Royal progress: From Point Break to breaking point

Once again, Simon Royal had fallen in at the deep end. So, once again, he kept quiet until whatever was going on became clearer.

Seated around him were all the primary health big names, gathered in Wellington for the very first session of the very first negotiation where they would figure out how hundreds of millions of taxpayer dollars should be divided.

It was 2001, and Mr Royal was attending the birth of the Primary Health Organisation Services Agreement Amendment Protocol (PSAAP) group.

From the chair, then-Ministry of Health chief advisor Jim Primrose looked out at the heads of groups such as Healthcare Aotearoa, the Independent Practitioners Association Council (IPAC), DHB organisations, various PHOs, a battalion of lawyers and, somewhere down the back, Mr Royal, representing the Auckland DHBs’ Māori health general managers.

It was tinder-dry stuff for that time of day but, with morning tea nigh, he saw the draft protocol had granted veto powers to the health minister and IPAC, which represented practices holding about 75 per cent of the country’s enrolled population.

“When I realised what they were doing, I stood up to get a question in: ‘What position does the Treaty of Waitangi play in the governing of this activity given it is Crown money and ultimately Crown governed by the minister who has the right of veto?”

After a pause for thought, Dr Primrose adjourned for morning tea and summoned some ministry advisors. The break was then stretched out to lunchtime and all those representing Māori primary care interests were asked to gather and prepare their argument.

“I was working for the Crown then,” says Mr Royal, “so I didn’t have a natural invite to that space. But I was walking past, the door opened, and they grabbed me inside.

“They were looking at me like, ‘What did you just do?’ and I said, ‘Do you know what’s happening here? My advice is you need to get organised, because they are doing the carve-up right now’.”

Then-general manager of Ngāti Kahu PHO, Te Orohi Paul, was elected spokesperson and a set of statements on the Treaty’s importance and relevance to the negotiations was laid out.

They also named themselves the Māori Caucus, a collective that in due course evolved into the National Hauora Coalition PHO, the organisation Mr Royal has served as chief executive from its incorporation until his resignation last month.

Now 60, and with that part of life in his rear-view mirror, he can enjoy the times of “elation” and a list of corresponding achievements, but the pressure and stress cost him a marriage. Then, two years ago, his GP told him blood pressure readings as high as his, usually put people in hospital.

“You can’t count the price at the beginning and that’s the issue, that only comes in retrospect…Did my job contribute to the end of my first marriage? Undoubtedly. Has it made things harder for me? Yeah of course. It’s also made a lot of things better, but the intense pressure, it takes its toll on people…I think that the cost of that is still to be fully accounted for.”

His career is a case study in cultural load. Again and again, he has been asked to take on tasks in service of Māori advancement, sometimes beyond his qualifications and experience, simply because there was too much work to be done for the hands available.

Yet, for the longest time, all he’d wanted was the freedom to surf and travel.

* * *

Simon Royal (Ngāti Raukawa ki Te Tonga, Ngāti Wharara, Ngāti Hine, Ngā Puhi) was born in the Auckland suburb of Glen Innes, the second of six boys born to Turoa and Maryrose Royal.

His father was a big-wheel Māori educator, principal of Wellington High School, foundation chief executive of Whitirea Community Polytechnic, and author of books on te reo Māori. One of these, written for children, was illustrated with Ans Westra photographs, and tells the story of his sons’ visit to an uncle’s farm. It’s still dragged out on special occasions to embarrass them.

Dr Turoa Royal was made Companion of the New Zealand Order of Merit in 2013 for services to education.

Mrs Royal was also a teacher and a staunch Catholic feminist, who hailed from Bolton-le-Sands in Lancashire, UK.

The whānau moved to Wellington to follow his father’s job with the Ministry of Education while their mother ensured her boys got a Catholic education, culminating at St Patrick’s College, Silverstream.

They are also related to some high-powered, activist Northland whānau and this, says Mr Royal, created “a dynamic family setting”.

“You’d wake up in the morning and find people sleeping on the couch. They’d come from all over the place for a visit.”

It made for rarefied conversation: “I grew up amongst nation-builders and they don’t think organisationally, they think really large thoughts about what needs to be transformed, so it’s a very interesting journey growing up around people like Whatarangi Winiata, Dad, Mason Durie, Hiwi Tauroa, and Steve (now Tā Tipene) O’Regan. Their level of thinking just isn’t around now.”

Young Simon Royal was more into sport. He captained his primary and intermediate rugby teams, and made the Wellington under-19 rep side, until surfing ended his chances of higher honours.

None of which was quite what his father had in mind, so he was sat down and asked about his life plan. “When I couldn’t come up with a coherent answer, his default position was ‘get in the car, I’m taking you to university’.”

In 1979, he enrolled at Victoria University of Wellington, and immediately felt way out of his depth.

“That just wasn’t my path, not at 17, I wanted to go surfing. By 14, 15, we were always jumping in cars and heading to the coast.”

After his mother “invited” him to leave home, he settled into a life of flat-hopping with bar work paying the bills: “I was, you know, enjoying uni life quite a lot.”

Graduating with honours in 1985 with little idea of what came next, he met a flatmate’s sister who was teaching English in Tokyo. Mr Royal mentioned he was learning te reo and Japanese, “and she said: ‘You need to get out of here, come to Tokyo’.”

Japan was “the most wonderful two years of my life”. He ended up living and teaching English in Takamatsu before moving to ritzy Kobe.

One of his flatmates worked for an advertising company producing English-language brochures and took on Mr Royal as a model. The high point of this stimulating sideline was a fashion show that doubled as a pool tournament featuring all his friends and an open bar, and was screened live on Japanese television. Yes, really.

By the end of 1987, it was time to go and he hatched a plan with a friend to get to Europe, overland.

One of their goals was to get to Tibet for the prayer ceremony; the only problem was, China had locked the place down.

Some shady help got them close to their destination, but they were arrested and ordered to leave. That was enough excitement, Europe would have to wait, so Mr Royal hit Bali and New South Wales until his big brother called him home to be his best man.

“I describe it as being dragged off the beaches of Asia, and I really struggled with that transition. I’d never suffered cultural dislocation going to Japan or anywhere else, but I really suffered when I came back to New Zealand.”

Not only that, his father sat him down for another “what are you going to do with your life?” talk.

* * *

He may have been unproven, but he had a university qualification, and “that got me through the door, there just weren’t enough Māori at university in the 1980s”.

Mr Royal joined Manatu Māori, a short-lived Treaty policy agency, headed by John Clarke, Rauru Kirikiri and Morrie Love, advising the Labour Government on its obligations.

“This was deadly serious stuff compared to what I’d been doing, dead right, and it wasn’t easy and I was having to reculturalise myself into the Māori and government worlds.”

His role shifted into natural resources and fisheries management with negotiators Tā Tipene and Tā Graham Latimer.

“I didn’t know it then, but this was the best time to be involved in this stuff, the halcyon days of Māori public policy in my view. But the adaption was still hard, no question, I really struggled, and I think my bosses knew that.”

In 1992, the Iwi Transition Agency and Māori policy ministry were merged into Te Puni Kōkiri and Mr Royal joined the brand new Māori Fisheries Commission headed by Tā Tipene.

After an advisory role at the Manukau Urban Māori Authority in south Auckland he met, married and had a child with Catherine Graham, daughter of Māori sculptor Fred Graham, in 1995, and the couple moved to Wellington. He worked for consultancy KPMG with Awerangi Durie.

“But that wasn’t my cup of tea” so, after a year, they skipped back to Auckland, house-sitting at former NASA aeronautical engineer John Bollard’s Waiheke vineyard, while Mr Royal found a job with Dame Naida Glavish at the then-Auckland Area Health Board.

Mr Royal also served as chair of his children’s school, Piritahi Kohanga Reo of the Te Whānau a Haunui Papakāinga Trust, where his hapū is in Waimango in Hauraki, one of the last remaining tribal lands in Tāmaki where title has never left Māori control. It is tūrangawaewae for the Royal whānau, and where his grandparents, Haunui and Nana Mere, laid the educational and cultural foundations for future generations.

“This is an important part of my story,” says Mr Royal. “That cultural security coupled with higher education they instilled, is my real privilege.

“My Māori story of privilege is very rare, one which is lost to countless Māori because of alienation of land, society’s prejudice and destructive government policies.”

In 1998, he reviewed a business case for the $500 million rebuild of Auckland City Hospital and buildings on the National Women’s Hospital site. He tossed it back, saying there was nothing in it for Māori healthcare: “I wouldn’t submit a case like that.”

It went through regardless, only to be returned with the instruction to fill in the gaps where references to Māori health aspirations and outcomes should be.

As a result, the DHB’s then general manager of hospital services delivery plan, Nigel Murray, pulled Mr Royal into the project team and for the next three years he worked within a team of engineers, consultants, architects and surveyors.

Once that project ended, he was sent to Wellington to wrap his head around the new Primary Health Care Strategy – it was during this stint that he sat in on the first PSAAP meeting.

“OK, I knew nothing about primary care, so I had to quickly learn who was who in the zoo, but I was still carrying the same thoughts and concepts about how this stuff had to be responsive to the needs of Māori.”

Back in Auckland in 2005, he figured his health days were over. “I went to see Naida Glavish and said, ‘I’m done’. She just looked at me and said: ‘No, you’re not’.”

Waipareira Trust’s new Waiora Healthcare PHO apparently had a Simon Royal-sized hole where its chief executive should be. “Right, two years and then I’m done,” he said as he contemplated his new empire, which boasted three practices owned in a 50–50 split between the trade unions and the trust.

“I had to build it from scratch, really, and I went to my pōwhiri not knowing what I was inheriting.” That was made clear when he was asked to collect Waiora’s belongings – a pot plant, a miniature photocopier/ printer, three laptops, a box of transaction records and a cheque book. With everything tossed into his car, he drove to the nearby Mitre 10 and set himself up in the café, his office for the next three months.

He took charge of the PHO’s three west Auckland practices.

* * *

Come 2007, Mr Royal was not only still in health, he was the new chair of the Māori Caucus, and was neck deep in the Waitangi Tribunal’s massive Kaupapa Māori Health Services and Outcomes Inquiry.

Change was now afoot, and as caucus chair, he headed to Wellington. “I went straight to the ministry and said: ‘Healthcare Aotearoa have a contract with you to support their objectives, Māori need one too.’”

The caucus then incorporated, with Mr Royal as chief executive. After a brief spell as the National Māori PHO Coalition, it became the National Hauora Coalition PHO. This new entity received funding of $500,000, which helped them push their Waitangi Tribunal claim through.

He’d barely settled into his new role when then-Māori Party co-leader Tariana Turia summoned him. “She gave me the biggest, hardest time. She was testing me. Who the hell are you? Then eventually she says ‘OK, we need to meet the minister (Tony Ryall)’.”

Also present was State Services Commission head Peter Hughes, and their discussion shifted the equity focus from opportunity and access to outcomes. The clincher was Mr Hughes’ confirmation his department could list every dollar spent in healthcare but had no idea if it had any tangible impact. A way of measuring outcomes must be found.

“That, for me, was the meeting that really shifted things in my head, that this was possible. To hear that admission from a senior official, and with a minister in the room, who was staggered by what he was hearing... that was a crucial meeting.”

The coalition was invited to submit a business case outlining how whānau ora could be implemented in healthcare using a whānau-centred model of care, coupled with community development and “commissioning for outcomes” procurement.

After their first draft was rejected, a second, more radical, case was put together over all-night sessions in an Avondale garage by a group including now co-chair of the interim Māori Health Authority, Sharon Shea, and Capital & Coast DHB director Rachel Haggerty.

From being one of 75 applicants to be part of the Government’s “Better, Sooner, More Convenient” policy, the coalition got down to the final 12 and, finally, the successful nine.

“We were all sitting in [the] minister’s waiting room at the Beehive, Tony Ryall and Tariana were meeting alone. We didn’t realise it, but this was the ‘go/no go’ meeting, and when word got out that the Government was going to back our whānau ora business case, things just blew up. The ministry was in place, but this gave it teeth and the impetus to move forward.

“But it sounded like the end of the world for some organisations, people started to say ‘ah, you’re writing us out of the loop’. Well, if that’s the case it’s not deliberate, we are wanting better systems producing better outcomes for our people.”

But by 2020, Mr Royal was looking to get out. His mother’s death had affected him deeply and his health wasn’t flash, but when COVID-19 dropped from the sky, no one was going anywhere.

If the pandemic wasn’t enough work, the Waitangi Tribunal hearings are ongoing, and Mr Royal is also part of a group looking to reset the primary care funding algorithm.

“It’s as dry as anything, but it’s about real money and shifting it towards communities…I think we’ve done a brave thing and I pray it gets the whole way through.”

His exit, he says “was just about timing…I’ve always believed you go where you think you can be most influential, and I think we’ve done that bit now. NHC has proven a Māori organisation can be up and exist, be best of breed and be deeply influential...What needs to be understood is that NHC’s real purpose was to advocate on behalf of communities that didn’t have that ability themselves. The fact that we happen to be a healthcare organisation, that gave us a lot of things, and PHOs are a wonderful vehicle because Māori had never been in charge of funding like this and that’s huge, because then people chase you…”

But his life has also changed as three years ago he met Tamah Clapham, a nurse practitioner working with high-needs whānau, and the couple are now raising her three young children.

Mr Royal has also been reflecting on his mother, and the speech she gave on her 70th birthday.

“Well, she’s been an interesting life,” she said, “and I have always considered this question, if I had my time again, would I do this? Would I do it over? And, I think, in all honesty, I wouldn’t.

“I love all my children and I love the experience we have had together, but I have paid a big price and made significant sacrifices…”

Mr Royal says he has now “played with that idea as well, and my answer is if I get 10 shots at it…four maybe five times, I would, I’d do it again. But five, maybe six? Nah.

“I think it’s one of the issues I’ve had, don’t martyr yourself. I think that’s what Mum was saying, don’t martyr yourself, be sure you own your decisions and then live with them.”

As for what comes next, he’s feeling relatively intact and ready for one last career swerve. First though, a good break and...his long board and guitars are in need of some love…

Once more into the deep end it is then.