Transparency in Healthcare Reporting: The Case of External Contractors and Consultants in New Zealand’s Healthcare System

Document Type : Short Communication


1 Centre for Health Systems and Technology, Otago Business School, University of Otago, Dunedin, New Zealand

2 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand


This study investigates the quality of reporting around the spending related to the use of external consultant and contractors in New Zealand’s 20 District Health Boards (DHBs). We make use of the publicly available annual reviews conducted by the New Zealand Parliament Health Select Committee (HSC) as well as DHB data which were retrieved using Official Information Act (OIA) requests. The quality of reporting was judged on the differences and discrepancies observed in the HSC reports each year as well as the DHB internal data. Perhaps, unsurprisingly, total spending on external consultants and contractors has been increasing over the years while the quality of reporting has been decreasing. Our analysis highlighted a number of quality issues—mistakes, discrepancies and an overall lack of standardised reporting in almost all of the DHBs. Some of these discrepancies included failure to provide information required by the HSC, differences in yearly total amounts in consecutive reports and differences between information provided to the HSC and to the authors of this article. It is hoped that this research and the prospective areas for improvement highlighted here are used as a guide to improve the quality of healthcare financial reporting.


  1. Hood C. A public management for all seasons? Public Adm. 1991;69(1):3-19. doi:10.1111/j.1467-9299.1991.tb00779.x
  2. Boston J, Martin J, Pallot J, Walsh P. Public Management: The New Zealand Model. USA: Oxford University Press; 1996.
  3. Gauld R. The New Health Policy. London: McGraw-Hill Education (UK); 2009.
  4. Penno E, Gauld R. The role, costs and value for money of external consultancies in the health sector: a study of New Zealand's District Health Boards. Health Policy. 2017;121(4):458-467. doi:10.1016/j.healthpol.2017.02.005
  5. Oliver D. Exclusive: government spending on management consultants trebles in three years. BMJ. 2019;366:l5404. doi:10.1136/bmj.l5404
  6. Skouteris H, Kirkpatrick I, Currie G, Braithwaite J, Teede H. Are external management consultancies effective in healthcare improvement, do they reflect value for money and what are the alternative models? Intern Med J. 2019;49(11):1451-1455. doi:10.1111/imj.14634
  7. Kirkpatrick I, Lonsdale C, Neogy I. Management Consulting in Health Care. Oxford, UK: Oxford University Press; 2016.
  8. Ylönen M, Kuusela H. Consultocracy and its discontents: a critical typology and a call for a research agenda. Governance. 2019;32(2):241-258. doi:10.1111/gove.12369
  9. Kirkpatrick I, Sturdy AJ, Alvarado NR, Blanco-Oliver A, Veronesi G. The impact of management consultants on public service efficiency. Policy Polit. 2019;47(1):77-96. doi:10.1332/030557318x15167881150799
  10. Limb M. No evidence that employing management consultants improves efficiency in NHS. BMJ. 2018;360:k893. doi:10.1136/bmj.k893
  11. Naylor C, Goodwin N. The use of external consultants by NHS commissioners in England: what lessons can be drawn for GP commissioning? J Health Serv Res Policy. 2011;16(3):153-160. doi:10.1258/jhsrp.2010.010081
  12. Iacobucci G. Sixty seconds on . . . management consultants. BMJ. 2020;370:m3310. doi:10.1136/bmj.m3310
  13. McLachlin RD. Factors for consulting engagement success. Management Decision. 1999;37(5):394-404. doi:10.1108/00251749910274162
  14. Wye L, Brangan E, Cameron A, et al. What do external consultants from private and not-for-profit companies offer healthcare commissioners? a qualitative study of knowledge exchange. BMJ Open. 2015;5(2):e006558. doi:10.1136/bmjopen-2014-006558
  15. Adebajo A. The role of service design consultancy in public sector: inferences from KIBS and service innovation perspectives. Paper presented at: ServDes2018 - Service Design Proof of Concept; June 18-20, 2018; Milano, Italy.
  16. Oliver D. Stop wasting taxpayers' money on management consultancy for the NHS. BMJ. 2014;349:g7243. doi:10.1136/bmj.g7243
  17. Gauld R. Public sector information system project failures: lessons from a New Zealand hospital organization. Gov Inf Q. 2007;24(1):102-114. doi:10.1016/j.giq.2006.02.010
  18. State Services Commission. Resource for Preparation of District Health Board Governance Manuals. Wellington, NZ: State Services Commission; 2014.
  19. Ministry of Health. Briefing: Final Audited Results for the District Health Boards for the 2019/20 Financial Year. Wellington, NZ: Ministry of Health; 2020.
  20. Hafner JM, Williams SC, Koss RG, Tschurtz BA, Schmaltz SP, Loeb JM. The perceived impact of public reporting hospital performance data: interviews with hospital staff. Int J Qual Health Care. 2011;23(6):697-704. doi:10.1093/intqhc/mzr056
  21. House of Commons Health Committee. The Use of Managment Consultants by the NHS and the Department of Health. London: House of Commons; 2009.
  22. New Zealand Treasury. Vote Health. Wellington: New Zealand Treasury; 2019.
  23. Akmal A, Gauld R. What components are important for effective healthcare alliance governance? findings from a modified Delphi study in New Zealand. Health Policy. 2021;125(2):239-245. doi:10.1016/j.healthpol.2020.12.012
  24. Christopher H, Hood C. Gaming in targetworld: the targets approach to managing British public services. Public Adm Rev. 2006;66(4):515-521. doi:10.1111/j.1540-6210.2006.00612.x
  25. Akmal A, Foote J, Podgorodnichenko N, Greatbanks R, Gauld R. Understanding resistance in lean implementation in healthcare environments: an institutional logics perspective. Prod Plan Control. 2020:1-15. doi:10.1080/09537287.2020.1823510
  26. Erniaty E, Harun H. Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS. Health Policy Plan. 2020;35(3):346-353. doi:10.1093/heapol/czz165
  27. Numerato D, Salvatore D, Fattore G. The impact of management on medical professionalism: a review. Sociol Health Illn. 2012;34(4):626-644. doi:10.1111/j.1467-9566.2011.01393.x
  28. Burau V. Comparing medicine and management: methodological issues. BMC Health Serv Res. 2016;16 Suppl 2:157. doi:10.1186/s12913-016-1390-x
Volume 11, Issue 9
September 2022
Pages 1642-1649
  • Receive Date: 02 November 2020
  • Revise Date: 24 May 2021
  • Accept Date: 12 June 2021
  • First Publish Date: 07 July 2021