The accuracy of District Health Board (DHB) data on the use of consultants and contractors has been questioned by an Otago University research team.
The research team from the University's Centre for Health Systems and Technology includes its Director Professor Robin Gauld, Department of Preventive and Social Medicine Lecturer Dr Erin Penno, and Research Fellow Dr Adeel Akmal.
They recently published their work in the International Journal of Health Policy and Management, titled “Transparency in healthcare reporting: the case of external contractors and consultants in New Zealand's healthcare system”.
The team reviewed the data on the use of consultants and contractors, which was sent by the country's 20 DHBs to the Health Select Committee. They then asked for the same information through an Official Information Act (OIA) request.
One DHB failed to respond to the request, and many of the 19 DHBs that did respond referred to the information that they supplied to the Health Select Committee.
Dr Akmal says there was a range of inconsistencies in the data the group received, and the data provided to the Health Select Committee. He says there shouldn't be any inconsistencies as they were asking for exactly the same thing.
“The data provided by the DHBs isn't easily comparable and can't be used for improvement or any other work. Very few DHBs are providing useful information.
“We recommend that the Health Select Committee reviews its reporting guidelines and create consistency in the data. This will aid in highlighting current issues and future concerns especially going forward with the health reforms towards a single provider system (Health New Zealand).”
The research team recommends that the data provided by the DHBs is made more easily accessible and understandable to the public.
“Long sheets of consultant/contractor names and fees charged don't provide any useful information.”
Dr Akmal says that one of the DHB's response files was uploaded by the Health Select Committee on to the Parliament website with password protection, so no one could view it.
Earlier University of Otago research had shown an increase in spending by DHBs on contractors and consultants from 2012-15, and this new research has highlighted a similar increase, along with additional information by categorising the expenditures.
From 2016-19 DHB spending on consultants and contractors had increased from around $60 million to around $160 million annually in 2019, Dr Akmal says.
Professor Robin Gauld says that their research is just “the tip of the iceberg”. He says that further research is needed into use of consultants and contractors and that improved healthcare reporting is demanded in New Zealand.
Among their legislative obligations, DHBs are required to seek to optimise the efficient and effective delivery of health services and to monitor the delivery and performance of services, whether they are provided by the DHB or contracted out. Funding constraints paralleled by growing demand has seen DHBs facing significant financial pressure, with almost all 20 DHBs reporting a deficit in 2020 and overspending characterised as a chronic feature of the system, Professor Gauld says.
Dr Akmal concludes that a thorough reporting of the health system's use of contractors and consultants is needed, and perhaps a national procurement policy should be designed before the health reforms are concluded.
Recently the Minister of Health Andrew Little announced that interim agencies to replace the DHBs will be set up later in the year and legislation will be passed in July next year to make the new entities fully operational in September 2022.
Transparency in Healthcare Reporting: The Case of External Contractors and Consultants in New Zealand's Healthcare System
International Journal of Health Policy and Management
For further information, contact:
Dr Adeel Akmal
Centre for Health Systems and Technology
University of Otago
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