In the South Island health services implementation plan, the boards acknowledge previous arrangements for working together "are generally acknowledged not to have worked as well as they could have".
The boards' failure to reach agreement over neurosurgery services in the South Island, after several years of deliberation, meant that dispute was taken to the Director-general of Health and an expert panel was subsequently appointed to sort out the matter last year.
The recently signed alliance agreement, similar in some ways to that drawn up for the old Southland and Otago boards when they were working together before their merger, emphasises consensus decision-making on the basis of "best for patient, best for system".
In the alliance agreement, the boards agree that "we will have a robust airing of views, but that once our team has reached a decision we will all abide by that decision and support it publicly".
This included keeping confidential the views of, particularly, individuals expressed during discussion, but did not prevent sharing of issues that were balanced in reaching that decision.
The agreement also acknowledges there may be times when a board might wish to be fully or partially excluded from alliance activities.
Boards would have that option before an activity commenced and, if they wanted to exercise that right, were expected to consult first and do so in good faith.
The alliance agreement says if members do not act in accordance with principles and commitments, the situation will be collectively discussed and an "appropriate resolution" sought.
If no resolution could be found, then "depending on the magnitude of the issue, this may jeopardise the existence" of the alliance.
If that arose, the alliance governance board, consisting of the board chairpersons, would address the issue and "determine the pathway forward".
Asked if the lack of a set way of dealing with disputes could be problematic, Southern District Health Board acting chief executive Lexie O'Shea said by email that the alliance principles provided a "very clear approach with the decision-making principles available as a fallback position, should the need arise".
She saw the strength of the alliance as the commitment of all the DHBs from the boards down to work on a "principles approach" to decision-making.
Commenting generally about regional collaboration, Mrs O'Shea said there was already increased activity and commitment from staff towards regional planning under the new arrangement.
Focus on a select number of areas had ensured resources could be assigned to give the programmes momentum.
The implementation plan said the aim of the alliance was to create a high-trust, low-bureaucracy environment. It also places emphasis on clinical leadership.
At the Southern DHB meeting this month, chairman Joe Butterfield said the alliance agreement wording had not been reached without a "great deal of difficulty" and had taken much "hammering out" among the chairpersons and the chief executives.
He noted there was a requirement, under recent amendments to the law, for boards to collaborate regionally.
The country is divided into four regions: the South Island, Central, Midland and Northern.
The areas the alliance is working on this year are cancer, child health, health of older people, procurement, and information technology.
Each of these areas has a lead chief executive, and five have clinical leaders, two of them from Southern DHB.
Southern DHB oncologist Dr Shaun Costello leads the cancer services regional alliance while internal medicine specialist Dr Andrew Bowers is the clinical leader for the information technology alliance.
The plan
South Island regional health services plan. Work for this financial year includes:Cancer services Developing a South Island blood and cancer service plan.
• Improving South Island cancer information system.
• Developing a 10-year plan for radiation oncology.
• Improving access, waiting times for lung, bowel cancer patients.
Child health
• Evaluating South Island data to assess health status of young people.
• Improving co-ordination of services for children.
• Developing an early warning protocol to improve assessment of unwell children.
• Encouraging greater collaboration between members of the paediatric workforce and shared training.
Older people's health
• Developing a common approach for community services.
• Standardising eligibility criteria and processes for entry to services.
• Improving skills for those working with dementia patients.
Mental health
• Supporting improved community care for mothers and babies.
• Shortening the waiting time for eating-disorder treatment.
• Improving education for medical detoxification.
• Supporting Odyssey House (Christchurch) to define roles and responsibilities for child and youth alcohol and other drug (AOD) residential services.
• Improving collaboration between services over child and youth AOD services.
• Developing more standardised approach to forensic mental health services for more consistent access to services.
Information technology
• Ensuring IT developments appropriately link DHBs and other clinical networks.
• Increasing the sharing of information.
• Improving cancer information data and sharing.
The issues
What problems is plan trying to solve?
• Catering for an extra 96,205 people in the South Island by 2026.
• The rapidly ageing population pushing up demand for services including hospital and aged-care beds.
• Increasing inequalities in health status and outcomes because of differing access to treatment across the island.
• Keeping services clinically sustainable when some small specialties struggle with low patient numbers, difficulty attracting clinicians and keeping equipment up to date.
• Financial sustainability with health care costs increasing faster than funding.
• Ensuring capital expenditure proposals take into account regional planning.
• Non-standardised patient information held in disconnected electronic and paper systems - the DHBs alone have seven different patient-management systems.
