1. The New Zealand National Health
Board: home thoughts from abroad
Dr Judith Smith
Head of Policy, The Nuffield Trust, London
22 September 2010

2. Observations on the New Zealand NHB
• This is a small country in population terms
• NZ has managed to craft itself a very complex set of
governance arrangements for the health system
• It is not always easy to work out the lines of performance
management and accountability
• The Ministry of Health was (prior to the recent changes) large
in size for the country’s population
• The Ministry was not subject to the same degree of respect as
its UK cousin

3. Challenges for NZ
• To try and work out what problem the NHB is trying to solve
• Is this about shaking up the Ministry, and removing their
funding and system management role?
• Will it have the courage to enact national decisions about
funding and planning, beyond the locally elected district
health boards?
• How different is the NHB from what went before?
• Is it a staging post on the way to the former Health Funding
Authority (national purchaser) of the late 90s?

4. Challenges posed for the NHS by the NZ
experience
• Beware the risk of creating a new national board within the
same building and using the same staff
• Try and avoid the DH looking like ‘what is left’ or somehow
diminished – needs a clear new role
• Need to be absolutely clear about remit, functions and
specific responsibilities
• Work this out in relation to the remnant DH, GP
commissioners, regulators and others
• Accountability is critical, along with an appropriate degree of
independence

5. Conclusions
• We need to create a narrative for each of the new
organisations – DH and NHSCB
• Organisational development support and investment will be
needed, and yet hard to justify
• A truly independent commissioning board may be the aim,
but the temptation to keep it ‘in house’ and with a line to the
minister, may be too great
• Whilst it is easy to criticise the approach taken by a small
country on the other side of the world, some of the lessons
offered are in fact very real, pertinent and close to home

6. www.nuffield trust.org.uk