Chief executives and chairs of the country's 20 district health boards are meeting today to discuss a proposal to overhaul their governance, Radio New Zealand understands.

A leaked document shows the Government plans a major overhaul to the governance of DHBs, possibly requiring new legislation.

The document is part of a series of reviews of the health sector put in place when new Director-General of Health Chai Chuah was confirmed in the role permanently in March.

Photo: RNZ / Alexander Robertson

The proposal has come out of the Director-General's office, and would reduce the number of DHB members and have two-thirds appointed by the Minister of Health.

Health Minister Jonathan Coleman said he had not yet read the review, and told Morning Report it was a third party report and not yet government policy.

"I'd have to consider it in a wider context, but changes to DHB governance are not top of my list - I think it's pretty unlikely."

"This is a long way from being government policy."

He said democracy was important around the running of DHBs.

Plan to cut elected board members

At present most DHBs have 11 members, seven elected at local government elections and four appointed by the Minister of Health.

The proposed changes include reducing the number of board members to nine - six of which would be appointed by the minister.

The remaining three members would be drawn from a new community advisory board, but would only spend six month terms on the actual board.

The leaked document also shows the Director-General of Health would be involved in setting the criteria for part of the incentive chief executives get paid, and in assessing whether the chief executives get paid that part of the incentive.

Under the Public Health and Disability Act, the terms and conditions of the appointment of a chief executive are set by the board, and cannot be finalised without the consent from State Services Commission.

Photo: Supplied

Mr Chuah said a decision to overhaul the governance of District Health Boards has not been made and the proposal is just part of a review.

He said the reviews were for his consideration and no decision has been made on the recommendations.

Labour health spokesperson Annette King said the Government was trying to sneak through changes to the health system and she she did not believe that the report had not been seen by the minister.

"I do not believe the minister was unaware of what went out, and if he is unaware, he's incompetent."

She said the move was a major push to centralise the control of health into the Director General's office.

"The recommendations, apart from reducing the size of District Health Boards, are also looking to get rid of some of the structures that are in place like the National Health Board and so on.

"The bigger concern to me is this is a very sneaky move to take away democracy from District Health Boards by having the majority of members appointed by the Minister, so the Minister's stooges become those that make the decisions in the community, and not the majority community members as it now is."

She said it would be a major change to the way things were run, and therefore should have been put to the public.

Political commentator Colin James said the move in effect really made the six minister-appointed members commissioners.

"The board becomes in effect a commission, with a token local representation, except to the extent that some of the appointees obviously would be local, they'd still be at the Minister's bidding, so this would be quite intrusive and it would be quite a big step to drive through what the Government wants done by the boards."

Ian Powell, who heads senior doctors' union the Associaton of Medical Specialists, said the proposal was Stalinist and did not address key issues boards face; leadership, funding pressures and workforce shortages.

"They are the challenges. People who tend to focus on changing a structure tend to be ignoring the real problem."

He said the current DHB model was based on defined populations and stood up well to international comparisons.

It is likely that should the changes go ahead they would require a change to the law.