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 WELLINGTON
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, New Zealand 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 Committee s deliberations, the Advisory Committee (comprised of the Executive Staff of the District Office, Lake Alice Hospital, and the Wanganui Hospital Board, and the Hospital Board s 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 O Neill 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); Palmerston North.
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 Taumarunui 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 Ohakune Boroughs 1 Waiouru, Taihape Borough, Northern Rangitikei County 1 Southern Rangitikei County 1 Marton and Hunterville 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 Board s 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 Minister s 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 Board s 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 Board s 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 Committee s 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 Board s 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 Mangaweka) 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 Board s 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 Board s 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 Board s 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 Board s 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 Board s 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 Board s 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 Board s 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 Committee s 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 Board s 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 O Neill 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 Women s 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 Women s 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 can t 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 can t? Doesn t an Area Health Board, like any amalgamation, imply a bigger bureaucracy? And therefore won t 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? Aren t 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? Shouldn t the date be delayed intentionally to allow an election? Isn t it just a Hospital Board takeover? Hasn t the decision to establish an Area Health Board already been taken? -71-
Lake Alice Hospital
Why hasn t 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? Wouldn t 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? Aren t public meetings just a matter of going through the motions of consultation? Wouldn t 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)? Won t 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 Officer s 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