KEY POINTS:
Health Minister David Cunliffe seems an imperious character, declaring himself in charge the first day he faced parliamentary questions. He has proved himself more than ready to intervene in the affairs of district health boards, even wading rather foolishly into their current industrial dispute with senior doctors.
He has already replaced the leading members of one board, Wellington's Capital & Coast Health, and this week he dismissed the Hawkes Bay board for reasons he has not made entirely clear. One of them seems to be the board's criticisms of him.
Whatever the Hawkes Bay board's faults, it clearly enjoys the confidence of the district and its doctors despite an accusation of a member's conflict of interest over a multimillion-dollar tender process. Local mayors have sent a letter in support of the board and even a group who took the board to court over the sale of Napier Hospital have said they do not want a commissioner appointed in its place.
Unmoved, Mr Cunliffe has done exactly that, dismissing the board elected just four months ago, explaining to Parliament last week that he was ignoring the mayors' plea because, "I care more about the health-care standards of the people of Hawkes Bay than I do about local politics".
In that case the honest course for his Government would be to abandon the whole pretence that health services are run by locally elected boards.
If the minister and his advisers believe they care more for the health service standards of a district than those elected to represent it, let the ministry manage the lot and let the minister answer for them.
If that were to happen, not much would change.
District boards function entirely on funds allocated by the ministry and their spending priorities are largely dictated from Wellington. The boards exist to lend a semblance of local democracy to the vexed business of running health services but they are not very successful even as political devices.
Their elections, appended to the ballot for councils and other local bodies, usually attract a lower vote than the others, partly because their seats are allocated by a complicated system of proportional representation but principally because voters are asked to make a selection beyond their competence.
Voters expect Governments to appoint administrators of a public service and account to voters for the appointees' performance.
The Government's real purpose in setting up elected health boards had less to do with local democracy than giving itself a buffer against voters' discontent.
Health is the most contentious of state services because no matter how much is spent it can never satisfy the demand for free healthcare.
Medicine and other health-enhancing industries have an infinite capacity to improve their products and services at ever-increasing cost to the taxpayer.
The Government is answerable to voters for both taxation and standards of service. It passes the buck to district boards by giving them a fixed budget and demanding impeccable standards of service.
When some aspect of their service arouses public discontent, the minister can intervene, posing as a popular white knight, and over-rule the hapless board.
If it does not comply with his directives, or even criticise them, he can replace the board with a commissioner.
Mr Cunliffe says he has acted over the board's predicted $7.7 million deficit for this year, "dysfunctional" relationships between the board and its managers and his belief the board was challenging him through the media.
The last mentioned is no reason for dismissal, it is the sound of a minister too self-important for our confidence.
