Three years into attempts to get district health boards to work more closely to improve patient care and cut costs, there are no obvious signs of progress.
A wide-ranging, 18-month review by the Office of the Auditor-General has found it is impossible to tell what difference the initiative has made - because the Ministry of Health has not been keeping statistics.
In 2009, the Government laid out a plan for DHBs in the same region to work together, aiming to improve patient care, reduce costs, and keep vulnerable services going.
But Auditor-General Lyn Provost said her staff were dismayed at how little evidence they were able to find of regional service planning in the health sector.
"In 2013, my staff found the Ministry of Health had not been systemically monitoring and quantifying the benefits achieved by regional services planning," she wrote in the office's report.
"The contribution to . . . reducing service vulnerability, reducing costs, and improving the quality of care is unproven."
Yesterday, audit manager Ruth Wilkie said there had been some successes, with regional projects under way in many DHBs.
And Crown company Health Benefits had reported $114.6m in savings in its first two years, through centralising contracts.
But the relationship between the ministry and DHBs was fraught with difficulty, with many health boards feeling the ministry yo-yoed between being too prescriptive and giving scant information about expectations.
The lack of a long-term plan was a concern, Ms Wilkie said.
"There wasn't as much progress as expected, and there are some challenges they need to overcome. And because they're not measuring progress, they don't know if they're going far enough or fast enough."
The report made seven recommendations around closer communication between the ministry and DHBs on governance, sharing of data, consistent cancer treatment indicators, better guidance, and evaluation of success.
A Ministry of Health spokesman said many points in the report were already being addressed.
A "flexible evolutionary approach" to measuring results had been taken to recognise the level of change and different starting points for different DHBs, he said. This was considered more useful than a long-term plan.
"There has been monitoring through regular quarterly reporting, though that is expected to become more specific over time."
Examples of services that were working well included the new Regional Women's Health Service in MidCentral and Whanganui, to improve maternity services for women in these regions.
Health Minister Tony Ryall was unavailable for comment on the report.
- The Dominion Post
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