The axe fell on the Southern District Health Board a year ago this month, and its board members were sacked. Since then a commissioner has run the board, largely out of the public eye. Her term was recently extended by three years. Health reporter Eileen Goodwin assesses progress.
A few days after Kathy Grant was appointed to run the Southern District Health Board, she asked health officials a question.
Had the beleaguered board done anything right, even one thing?
The Wellington health bureaucrats were evidently in no mood to be generous.
"Nothing,'' came the reply.
It made an impression on Mrs Grant, who tells the anecdote in talks to community groups to convey what she walked into a year ago.
"You have heard the story correctly,'' Mrs Grant confirms in an interview.
"For a long time, a number of people have seen Southern only through a financial lens ... it's all about the lens through which you are looking.''
Joining the commissioner at an interview this week is deputy commissioner Richard Thomson, a veteran of Otago health who survived the fallout from the board's sacking.
The pair talk with pride about leeway granted by Wellington to do things differently without the extreme budget pressure that became bitter and corrosive for the previous board.
It appears to be the trade-off for the loss of local control, although the pair will not admit this, of course.
Mr Thomson says his boss has a "degree of steel'', on occasion standing up to "quite powerful'' Wellington health officials.
And that must not be easy for appointees who serve at the whim of Health Minister Dr Jonathan Coleman.
Notwithstanding a clutch of other ministerial and civic appointments, Mrs Grant, a lawyer, had no experience of the health sector, nor of politically fraught roles.
She had to learn fast.
She admits to being told off a couple of times by Wellington officials for failing to pass on sensitive information.
At times, the commissioner team has seemed out of step with the general public, but the pair tend to put this down to misunderstanding and the inability to get their message out unfiltered by the media.
They are sensitive to public criticism, and Mr Thomson says there are good things under way, but they are not the stuff of exciting newspaper articles.
Mrs Grant dismisses the food outsourcing debacle as a "distraction'' from the "momentum'' in areas like IT, which is about to take a big stride linking hospitals and general practice.
They are clearly still exasperated by the outcry, and Mrs Grant worries that it has unnecessarily put people off the food.
The commissioner team was ridiculed for flying in a London consultant to run "listening sessions'', and develop "draft values'' that seemed self-evident.
Mrs Grant and Mr Thomson insist it was part of a valuable process of "clinical engagement'' that has proved successful in other places.
The most powerful health union, representing senior doctors, appears cautiously satisfied, and has kept the heat off the commissioner team in its first year.
"The commissioners have not made any particular decision that has caused us any angst,'' senior doctors' union executive director Ian Powell says.
But the commissioner team tends to sidestep unions, and some organisers are feeling troubled.
"I feel a bit like we're in the 1990s, where the word union is obliterated from the language,'' Public Service Association organiser Julie Morton says.
And this week it emerged the relatively soft approach to staff "culture change'' had hardened.
Human resources staff were said to be reeling from a major restructuring under way.
Four unions, including the powerful Association of Salaried Medical Specialists, expressed concern to the Otago Daily Times about a loss of institutional knowledge.
Mrs Grant admits it is unsettling for staff, but says its purpose is to set up a new kind of service that will foster a strong "culture'', and not just deal with bread-and-butter HR.
A source who did not wish to be named speaks of Mrs Grant being a tough taskmaster behind the scenes, and that is a characterisation she accepts.
Abrupt departures of senior executives in HR, IT, and infrastructure give a sense of upheaval in certain areas, none of them clinical.
The board is relying on consultants to plug some quite senior gaps.
So where does it leave the deficit, the reason board members were so very publicly sacked last year?
It appears stubbornly fixed at more than $30million until at least 2019, according to a document on the board's website.
Mrs Grant and Mr Thomson are coy about that, saying those are outdated figures, and various projects will bear fruit over time to reduce it.
Mrs Grant remains insistent the board is not under pressure to cut costs to afford the new hospital, which for quite some time has officially been "seven to 10'' years away from completion.
The rebuild is controlled by another group of Government appointees, of which Mr Thomson is a member.
The commissioner team is also at a distance from the vexed question over the future of Lakes District Hospital in Queenstown.
No-one knows what will happen nearly two years after the board walked away from a hospital upgrade.
The pair suggest asking the Ministry of Health, which commissioned a report on the Wakatipu issue last year.
What the commissioner team has not done is convincingly explain how it will get rid of the $30 million-plus deficit.
Some observers wonder if there is a bigger plan waiting in the wings, which the pair deny.
"There seems to be an assumption that we are there to somehow gut services to take the cost out, and I suppose my frustration is that after almost a year in the job I'm not aware of a single service that we've gutted or cut,'' Mr Thomson says.
"You'd think that the message might start to flow through by now that we're actually trying to go a different route here, but it probably won't because that's just the nature of the way things are.''
Mr Thomson has been reading widely about what turned around health organisations overseas.
He started this when he got "bored'' as a health board member and decided there must be a better way of doing things.
Experienced director and Dunedin accountant Graham Crombie is another deputy commissioner.
He declined to be interviewed. He reportedly had the outsider's enthusiasm evident in Mrs Grant.
Both were used to well-resourced organisations, and are said to have got a shock when they saw the state of things.
A source says the pair were "excited and naive'', and had an expectation of sorting things out in a six-month period, which was "a little frightening''.
"I think as soon as they saw the state of the IT system, they realised just how difficult the job was going to be for them.
"When they realised they couldn't count the money, and they couldn't determine where it was being spent, then how could they solve the basic issues around expenditure and budgeting?''
The computer system was held together with "tape'', and few staff were left who knew how it worked.
The source says the team, keen to do the best job possible, viewed input from the public as a potential hindrance.
The source, who views the degree of secrecy as unacceptable, would not be named, but other critics have been outspoken about this issue recently.
It appears the need for public input was only taken seriously after the commissioner term was extended by the Government from the initial 18 months, to four and a-half years.
Until now, the team has operated with an unprecedented lack of transparency.
Mrs Grant admitted last month that in an "ideal world'' statutory committee meetings would have been held in order to comply with the New Zealand Public Health and Disability Act.
The meetings resumed last month, but, comprising the commissioner team, staff, and a yet-to-be-appointed iwi representative, are bland affairs.
Mrs Grant says the next step is establishing a public forum at the start of the meetings.
"For whatever reason, it has seemed to be difficult [to involve the public],'' Mrs Grant said.
Hiring a respected clinical leader from the Canterbury District Health Board for the crucial chief medical officer role was a coup.
Being willing to twice halt the recruitment process was crucial in finally securing Dr Nigel Millar, Mr Thomson explains.
Dr Millar was involved in work at Canterbury, particularly around clinical engagement, which the team wants to emulate.
Mrs Grant is pleased with a new audio-visual link between Dunedin and Lakes District Hospital, which in one case prevented a transfer to the tertiary hospital.
The team are clearly involved in some day-to-day decisions, but insist they maintain the necessary distance to take a fresh and critical view.
They have increased financial monitoring to avoid the unwelcome surprises that plagued the board for many years.
Dr Coleman, who declined to be interviewed for this article, said in a statement he would be reappointing Mrs Grant for the extended commissioner term.
The law passed last month extending the term, but Mrs Grant continuing in the role had not been confirmed until this week.
A third deputy commissioner, Dr Angela Pitchford, a Christchurch clinician, was out of the country this week and unavailable for an interview.
Highs and lows
Highlights
• Appointing Nigel Millar chief medical officer
• Audio-visual links between Dunedin Hospital and Lakes District Hospital
• Progressing IT programme linking hospitals and GPs
• Improving health target performance
• Better financial monitoring
• Approval for building package including new gastroenterology unit
Lowlights
• Food outsourcing controversy
• Lack of public input and transparency
• Continuing reliance on consultants
• Controversy over "listening sessions'' and "draft values''
• Sudden departures of some senior staff
• Concerns raised by union over sterilisation practices
