The document discusses the New Zealand National Health Board and draws comparisons to reforms being considered in the UK National Health Service. It makes the following key points: 1) New Zealand has crafted complex governance arrangements for its health system despite its small population. 2) It is unclear what problem the National Health Board is intended to solve and whether it will make courageous national decisions about funding and planning. 3) Reforms in the UK should avoid simply creating a new board within the existing structure and using the same staff, and should make accountability and responsibilities absolutely clear.

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