Yesterday Health Minister Tony Ryall published the first district health board league tables. Officially known as the 'Health Targets', the first quarter report shows how each DHB is performing with respect to the six Government determined health targets.

These targets are improving access to elective surgery; improving immunisation coverage; reducing cancer waiting times; reducing avoidable hospital admissions; improving diabetes and cardiovascular services; improving mental health services; and improving nutrition, increasing physical activity and reducing obesity.

In a blog over the weekend regarding American actor Jon Voight's outburst against our health system, I remarked that it was a good thing that our public health system is held accountable for its performance. However, I am not in favour of a league table approach for a whole host of reasons.

Firstly, it prioritises competition between DHBs rather than the collaboration demanded under the Public Health and Disability Act. The sharing of best practice knowledge and staff between DHBs could be impeded if they are instructed (as I fear they will be) to take a more competitive approach to improving performance.

Secondly, the setting up of a league table system could possibly presage a change in the formula used to calculate health funding. Currently, funding is allocated according to a population based model that, in my view, is not the best as while it might favour heavily populated regions who need additional funding, it also takes away funding from predominantly rural regions like Otago where the population is more dispersed. For example, the Otago DHB has been classed as being 'overfunded' and has been subject to a sinking lid policy since about 2003 when the PBF model came in. Now I fear that National will go one step further and introduce a more market driven model. This might be one where DHBs are given extra funding for meeting a set number of targets and, conversely, less funding if they don't. In other words, DHBs might be treated as mere health businesses whose funding would be performance based rather than needs based. Furthermore, 'failing' health boards could be merged with 'successful' health boards. A similar model has been used in the UK education system in recent years and with disastrous consequences, particularly for schools in low income communities.

Thirdly, league tables will not take account of the differing nature of various regions. For example, the three Auckland health boards (Waitemata, Counties-Manukau and Auckland) have larger populations and might find it difficult to meet some targets including the need to reduce avoidable hospitalisations. This might be the case as more people in a large centre like Auckland would need to wait longer for emergency department admission than someone in Invercargill. The Lakes DHB, which has the worst immunisation coverage in the country, has a high Maori population who generally have poor health status. Fourthly, the Government has already committed some own goals in respect of other crucial targets. For example, the goals to improve diabetes and cardiovascular services and that of improving nutrition, increasing physical activity and reducing obesity, all sound fine enough. But when the National Government permits retailers to continue with 'power wall' displays of tobacco products, ends the ban on junk food in school canteens and cuts funding for sports programmes in rural schools, then how can these public health goals be achieved? Moreover, how can public hospitals be expected to deliver increased surgery volumes when many health boards are facing funding constraints?  That's why Tony Ryall is heading for a fall.

After all this criticism, what would be my solution? Well, Labour actually had a fairly good system of national health targets reporting which looked at the total picture across New Zealand. While DHB performance figures were published, they weren't lined up against one another as is so cynically the case with Ryall's league tables. As I have mentioned above, different regions have different population and service mixes and the previous reporting system took account of this through taking a unitary approach.

I say that there is a need to scrap the league table based approach to health reporting. The potential is there for it to undermine already low health service staff morale. The tables could be the first real indication too that Tony Ryall is serious about taking us back down the health privatisation pathway.

That's why we do need accountability but not league tables.