The New Zealand Health Strategy

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Date of publication: December 2000This is the full text online version of this document. You can also download this publication in PDF format.

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Appendix 3:
Communities and Consultation

The elected membership of District Health Boards will help ensure democratic participation in the decision-making process.

However, this is not a substitute for community, consumer and provider involvement and participation in decision-making through other mechanisms. District Health Boards will establish consultation processes whereby providers and users of services, and the community, will be able to have input into major decisions taken by the Boards.

Consultation should include those who provide or use the services that could be changed as the result of a decision.

It is a process by which an organisation, such as the District Health Boards or the Ministry of Health, encourages feedback from a range of people such as providers, health care users and the general public on a proposal it is considering. It then considers that information, along with other information, in the process of making a final decision.

Although formal consultation is usually only carried out for a small range of issues, there is also a need for the District Health Boards to be open to responses from individuals and groups who are concerned about issues that may affect them. District Health Boards will develop methods of ensuring that this more informal consultation takes place freely, including:

• establishing a system to ensure the availability of useful and timely information on the Board’s processes and decisions

• ensuring Board members and ‘liaison’ staff are available to respond to issues

• encouraging community health groups that will in turn have an established feedback loop with the Board.

Legal understandings of consultation

In the landmark case of Wellington International Airport Limited v Air New Zealand in 1993, the concept of consultation was discussed by the Court of Appeal. The principles or elements of consultation identified by the Court have been widely accepted as defining consultation. Those principles are:

• consultation is a process of seeking the views of others

• consultation is not equivalent to merely providing information, nor is it equivalent to negotiation (consultation may occur without those consulted agreeing with the outcome as implied in negotiation)

• consultation includes listening to what others have to say and considering the responses

• the consultation process must be genuine and not a sham (a decision should properly be seen as having been made after consultation)

• sufficient time for consultation must be allowed

• the party obliged to consult must keep an open mind and be ready to change and even start afresh, although it is entitled to have a work plan already in its mind

• consultation is the statement of a proposal not yet fully decided on.

District Health Boards’ obligations to consult

The New Zealand Public Health and Disability Act requires District Health Boards to consult their resident populations on the significant aspects of district strategic plans before determining or amending those plans.

Strategic plans have a five to 10 year focus and should be reviewed at least once every three years. District Health Boards may amend or replace their district strategic plan at any time.

The Ministry of Health will be responsible for consulting on issues of national significance when it is important to identify the national direction and priorities (for example, the New Zealand Health Strategy). District Health Boards’ strategic plans will have to be consistent with the New Zealand Health Strategy and the New Zealand Disability Strategy.

District Health Boards will be expected to consult on their strategic plans, when:

• initiating significant new policies, services or plans

• making significant changes to existing policies, services or plans

• establishing local priorities, within the context of national priorities set by the Ministry of Health

• significantly changing the range or type of services, or access to them

• proposing significant changes in methods of funding.

District Health Boards may create legitimate expectations that go beyond the requirement to consult on the strategic plan. An established practice about consultation, or specific promises about who will be consulted or what will be the subject of consultation, may create legitimate expectations that are enforceable.

The New Zealand Health Strategy signals the Government’s intention that guidelines be developed for consultation in the health sector. District Health Boards will be expected to participate in developing those guidelines. The guidelines will have a more detailed operational focus and will be consistent with the overarching obligations included in the operational policy framework.

District Health Boards’ obligations to consult with Maori

District Health Boards have particular responsibilities to ensure the participation of Māori in decision making on health issues and the delivery of health services. They will therefore have the obligation to ensure Māori have an opportunity to participate in the discussion about the strategic plan.

It is inherent in the Boards’ duty to act in good faith that the Crown is obliged to make informed decisions in its dealings with Māori. While this does not extend to an absolute duty to consult, it has been accepted that the requirement to act in good faith frequently requires the Government to consult with Māori on issues of major importance.

District Health Boards’ functions, as set out in the New Zealand Public Health and Disability Act include:

• establishing and maintaining processes to enable Māori to participate in, and contribute to, strategies for Māori health improvement

• continuing to foster the development of Māori capacity to participate in the health and disability sector and for providing for Māori needs

• providing relevant information to Māori for the purposes of the two points above.

The implication of these functions is that District Health Boards have quite specific obligations to consult with Māori when planning strategies that contribute to health improvement for Māori.



Why consult?

The involvement of consumers, communities and providers in strategy or programme development contributes to the development of good public policy. Consultation helps organisations to:

• gain the full picture: understand and identify different communities’ needs and priorities

• be accountable: from those who design and provide services to those who use them

• be acceptable: fostering development of solutions that are acceptable

• ensure that consumers’ rights are upheld

• ensure provider, community and consumer input is valued and takes advantage of a range of expertise

• provide opportunities for communities (geographical and professional, and communities with common interests) to participate in the development of policy and strategic directions and to test new ideas

• enhance decision-making by receiving information, opinions and ideas as well as feedback from communities which helps identify and avoid pitfalls

• build positive relationships with consumers, providers and the wider community, encouraging co-operation, understanding, respect and support

• build consensus by encouraging understanding of issues and problems and encouraging other organisations or people (for example, health providers) to take appropriate coordinated action to solve those problems

• build better, sustainable decisions and therefore save time and money.

Consultation is also important for those who are affected by the decisions taken. It:

• develops a sense of partnership in the decisions that are made

• leads to collaboration by fostering shared ownership of solutions to problems

• gives a shared understanding of the decision-making process and of the decisions that are reached, even where some members of the community do not agree with these.

What to consult on

The topics to be consulted on will be determined by legislation or Ministers, by the Ministry of Health or District Health Boards, or may arise from widespread concern about an issue.

The choice of some issues will be clear-cut: for example, decisions that may substantially change the delivery of services or the development of new guidelines. There will also be a need to develop mechanisms whereby consumers and the general public can raise topics for consultation with the District Health Boards and the Ministry of Health.

Who should be consulted?

In many ways the mechanics of consultation – who to involve, the specific issues to be discussed, when people should be consulted and the resources to be allocated to consultation – are determined by the subject to be discussed. For instance, a consultation on delivering services to people with multiple sclerosis will probably focus on people with the condition and their providers and carers and will be relatively focused and small scale.

A consultation on an issue that has implications for large numbers of the community, such as prioritising services, will require a much wider consultation and therefore different methods. People it may be appropriate to consult in the health sector include:

• members of Māori communities

• Pacific peoples

• patients/users of health services (for example, youth, mental health services users)

• caregivers and family/whanau members

• health care providers

• other sectors (for example, local or central government agencies)

• representatives from community and consumer groups

• other members of the general public

• non-governmental organisations providing health services

• experts in specific areas.

It is important that any consultation should include consultation methods that can reach those members of the community who may not be able to attend public meetings, make written submissions or may not feel comfortable doing so.

These may include rural people, Māori and Pacific peoples, people with disabilities and older people or young families.

It is important that the consultation methods used with these groups should be acceptable and practicable. For example, those organising rural consultations need to consider the effect of distance on people’s ability to attend meetings. Language may be an issue.

Assistance with consulting other groups is available from several sources.

Te Puni Kökiri provides advice on consulting with Māori and has a set of guidelines, ‘A Guide for Departments on Consultation With Iwi’, available.

The Ministry of Pacific Affairs provides advice on consulting Pacific peoples and has a set of guidelines, ‘Pacific Consultation Guidelines’, available.

The Ministry of Women’s Affairs can advise on consultation with women. Contact with other groups such as refugees or Asians can usually be organised through initial contact with provider and consumer groups. The Ministry of Health can usually advise if needed.

Problems and solutions

There have been concerns expressed about consultation recently, including:

• a concern that despite consultation, the consulting agency is unwilling to change its intentions as a result of submissions

• a feeling that there is a lack of logic to the increasing range of subjects that are consulted on that results in some people feeling they are being over-consulted

• a concern that not enough time is given for compiling and presenting submissions

• lack of feedback about the final decisions taken and the reasons for these decisions.

Ways of responding to these concerns have been offered, including:

• the agency has the right attitude – accepting consultation as good management practice rather than a compliance requirement

• clearly describing the context for the consultation

• giving a clear indication of what the effects of the consultation will be

• actively promoting public awareness and interest in the consultation, including giving adequate notice of meetings and deadlines for submissions (normally one to three months)

• where there is a tight time frame for responding, it is important that a very proactive media strategy is adopted

• providing accessible materials (leaflets, documents) that are presented attractively, are in plain English (or other languages where appropriate) and are easy to follow

• distributing the information widely through a variety of venues and channels, including relevant networks

• identifying clear method(s) for making a submission

• providing good feedback on the decisions made and the reasons for them