTEs. The financial budget for the District Office is set on the staff ceiling of 36.38 FTEs and the positions not financed this coming year are as follows: -85-

Health Education Officer 1.00 Medical Officer 1.00 Health Auxillary 1.00 Tea Attendant 0.37 3.37

The staff ceiling for the District Office has been decreased by .2 only in the 1985 year, whilst the staff establishment has dropped from 41.25 to a new figure of 39.75 in the 1985 year. It is considered that funds should be provided for the extra 3.37 staff and this would amount to $71,045. It is also considered that 2.00 Health Education Officers would be required.

On top of the above figures there is also the new staff recruited under the Priority Area Programme. These are as follows:

Public Health Nurse 1.00 Health Assistant 1.00 Medical Officer (yet to be 0.5 appointed) 2.5

As well as the above an extra 29.50 Dental Staff will be brought into the Area Health Board (these are presently controlled through the New Plymouth and Palmerston North Offices). These consist of 28.00 Dental Nurses, 1.00 Supervisor and a 0.50 Principal Dental officer. The Lake Alice staff ceiling is 344.7 FTEs for 1985 and the establishment level is set at 356.6 FTEs. Both the staff ceiling and the establishment figures have remained constant in the last three years. When the budget is set a planning figure of 338 FTEs was used to compensate for those positions which may be unfilled during the year. This difference in the planning figure of 338 FTEs and 344.7 as the staff ceiling, must be recognised if an Area Health Board comes into existence as allowance should be made in the salaries figure to fund the staff ceiling of 344.7 and further discussion will be required as to whether the staff establishment level of 356.6 should be funded. The Steering Committee has now also indicated that it considers the establishment level should be fully funded.

Houses and Land

All the three organisations have properties other than their main offices or hospital buildings. These are as follows:

Wanganui Hospital Board Endowment properties 30 (land only) Staff houses and flats 15 Halfway House Wanganui 1 Health Clinics 3 -86-

lake Alice Hospital Houses at Marton 22 Houses on Lake Alice site (2 used as offices) 39 Halfway House at Palmerston North (includes 2 flats) 1

Department of Health District Office House at Taumarunui 1 House/Clinic at Raetihi 1 House/Clinic at Taihape 1 Garages currently under construction adjacent to clinics 2

It is assumed that all of the above houses would fall under the control of the Area Health Board and would include the halfway house in Palmerston North. Further discussions will be required to be held with the Department of Health on this.

The Lake Alice Hospital is also sited on a large area of land and it has to he confirmed that the Area Health Board would take over the land on the hospital site as well as all the land surrounding it. Leasing of such land could create a substantial amount of revenue for an Area Health Board. It is assumed that the Area Health Board would take over all the land. The ongoing maintenance of the houses situated at Marton and Lake Alice would also have to be discussed with the Department of Health. The Wanganui Hospital Board also has 30 endowment properties the proceeds of which, when sold, remain with the Board. It is assumed that this would continue but this is another area requiring clarification.

Amalgamation of Bank Accounts

With the setting up of an Area Health Board the bank accounts of the three organisations would require amalgamation and this is another area that would have to be considered.

Population Based Funding Model

Another area that would have to be discussed with the Department is that of the population based funding model and its effect on an Area Health Board. It is envisaged by this Committee that the Department of Health local office would be unaffected by the funding formula but this point requires further clarification. Also needing further clarification is whether the maximum security villa at Lake Alice would be funded externally from the population based funding formula because if not it is considered that a supplementary cost ratio would be required in the population based funding formula to cater for it because of the special staff ratios required in the unit.

The other major concern of the Committee was the funding that would be required to cover any unforeseen items not recognised at the time funds were transferred. It is for this reason that the Committee feels that a commitment from -87-

the Department of Health would be required to continue to fund any unforeseen items not established at the time the Area Health Board was set up.

To summarise, I would suggest that even though some of the costs of an Area Health Board have yet to be established one could say with some degree of certainty, that as long as a commitment was made by the Department to fund any unforeseen items already funded under the present system, then I can see no reason why an Area Health Board in Wanganui would not be a viable proposition. This comment however is subject to the following two conditions.

1. Subject to further clarification on how the population based funding model would be applied and;

2. On the outcome of the negotiations with the Department of Health on the areas outlined in this report that need further clarification.

I would therefore conclude this report to say that further discussions will now take place between the local members of this Committee and the Department of Health, Head Office and we are all hopeful that these discussions will result in the smooth merger of the three organisations into an Area Health Board if this is so decided. The success of these discussions are of course subject to the availability of and co-operation received from the Head Office of the Department of Health.

N J B RCLAY DIRECTOR OF FINANCE -88-

PERSONNEL MATTERS

CONCERNS EXPRESSED BY HEALTH DEPARTMENT EMPLOYEES

(from notes taken at a meeting between Health Department employees and representatives of the Health Services Personnel Commission on 7.6.85. 28 staff were present)

TRANSITION

Some wanted assurances that the right of an Area Health Board to hold staff for two years would not be used against the workers interests.

Some were concerned that no guarantee of alternative employment could be given and that they might suffer a loss of grading if they moved.

Some wanted a guarantee of right of access to the Public Service Circular and that an Area Health Board would retain their current merit system.

Some would like clarification on the bonding issue and whether or not the Public Service Bonding System would be transferred to an Area Health Board.

Dental nurses are needing assurances that their transfer system and their educational role would be retained by an Area Health Board.

EDUCATION

Concern was expressed at the reputation of the Hospital Board education policy and assurances sought that an Area Health Board would offer more than the current Hospital Board.

In particular an assurance was sought that current Public Service educational /refresher entitlements would be retained.

Some wanted to know who would be released/ recommended for various courses and on what basis.

Some were seeking an assurance that the educational funding currently supplied by Health Department Head Office will continue to be available to workers in the health department section of an Area Health Board. -89-

UNION COVERAGE AND RIGHTS

Some wanted to know which union will represent them

Some wanted to know if their promotion and other rights will be protected in an Area Health Board set up.

RIGHTS OF TRANSFERRING EMPLOYEES

Some were seeking assurances that rights such as access to Housing Corporation home finance and pool housing would remain under an Area Health Board.

AMOUNT OF TIME FOR CONSULTATION

Some were concerned about the speed of process towards the introduction of an Area Health Board and indicated they would appreciate more time to learn more and to get answers to their questions.

ADDITIONAL MATTER OF CONCERN OF PUBLIC HEALTH NURSES RAISED AT OTHER MEETINGS

ROLE OF PUBLIC HEALTH NURSES

Public Health Nurses expressed concern about safeguarding their role. In particular there was a fear that they could be made to work in the hospital setting. •1

CONCERNS EXPRESSED AT HOSPITAL BOARD EMPLOYEES MEETING

(from notes taken at a meeting between Hospital Board employees, their representatives, and representatives of the Health Service Personnel Commission on 6.6.85 42 people were present)

AMOUNT OF TIME FOR CONSULTATION

Some concern was expressed that the target dates of October 1 and July 1 left too little time to discuss and settle the issues they could see arising from the proposed transfer to an Area Health Board.

NEED TO SETTLE UNION MATTERS BEFORE PROCEEDING

Some assurances were sought that union matters (particularly the question of union recognition) will be settled prior to a decision being made to proceed with an Area Health Board.

There were fears that some may become worse off as a result of the change and prior settlement of union matters is sought to allay those fears.

Some wanted more information and time to evaluate the new disputes procedure which they see as being not as good as that available under the Industrial Relations Act.

Some had a strong preference to negotiate with their employers and want to retain this right under an Area Health Board.

MANAGEMENT PROCEDURES UNDER AN AREA HEALTH BOARD

Some assurances were sought that there would be provision under an Area Health Board for consultation with the staff on any proposed changes to procedures.

ELECTION OF AN AREA HEALTH BOARD

Some believed an Area Health Board should be elected and do not want to see the current Hospital Board translated into an Area Health Board. Workers feel an election is the best way to ensure the best Board is achieved. -91-

NEED FOR MORE INFORMATION ON AREA HEALTH BOARDS

Some believed that the public would like to hear more about Area Health Boards and have more opportunity to discuss the pros and cons. -92-

NOTES ON MEETING WITH DIRECTOR, DENTAL DIVISION DEPARTMENT OF HEALTH, HEAD OFFICE, AND CO-ORDINATING COMMITTEE ON WEDNESDAY 19 JUNE 1985 AT 1300 HOURS

The following were agreed upon:

1. The Principal Dental Officer for the Palmerston North Dental District be the Principal Dental Officer for the • Wanganui Area Health Board and that this position be shared on a 50/50 basis by both organisations.

2. That the Principal Dental Officer be based in Palmerston North.

3. That the Area employ 28 Dental Nurses and one Supervisor.

4. That the Department of Health will transfer resources to the Area Health Board to enable it to implement existing national policies in regard to the school dental service.

5. That the funds for school dental nurses be transferred to the Area Health Board.

6. That the funding on the ceiling be transferred for staff numbers, not the actual number employed.

7. That the 60 Rangiwahia patients treated in the Palmerston North area by the school dental nurse based in Hunterville continue to be treated by this nurse as an employee of the Wanganui Area Health Board.

8. That the Department continue to buy and replace dental equipment.

9. That all dental equipment remain the property of the Area Health Board.

10. That Departmental refresher and conference expenses be funded from a central budget.

11. That dental nurses to be employed by the Wanganui Area Health Board remain within the present transfer system in regard to making staff appointments, but that the Area Health Board retain the right to make final decisions regarding the appointment or dismissal of school dental nurses.

12. That the Principal Dental Officer be a member of the Community and Environmental Health Service Management Team.

13. The Principal Dental Officer be responsible to the Head of Medical Services for the Area Health Board.

14. That funding be provided for supplies used by school dental nurses, and that further negotiations be held with the Department of Health to identify actual expenses and the best means of providing supplies. -93-

15. That the District Office supply office accommodation to the Supervising School Dental Nurse, including office equipment.

GENERAL COMMENTS

The Director was adamant that national policies should continue to exist and advised the Co-ordinating Committee that Clauses 36 and 37 of the Area Health Board legislation in which the Minister can direct Area Health Boards would be used to ensure that this occurred. His Department did not have any information available on what these national policies were and members of the Co-ordinating Committee suggested to him that this would be helpful.

The role of a local authority dealing with national policies was examined by all present in some depth.

The Director explained that he saw some issues such as the appointment system and the maintaining of a central budget for training, conferences etc as being transitional only until more Area Health Boards were formed.

The meeting closed at 1440 hours. -94-

Letter from Minister of Health - l Sent at: TI 07 A..!UPT

N.Z. (121 JUN5j

TSMEMEML

Mrs B Bourke Chairman Wanganui Hospital Board Private Bag WANGANU I

Dear Mrs Bourke Thank you for your letter about the transfer of Lake Alice Psychiatric Hospital to a Wangaflui Area Health Board.

I firmly believe that such a transfer is in the best interests of your area and I have expressed to the PSA my belief in the desirability of the transfer. I believe that transfer should take place on 1 April 1986. If (for reasons that at this stage I cannot envisage) a Wanganui Area Health Board is not in place on 1 April. 1986, the transfer would take place as soon as is possible after the establishment of an area health board. I would also mention that the necessary action is being taken to arend the Health Personnel Commission Act to allow the transfer of Lake Alice Hospital staff.

Yours sincerely -

iliohael Bassett Minister of Health -95-

WANGANIJI AREA HEALTH BOARD STEERING COMMITTEE

INTRODUCTION

1. The Area Health Boards Act 1983 is enabling legislation: it is open-ended in time and in geographical coverage. The initiating action rests with individual hospital boards; the ultimate political decision is that of the Minister of Health who has the responsibility of recommending to the Governor-General the necessary Order-in-Council.

2. An Area Health Board is, in administrative terms, essentially the bringing together of the two public sector agencies concerned with the planning and delivery of health care viz the Hospital Board and the District Office of the Department of Health. In more philosophical terms - recognised in s9 of the Act - "Primary objectives of Boards" - an Area Health Board is the expression of a concern for "total health". It recognises the "oneness" of an individuals health and the interconnections among the various aspects of the health of a community.

3. The private and voluntary sectors come within the ambit of the Act. A primary objective of an Area Health Board would be "to provide for the effective co-ordination of the planning, provision, and evaluation of health services between the public, private and voluntary sectors" (s9(b)).

4. No threshhold conditions for the establishment of an Area Health Board have been set in the legislation. The Minister is required "before tendering any advice (to the Governor-General) to satisfy himself that there has been adequate consultation, planning and preparation for the establishment of an Area Health Board in the proposed Area Health District". The various discussion documents have referred to the ability to provide "comprehensive services".

5. An Area Health Board will provide for the effective co-ordination of the planning, provision, and evaluation of health services between the public, private, and voluntary sectors in its region. It will increase local autonomy in the determination of health service priorities and maintain a balance between all sectors of the health service - between community and institutionally-based services, and between preventative and treatment services. It will incorporate in its general purpose the direction and control of the development of health services in such a way as will most effectively promote and protect the health, the safety, the convenience and the economic, cultural, social and general welfare of the people. An essential element in the total health philosophy is I.

the emphasis on services to promote and protect health. This is reflected in the prominence given to these services in those sections of the Area Health Board Act defining the functions of an Area Health Board. Concern has been expressed by District Office Public Health Staff that the treatment services, institution rather than community, will receive the lions share within an Area Health Board. However the Wanganui Hospital Board members have over the last years become very aware that the appetite of the health services they provide will never be satisfied, and recognise the need for rationalisation of thinking and attitude to health, and education of people to change this trend. The preventive system has been treated somewhat as the poor relation, so there is a definite need to positively reverse this attitude, and present and previous trends in health spending.

6. The Wanganui Hospital Board has actively considered the Area Health Board concept since 1978. The Board formally resolved in 1981 to become an Area Health Board and in the same year the Wanganui Area Health Co-ordinating Committee was established by the Board. The Committe consisted of representatives from the Hospital Board, the District Office of the Health Department, the United Council, the New Zealand Medical Association, and the District Planner of the Ministry of Works. It examined aspects of health from a wider perspective and investigated the feasibility of an Area Health Board being established in Wanganui. The Committee appointed shadow service development groups to look at various services. The performance of the committees varied, however, one result was clear: that the recommendations from the committees impacted on many organisations, and not just the Hospital Board. The Board proposes as a result of its experience in establishing the Wanganui Area Health Co-ordinating Committee, that the health services of its region can best be provided for by a new organisation - the Area Health Board. A regional health system designed to meet local needs, must emanate from the region itself drawing upon local. expertise and reflecting local conditions and needs.

OBJECTIVES OF AN AREA HEALTH BOARD

7. The primary objectives of an Area Health Board outlined in the legislation are as follows:

(a) To promote, protect and conserve the public health and to promote health services.

(b) To promote the effective co-ordination of the planning, provision and evaluation of health services between the public, private and voluntary sectors.

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(c) To establish and maintain an appropriate balance in the provision and use of resources for health production, health promotion, health education and treatment services.

NEED FOR NEW ORGANISATION TO BE ESTABLISHED

8. (a) An Area Health Board is not an enlarged Hospital Board. Its brief embraces a much wider concept and is far more comprehensive. A new organisation would emphasize the extent to which the responsibilities of the proposed Area Health Board differ from those of a Hospital Board.

(b) There is a growing acceptance by health providers of the need to gain a fuller understanding and appreciation of each others roles and to work together in achieving a better organisation of health services.

(c) It would make easier the melding into an harmonious entity the staff of the Hospital Board and the District Office of the Department of Health.

ESTABLISHMENT OF AREA HEALTH DISTRICTS

9. Before tendering advice to the Governor-General who may by Order of Council, declare that the hospital district shall become an Area Health District the Minister must satisfy himself that there has been adequate consultation, planning and preparation for the establishment of an Area Health Board in the proposed Area Health District. The format that is being used in Northland and Nelson, and which was used in Wellington, was to create an Advisory or Steering Committee. As the organisation promoting the formation of the Area Health Board, the Board needs to create a Steering Committee which reports to the Minister on its findings. The Department of Health officials who have been assisting the Board, have recommended that the Board create a Steering Committee, and prior to announcing the Committee, submit the names of the Committee Members to the Minister for approval

MEMBERSHIP OF STEERING COMMITTEE

10. In the other areas where Steering or Advisory Committees have been formed the Principal Officers of the organisations involved have been members of the Committee. In terms of the requirement of the Minister to ensure that there has been adequate -98-

consultation, planning and preparation for the establishment of an Area Health Board in the proposed Area Health District, it is suggested that the Committee Membership consist of members of the Hospital Board and others from names submitted by Hospital Board members, the regions local Members of Parliament, the United Council and the District Office of Health. To ensure objectivity and detachment it is considered advisable that no Principal Officers be members of the Committee, however, they should be used in an advisory capacity. This recognises that the Area Health Boards Act is based on the work already carried out by officials in Northland and Wellington.

11. The Board representatives in their discussions with the Minister of Health on 18 December 194, agreed on a provisional date of 1 October 1985 for the formation of an Area Health Board. The time frame for this is tight and accordingly the membership of the Steering Committee would need to be at a workable size to enable it to undertake the work required in the time specified.

12. It is suggested that Membership of the Steering Committee be five members with two from the Hospital Board, and the balance being selected from the private and voluntary sectors.

13. The officials who will act as advisors will be the Principal Officers of the Lake Alice Hospital, District Office, and the Wanganui Hospital Board, namely the Medical Superintendent of Lake Alice, the Medical Officer of Health, and the Boards three Principal Officers (Chief Executive, Medical Superintendent-in-Chief and Chief Nurse). Other staff of these organisations may be required to assist the Steering Committee from time-to-time.

14. The Wanganui Hospital Board will arrange the servicing of the Steering Committee

TERMS OF REFERENCE OF STEERING COMMITTEE

15. i To ensure that there is adequate community support for the establishment of an Area Health Board.

ii To complete the report to the Minister no later than 1 July 1985.

iii To establish as necessary working parties to consider and investigate specific areas for inclusion in any final report.

• • iv To ensure that all administrative prerequisites are completed in readiness for the target date of 1 October 1985. v To investigate the procedures necessary to ensure the smooth transfer of the Wanganui Hospital Board and the Wanganui District Office of Health into an Area Health Board as set down by the Area Health Boards Act and the Health Services Personnel Act.

vi To establish a system of communication through which organisations in the Wanganui Hospital Board Area can be kept informed of developments and have the opportunity to make submissions to the Steering Committee.

vii To identify any matters as listed in the Area Health Boards Act 1983 and any other matters which require further clarification.

PREPARATION OF DISCUSSION DOCUMENT FOR STEERING COMMITTEE

16. A discussion document needs to be prepared for the Steering Committee which includes the following:

i Background to the Boards request ii Terms of reference of the Steering Committee iii Key issues to be determined in terms of the legislation iv Timetable involved v Key issues requiring further clarification. These are listed below: a. Structure of An Area Health Board

The Act refers to the constitution of an Area Health Board under section 8 and the election and appointment of members under sections 11 - 22. The issues outlined here will need to be considered by the Steering Committee. The key issues are the membership of an Area Health Board in terms of numbers and constituent districts. b. Management Structure and Appointment of Principal Officers

Consideration needs to be given to the form of the management structure in the new organisation.

C. Boundaries

These need to be established and the views of neighbouring Hospital Boards need to be elicited. d. Finance

The Steering Committee in consultation with the Hospital Board and the Department of Health will need to examine the financial issues involved in the -100-

creation of an Area Health Board which includes Lake Alice Hospital. The existence of the maximum security unit at Lake Alice has financial implications in terms of the present method of funding Hospital Boards. e. Personnel

Consideration should be given to personnel issues, bearing in mind however, that industrial matters will be negotiated centrally. The Area Health Boards legislation and Health Service Personnel legislation refers to the rights of trans-ferred employees. f. Legislation

The Steering Committee should prepare a proposal that fits the framework of the Act. The Steering Committee will need to give consideration to the specific difficulties that may be posed if Lake Alice joins an Area Health Board. At the present time there is no legislative frame work for this occurrence and legislation to protect the rights of Lake Alice staff who transfer to an Area Health Board will need to be considered.

Service Development Groups

The Act refers to nine Service Development Groups; these are medicine (other than paediatric, geriatric or psychiatric medicine), surgery, child health, health of the elderly, mental health, dental health, health protection, health promotion, and primary health care.

Under the Act an Area Health Board shall appoint from time-to-time sufficient Service Development Groups. The Steering Committee should give some consideration to the creation of Service Development Groups in the future.

The Service Development Groups are a basis for planning and co-ordination and co-operation with the voluntary organisations in private sector and other public authorities.

h. Transitional Period

Because of the time-frame involved it is not possible to undertake the indepth study that took place in Northland. Key issues need to be determined and where these cannot necessarily be resolved prior to the creation of an Area Health Board, consideration will need to be given to a time-table for any outstanding matters to be resolved.

i. Communication with Communities

There is a need to ensure adequate consultation and information with relevant communities to ensure the Minister of support for an Area Health Board. _101-

3. Regional Planning

Consultation will need to be held with the United Council to look at the inter-relationships between the role of the United Council in regional planning, and the role of an Area Health Board. Consultation is necessary to see where there are common areas of understanding, and for the United Council to understand the legislative responsibilities given to an Area Health Board. k. Education

The role of an Area Health Board in relation to the educational facilities in the area should be examined.

1. Provision of District Health Office Services to the Taumarunui Hospital Board Area

Further consideration will need to be given to this issue and some consultation with the Health Department Head Office and the Taumarunui Hospital Board to identify workable options will be necessary.

M. Maximum Security Unit

The staff working in this Unit have special employment conditions. The Health Department Head Office wishes to retain the right to screen admissions to the Unit. Discussions will need to be held with the Health Department Head Office to clarify admission procedures. It may be necessary for a Working Party to be established with some members being the Boards clinical staff. A further Working Party may be needed to establish the funding of this institution in greater detail. n. Industrial

The industrial matters which need to be resolved are complex. They will be resolved on a National basis with the Health Service Personnel Commission negotiating with the Unions involved. It is likely that there will be some involvement of the Boards Chief Executive in these negoti-ations. It will be necessary to keep all staff informed. The position of the Lake Alice staff in regard to an Area Health Board is unclear, and the Steering Committee will need to give consideration to any possible legislative changes that may be necessary.

RECOMMENDATIONS

i. That a Steering Committee be appointed by the Wanganui Hospital Board consisting of five members and submitted to the Minister of Health for his approval. -102-

2. That the Steering Committee have two representatives from the Wanganui Hospital Board and the balance of representation including the voluntary and private sectors.

3. That the Chairman of the Steering Committee be appointed by the Wanganui Hospital Board.

4. That the terms of reference as outlined in paragraph 15 be approved by the Board as the Terms of Reference for the Committee and submitted to the Minister of Health for his approval.

5. That following receipt of the approval of the Minister of Health to the Steering Committee Members and the Terms of Reference, the Board publicly announce membership of the Steering Committee and its Terms of Reference.

6. That should the Minister seek changes to the composition of the Committee or the Terms of Reference, the Board delegate authority to the Chairman of the Board to make minor modifications to the terms of reference and make changes to Committee membership according to a short list drawn up by the Board.

7. That the Steering Committee be given a deadline of 1 July to complete its report to the Minister of Health with a copy to the Wanganui Hospital Board.

8. That the Health Department be asked to clarify the current position in regard to the status of Lake Alice employees should they transfer to an Area Health Board, and to advise if changes to current legislation are required.

9. That the Board approach the Health Service Personnel Commission to formally request that it investigate the industrial matters involved in an Area Health Board being created on 1 October 1985 in the Wanganui Hospital Board area with Lake Alice included; that the Health Service Personnel Commission assist the Board in resolving all industrial related matters prior to this date.

10. That the Chairman of the. Wanganui Hospital Board and Executive Staff meet with all Wanganui Hospital Board staff to explain the Boards request in wishing to become an Area Health Board and to assume administrative responsibility for Lake Alice. -103-

11. That the Board write to the Unions which have members employed by the Wanganui Hospital Board advising them of the Boards request to the Minister to become an Area Health Board and to assume administrative responsibility for Lake Alice by 1 October 1985, and invite union officials to the staff meetings to be addressed by the Wanganui Hospital Board.

12. That the officials who advise the Steering Committee be the Principal Officers of the Wanganui Hospital Board, the Wanganui District Office of the Health Department and Lake Alice Hospital.

13. That the Wanganui Hospital Board arrange and provide servicing of the Steering Committee.

14. That the Board seek funding for the members of the Steering Committee (fees plus travelling expenses).

15. That the Board seek bridging funds from the Department of Health to provide for additional planning assistance for Area Health Board and Psychiatric Services Planning.

Authors: Mrs B Bourke Chairman Mr 3 Boyack Chief Executive Mrs S Sinail Chief Nurse Dr R England Medical Superin- tendent-in-Chief

(Adopted by Wanganui Hospital Board on 28 February 1985) -104-

TASKS FOR STEERING COMMITTEE

Responsibility Structure

Steering Committee Determine boundaries for Area Health Board Steering Committee Determine appropriateness of having appointed members Steering Committee Determine representation for Area Health Board and constituent areas Steering Committee Consider SDGs and make appropriate recommendations Steering Committee Consider establishment of community committees - one required at Patea Steering Committee Consider committee structure of Area Health Board and make appropriate recommendations

Consultation/Communication

Steering Committee • Establish systems of communication and Advisory Committee publicity Steering Committee • Ensure adequate community support Steering Committee • Consult with Wanganui and Taranaki United Councils Steering Committee • Draw up timetable for consultation with communities Steering Committee • Consult with medical practitioners Advisory Committee • Communicate and consult with unions and staff

Management Steering Committee Advisory Committee Determine management structure

Personnel

Advisory Committee • Contact Minister and Department regarding Lake Alice and Public Service Association receiving official advice Advisory Committee • Contact HSPC regarding need for urgency in negotiations and need for monthly progress reports. Advisory Committee • Identify personnel matters requiring attention Steering Committee • Ensure personnel matters are being dealth with satisfactorily -105-

Finance

Advisory Committee Identify cost of providing District Office services to Taumarunui Advisory Committee Identify cost of running District Office Advisory Committee Identify true cost of running Lake Alice Advisory Committee Negotiate with Department regarding transfer of funds to Area Health Board for District Office and Lake Alice Advisory Committee Determine funding for MSV at Lake Alice

Planning

Steering Committee Consider SDGs and make appropriate recommendations Advisory Committee Chase up planning personnel recommended in background paper Steering Committee Determine relationship of Area Health Board planning to regional health planning of United Councils

Transition

Advisory Committee Consider need for transitional period and the , arrangements required for this Advisory Committee Establish time frame for resolution of outstanding issues

District Office

Advisory Committee • Identify cost of running District Office Advisory Committee • Sort out provision of services at Taumarunui Advisory Committee • Sort out functions of District Office to transfer to Area Health Board and those to remain with Department Advisory Committee • Arrange for continued occupancy of current premises by District Office Advisory Committee • Examine staffing establishment - present and permitted

Lake Alice

Advisory Committee Ensure that necessary legislative matters are being dealt with Advisory Committee Clarify Departments role in MSV admission/discharge procedures Advisory Committee Identify cost of running Lake Alice Advisory Committee Contact Minister and Department regarding Lake Alice and Public Service Association receiving official advice. -106-

Accommodation

Advisory Committee Arrange for continued occupancy of current premises by District Office Advisory Committee Identify accommodation requirements for Area Health Board administration and make appropriate recommendations Advisory Committee Identify accommodation requirements for Area Health Board community health services and make appropriate recom- mendations.

Miscellaneous

Steering Committee • Draw up timetable for achieving targets Advisory Committee • Identify administrative pre-requisites Advisory Committee • Identify procedures necessary for smooth transfer Advisory Committee • Consider situation of one local body (Area Health Board) having supervisory and controlling function over another local body. Steering Committee • Consider role of Area Health Board in relation to educational facilities in area Steering Committee • Ensure that plans exist for health promotion to be given appropriate emphasis Advisory Committee • Identify legal procedures necessary for transfer e.g. gazetting etc.

ki

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AREA HEALTH BOARDS ACT

DIVISION OF RESPONSIBILITY

Steering Committee

5. Establishment of area health districts 8. Constitution of Boards

11. Election of representatives of constituent districts 13. Alteration of representation 14. First election of members 28. Committees 29. Service Development Groups 31. Community Committees 60. Provision for combined institutions or health services 78. Annual estimate of payments and receipts

Advisory Committee

39. Appointment and dismissal of employees 46. Access by teachers and students 60. Provision for combined institutions or health services 78. Annual estimate of payments and receipts

Area Health Board

9. Primary objectives of Boards

10. Functions, duties and powers of Boards 18. Appointed members 19. Disqualification for election or appointment as member of Board 21. Vacation of office of members 22. Filling of extraordinary vacancies 23. Appointment of Chairman 24. Payment of Chairman 25. Deputy Chairman 27. Conduct of meeting 28. Committees 29. Service Development Groups 30. Reports by Committees and Service Development Groups 31. Community committees 33. Boards may regulate procedure 34. Proceedings not invalid because of vacancy 38. Performance and exercise of functions, duties and powers 39. Appointment and dismissal of employees 40. Medical Examination 41. Bonds 42. Superannuation 43. Contracting out of services 44. Board not to enter into agreement contrary to Health Service Personnel Act 1923 45. Opening and closing of institutions and Health Services -108-

46. Access by teachers and students 47. Access by persons conducting research 48. Facilities for training and instruction 49. Access to maternity hospitals and wards by medical practitioners 50. Non-disclosure of medical information 51. Computer systems 52. Duty to furnish information 53. Liability for cost of treatment 54. Contracts for recovery of cost of treatment 55. Contracts for provision of service or relief by other persons 56. Cost of service to injured persons to be charge on damages 57. Power to release persons from contractural obligations 58. Free care of persons donating organs of the body 59. Boards may provide relief 61. Collection of voluntary contributions 63. Liability of Board for negligence 64. By-Laws 66. Application of certain provisions of Transport Act 67. Appointment of special traffic officers 68. Acquisition of land under the Public Works Act, 1981 69. Vesting of Crown Land in Board 70. Sale or disposal of land 71. Dedication of endowment lands for road purposes 72. Leases of land 73. Property vesting in Board 74. Power to accept property in Trust 75. Power to deal with Trust lands 76. Investment of Trust monies 77. Borrowing powers 78. Annual estimate of payments and receipts 79. Grant payable to Board 80. Management of financial affairs 81. Expenditure not otherwise authorised 82. Money to be paid into bank 83. Imprest accounts 84. Application for boards funds 85. Control of expenditure 86. Fees allowances and expenses 87. Accounts to be kept by Board 88. Annual balance in statement 89. Annual Report 92. Contracts 93. Execution of documents 94. Payment without probate 95. Sale of unclaimed personal property

Department of Health

15. Subsequent elections 16. Cost of elections 19. Disqualification for election or appointment as member of Board 20. Ouster of office

22. Filling of extraordinary vacancies -109-

32. Director-General or other officer entitled to attend meetings 35. Duties of Minister 36. Minister and Department may delegate statutory functions to Boards 37. Minister may give direction to Boards 51. Computer systems 52. Duty to furnish information 68. Acquisition of land under the Public Works Act, 1981 69. Vesting of Crown Land in Board 70. Sale or disposal of land 71. Dedication of endowment lands for road purposes

85. Control of expenditure

91. Inspection of institutions

Minister of Health

13. Alteration of representation 14. First election of members 17. Appointment of members in default of election 26. Calling of meetings 35. Duties of Minister 36. Minister and Department may delegate statutory functions to Boards 37. Minister may give directions to Boards

62. Failure of Board to perform its functions and duties

65. Further provisions relating to By-Laws

77. Borrowing powers

85. Control of expenditure

90. Investigations into institutions and services

92. Contracts 96. Regulations 97. Power to rectify omissions or to validate irregularities etc. -110-

LIST OF RESOURCE MATERIAL DISTRIBUTED TO WANGANUI AREA HEALTH BOARD STEERING COMMITTEE MEMBERS

Area Health Board - Wanganui

Draft speech notes "Proposed Wanganui Area Health Board"

An Area Health Board for Wanganui - a proposed new approach to health care - 29.4.85

Paper by P d P Diver on Area Health Boards, March 1985 (prepared initially for Wanganui Hospital Board)

Paper on Wanganui Area Health Board Steering Committee - 26.2.85 (prepared initially for Wanganui Hospital Board)

The Good Health Board Guide (householder pamphlet)

Background to the establishment, of a Wanganui Area Health Board and the establishment of the Wanganui Area Health Board Steering Committee (Paper prepared initially for Wanganui United Council)

Pamphlet "An Area Health Board for Wanganui"

Area Health Boards - Other Areas

Health Service Re-organisation - New Zealands Area Health Boards Act (by Or R Barker)

Circular to Medical Officers of Health from Mr J Martin, Head Office - 26.3.85

Wellington Health Services Advisory Committee Report

Northland Health Services Advisory Committee Report, Volumes 1&2

Achievements of the Northland Shadow Service Development Groups - April 1985

Press release from Northland Hospital Board - 4.6.85

Nelson Health Services Advisory Committee Newsletters

Constitution/representation

Paper on constitution of board

Wanganui Hospital Board present representation -111-

Finance

The overall funding of the Wanganui Health Services: an assessment (by John Boyd)

Interim report on the funding of the Wanganui Area Health Board

Report on the funding of a Wanganui Area Health Board - final report

Management

Co-ordinating Committee report on Area Health Board management structure

Diagram of proposed management structure

Area Health Board management structure proposal (from Wanganui Hospital Board executive staff)

Nursing organisational structure for Area Health Board

Medical administration and planning structure

Proposed Area Health Board management structure (from District Health Office)

Suggested reporting mechanism for community committees and SDGs

Report of Co-ordinating Committee on SDGs and community committees

District Office functions and responsibilities

Division of responsibilities and functions between Area Health Boards and Department of Health Head Office - 14.5.85 (includes draft Gazette notices for Northland)

Transfer of functions to Area Health Boards (includes the detailed description of Whangarei District Office functions)

Clarification of District Office and Head Office responsibilities

Annual report 1984 of the Medical Officer of Health

Annual report 1984 of Principal Inspector of Health

Annual report 1984 of Principal Public Health Nurse

Dental functions in a re-organised health service (with a covering memo dated 21.5.85 from Janet Eden, Head Office) Press Statements and Articles

Waverley newsletter article on Steering Committee, June 1985

Press Statement by Steering Committee - 14.6.85

Northland newspaper clippings from early June concerning decision to become an Area Health Board

Press statements by Chairman of Wanganui Hospital Board - 22.1.85, 25.3.85

Time Out article

Correspondence

Letter to Minister confirming Wanganui Hospital Boards request to become an Area Health Board - 20.12.84

Letter to Nelson Health Services Advisory Committee from Mr J Martin, Head Office - 15.2.85

Taranaki Hospital Board - 30.4.85 (concerning boundaries)

Taumarunui Hospital Board - 1.5.85

Mr R J M Hill, Head Office - 27.5.85 (concerning date of Area Health Board establishment)

Taumarunui Borough Council - 2.5.85

Wanganui County Council - 17.6.85 (notifying support for Area Health Board concept)

Waitotara County Council - 21.6.85 (notifying support for Area Health Board)

District Office functions in the Taumarunui area (departmental memo 20.6.85) attached to Taumarunui Hospital Board letter - 9.5.85

Miscellaneous

Area Health Boards Act 1983

Explanatory notes on Area Health Boards Act 1983 - 7.3.84 (Circular letter Hospital No. 1984/29)

Health Service Personnel Act 1983

Health Service Personnel Act 1983 explanatory notes

Map of Area

Report of Care of the Elderly Shadow Service Development Group

Maori population statistics for Wanganui region. -113-

PERSONAL STATEMENT FROM G NE ILL

While supporting the concept of Area Health Boards I find myself to be at variance with the rest of the Steering Committee on the following points.

I do not believe that we have sufficiently met the terms of reference (particularly items i), iv), v) and vi)

I believe that there should be a resolution of Personnel matters prior to the establishment of an Area Health Board.

I feel some assurance should be sought that there will be no reduction in services without there being a decreased demand for those services.

I believe that the new Area Health Board needs to be an elected board rather than a translation of the Hospital Board.

I would like Community Committees to be able to form themselves and to be guaranteed recognition by the Area Health Board.

I would prefer that any appointments to the Area Health Board were made on the basis of ensuring representation for groups which did not gain sufficient representation through the electoral process, rather than for their expertise.

I believe that one of the appointed positions should be set aside for a Maori representative.

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G H N