Health boards could be stuffed with political flunkeys if a proposed shake-up goes ahead.
That is the call from a former Waikato District Health Board member who admits he landed an earlier public health role thanks to his high level contacts.
The Health and Disability System review, released yesterday, recommends slashing the number of district health boards in New Zealand to as few as eight and do-away with DHB elections, opting instead for the minister of health to appoint board members.
The proposal is prompting fears that any ruling government would fill the boards with favourites and stooges.
Dave Macpherson was first appointed to Health Waikato Limited without election, before it was replaced by the Waikato District Health Board, when he did stand for election, successfully.
He doesn't want a return to political patronage.
"At the time I was actually working for the deputy prime minister's office, which wasn't necessarily a good claim to fame," he said.
"You could even say I was a political hack at that time - I was appointed because of who I knew not because of what I knew, and that's a bit of a concern with these systems."
The entire Waikato District Health Board, including Macpherson, was sacked in 2019 because of deteriorating finances and a scandal over unauthorised spending by the chief executive.
Despite that direct experience, he still believes elections are better than the alternative.
"I mean that's democracy - elections throw up strange people. There's some strange people in Parliament at the moment but, you know, no system is perfect."
Former Green Party health spokesperson Sue Kedgley, who now sits on the Capital and Coast DHB, agreed that it would be a mistake to get rid of elected DHB positions.
"It would mean that all boards were comprised of politically appointed members who were there to carry out the instructions of the minister," she said.
"My concern is that there'd be less independence, less questioning and less challenging of the political ideology of the day."
The review concludes that DHB elections aren't the best way to ensure boards are able to govern effectively, preferring a competency-based approach to identify and recruit members.
Minister of Health David Clark told Checkpoint yesterday that getting rid of elections would actually create additional accountability.
"The feedback that I've had very clearly from across the sector is that they want professional governance and we all want to see healthcare continue to improve for our citizens and also for the sector to remain in financial balance."
Association of Salaried Medical Specialists executive director Sarah Dalton said the jury was still out on whether DHB elections should stay or go.
"On the surface, it sounds like trying to take away democratic input, but as we know there's very low turnout for DHB elections already. It's not well understood I don't think."
The government says the Cabinet has accepted the direction of the review and the need for reform.