4 DHB

Feature Article: Focus on Health

It's timely to turn towards our legal community in Health and check-in on how they are faring. We asked about their biggest challenges in the last 18 months, and how they are feeling connected or inspired at this time.

Pictured left to right: Karen Billinghurst, Southern District Health Board; Carolyn Gardner, Waikato District Health Board; Melanie Naulls, Hutt Valley District Health Board; and Bruce Northey, Auckland District Health Board.

Karen Billinghurst - Southern District Health Board

Can you tell us about the challenges that have faced the in-house legal function in the past 18 months?

I am in a sole role so the usual day to day challenge is keeping on top of things, across a varied portfolio such as: building & property work, contracts & procurement, privacy & official information, disputes, medico-legal advice, public health, resource management, and interacting with agencies such as the Police, The Royal Commission (abuse in care), Oranga Tamariki, Office of the Privacy Commissioner, Office of the Ombudsman, The Health & Disability Commissioner, plus external lawyers, and so on. I triage my work and plan my day, but have learned to expect interruptions at any time, especially from patient-facing staff seeking on-the-spot advice and who I always prioritise. It can feel a bit like working in the ED – there’s always a full workload but then something more urgent comes in that takes priority and bumps everything down the list. I’m a lot more “match fit” for the role and used to it now that I’ve been here 2.5 years. I’m pretty organised and resilient and use simple processes like calendar reminders to keep up to date. I check in with the CEO’s EA every day too. I manage two part-time people (Privacy Officer; OIA Coordinator) and by the nature of our work we catch up daily. This is the most purposeful role I’ve ever had with the greatest breadth and variety (no 2 days the same) – there seems to be no end to my learning on the job and helping people. I feel it’s a privilege and responsibility to work for the DHB and be part of the small group of DHB lawyers around NZ.

How are you and the team staying well and connected at this time?

In lockdown, we continue to have our Monday morning catch up by Teams with our manager. This is loosely structured around work and any issues, plus sharing information including news or LinkedIn articles (privacy is often a feature). Our manager shares things from the Exec team meetings and the Finance Audit Risk meetings she attends. In the office we’re closely located to each other so can pop in and out of offices to catch up, connect and go for coffee etc. We have good trust and flexibility in our team, knowing we’re humans with “life” happening so if we need to disappear or work from home, we can. We’re all in sole roles and no one else does our work, so we’re motivated to keep on top of things and find ways to be efficient and smart in how we manage our work, however we need to do that. Sole roles can present challenges when we take leave but so far, the wheels haven’t fallen off and the worst seems to be coming back to a large inbox.


Carolyn Gardner - Waikato District Health Board

Can you tell us about the challenges that have faced the in-house legal function in the past 18 months? 

Waikato DHB is a client with a diversity of legal work and there is never a dull working day for our small legal team. With the constantly changing landscape and wide range of challenges continually arising, our legal team has needed a high degree of resilience and ability to perform under pressure. Maintaining solid relationships both within the DHB and across the wider network has been even more essential when working in this environment, as is a sense of humour!

What have you seen across the health profession that you have been inspired by?

I have been inspired by our health professionals and the support teams working together with a high degree of professionalism in extraordinarily challenging circumstances to ensure that our people receive the best healthcare possible.


Melanie Naulls - Hutt Valley District Health Board

Can you tell us about the challenges that have faced the in-house legal function in the past 18 months? 

As the sole Legal Counsel at Hutt Valley DHB, I provide the in-house legal services to Hutt Hospital. This is a new role for the DHB. Prior to July all legal services had been provided by external legal providers. This is an extremely varied role, providing legal support to all operational and business units within the hospital, from assisting front line medical staff with issues around consent, privacy or duty of care to dealing with contracts for medical equipment. Often there are a lot of plates to keep in the air and I need to have gazelle-like agility to bounce between different, and sometimes novel, areas of the law, all within the same hour. As this new role is also somewhat of a start-up, it is, simultaneously, requiring selling to the business the need for an in-house legal function. This is all a work in progress but so far the presence of an on-tap lawyer seems to have been met with a lot of appreciation. Whether in times of health crisis or BAU, the work of a sole in-house lawyer in a DHB is constantly demanding and never dull.  

What have you seen across the health profession that you have been inspired by?

Two things stand out to me here. First, is the efforts that were undertaken by the specialist medical and management teams at Hutt Hospital, as a regional burns unit, to deal with the victims of the Whakaari/ White Island eruption. The round-the-clock effort needed to manage a trauma crisis of that nature and the challenges faced was remarkable. I have learned a lot about the work that was undertaken by the hospital during that time through work I am now doing for the Coroner’s Office. There are many moments in my job where I see some of the unpleasant aspects of working as a frontline healthcare worker. I am always inspired by those whose compassion or dedication to provide quality care governs their approach to these challenges. I know that wouldn't always be easy. Now, working within a hospital setting during this current COVID event, I have seen first-hand the efforts that are needed to continue to run a hospital through a health crisis, to keep both patients and staff safe. There is no ability to just close the doors and work from home as can be done with some other businesses. I am never required to carry out my work through layers of PPE and cumbersome masks and face shields. I am very glad of that.


Bruce Northey - Auckland District Health Board

Can you tell us about the challenges that have faced the in-house legal function in the past 18 months?

The last 18 months have been BAU for healthcare – mothers gave birth; a million patients received care; thousands died; privacy was breached from time-to-time in communicating with thousands of patients; some people complained about one or more of the forgoing and the Coroner investigated the deaths; billions was spent on procuring services, equipment and consumables, a small portion of this being PPE; privacy impact assessments for use of patient information held within clinical system became the new norm; Official Information Act requests came every day; thousands of patients requested copies of their clinical records; and treatment orders were sought from time to time. A new feature of BAU will take effect later this year when the End of Life Choice Act comes into effect, making provision of assistance to die for those suffering from a terminal illness a publicly funded alternative to medical treatments.

Auckland DHB was near the operational epicentre of COVID management, with the Auckland Public Health Service residing in the building next door to Legal Services at Greenlane. We thus worked with Medical Officers of Health and Health Legal in Wellington on ensuring contact tracing. Transfers of suspected or actual COVID positive individuals to MIQ occurred in compliance with the Privacy Act and otherwise lawfully and discovered that diplomatic immunity has a very practical application to COVID. In addition, a separate function was required to manage OIA requests regarding COVID, utilising national consultation between DHBs and the Ministry. The same approach was used to address the numerous privacy related issues that arose within the COVID response and the numerous IT systems implemented to manage individual COVID activities.

How are you and the team staying well and connected at this time?

The Legal Services team of five at Auckland DHB are all collocated in offices at Greenlane, so when at L2 or below staying well connected was straightforward, and there are several coffee providers on-site. At L3 and above, all members were able to operate from home, with some more affected by school age children or flatmates than other, older members. Provision of laptops for the home office was given priority by Auckland DHB, the only issue was thus transferring additional screens to those offices. Regular daily or thrice weekly Zoom calls keep everyone in contact; you could almost smell the home baking. These were also a reason for some to dress up out of a T-shirt and exercise gear.