FROM THE ARCHIVES: ‘No one gets left behind’ – ADHB chair puts political activism into practice

If you can provide care for the person who is the most vulnerable then, generally speaking, you can provide it for everybody

Pat Snedden has spent his life working on issues of social justice and serving on the boards of many organisations. He was politicised in the era of 1970/80s’ activism against apartheid and supporting Māori land claims. Now he’s in the political arena again, appointed by the health minister to chair Auckland DHB, for the second time. Cliff Taylor sits down with Mr Snedden to find out what still drives him to take on one of the biggest jobs in health

PAT SNEDDEN is sitting in a tiny glass cubicle in a building adjacent to the Auckland City Hospital car park, listening intently.

“So do people see you as some kind of left-wing political activist in a posh job?” Half an hour in and it seemed like a good time for me to send down a delivery Mr Snedden’s former test cricketer brother, Martin, might have appreciated.

“Hah!” he retorts, glancing around the cramped room. “The payment for this job is about roughly the payment of a clerk in this organisation. I get paid $54,000 for being the chair of the biggest business in Auckland. So – posh job? Well. Maybe.

“It tickles my fancy really, the whole idea of the flash and dash that goes with this. It doesn’t show in the pay packet.”

Even so, it’s a long way from the days when Pat Snedden was getting arrested at the re-occupation of Bastion Point and protesting against the Springbok tour. Today, apart from his second stint heading Auckland DHB with its yearly budget of $2.2 billion, he is a director of Ports of Auckland and chairs the Big Idea Charitable Trust, National Science Challenge and Manaiakalani Education Trust.

He has also previously chaired Counties Manukau DHB, Housing New Zealand and numerous other organisations, been a Treaty of Waitangi negotiator and a business adviser for Health Care Aotearoa, a primary care network of Māori, Pasifika and community groups within the not-for-profit health sector.

Like his ADHB predecessor, Lester Levy, he is a man with many hats. Which perhaps explains why it took nearly three and a half months to arrange our 45-minute interview.

Mr Snedden’s previous tenure as chair of the ADHB ended in 2010. Many saw him as being pushed out by then National Government health minister, Tony Ryall, but he seems to harbour no rancour about it. “I’m used to leaving things. Often in my life I’ve been taken on by governments; then, as governments change, taken off. I counted once, and I’ve been effectively sacked 13 times. It’s just the way it is. That’s the great strength of the New Zealand democratic system, and you just have to roll with it.”

Public service runs in the family, he acknowledges. His grandfather was mayor of Mt Eden, and various relatives have played top-class cricket and served as sports administrators and trustees of Eden Park. His own political leanings were nurtured around the family dining table.

Clearly, it inculcated in him a strong sense of social justice or, a phrase he uses twice in our conversation, “moral purpose”. He is drawn to the health sphere because it is an area where issues of equity are so entrenched – and often intractable.

When he accepted the ADHB job, he says his conversation with health minister David Clark was straightforward. He told him: “I’ve done this job before and I’m not interested in doing it again unless you’re really interested in equity and applying the Treaty in practice to the health delivery system.”

The challenge of a civil society is that no one gets left behind, he says.

Even though he believes “the level of goodness in major health systems is fantastic”, too often the term DNA (Did Not Attend) can be interpreted in the sense that the system Did Not Attract the patient.

Nobody comes to work in health to do harm, although that’s not to say systems get it right all the time. Interestingly, one of his first decisions after starting his job was to apologise for the “unfortunate experiment” in which women died while unwittingly taking part in research carried out at National Women’s Hospital in the 1960s and 1970s. The apology was just the right thing to do, he says, acknowledging the groundwork put in by chief executive Ailsa Claire and chief medical officer Margaret Wilsher.

Less than six months in, he’s still getting used to the lay of the land, particularly in primary care. He admits he doesn’t know all the details of the after-hours and urgent care agreement signed earlier this year, after years of divisive wrangling. He is a recipient, though, after breaking his ankle while mending a fence a few weeks back and ending up in the White Cross clinic in Greenlane. The service was great, he says. But these are “tricky areas” to get right.

Similarly, dealing with PHOs is likely to be challenging. Relations between PHOs, especially the big and opinionated ProCare, and the DHBs have not always been plain sailing.

“I’ve been a Treaty negotiator for 10 years,” he points out. “I understand about people having really strong opposing views about things and implacable positions to be adopted. I’m going with an open mind but that doesn’t mean an unchallenging mind.”

One thing he has noticed on his return to the role after eight years is the rise of corporatisation in healthcare. “The way healthcare has been corporatised at primary and community level is really marked. Venture capital is starting to show its face.”

Is he concerned about it, as former RNZCGP president Tim Malloy is?

“It’s different. At primary level price is a function of access. The degree to which government and DHBs work out price has a profound effect on who gets what. It’s very hard in a corporate model to see the financial return associated with the kind of in-depth engagement with communities that is necessary to shift, at the very hardest end, the outcomes for people’s health.”

He sees tensions in the relationships between primary and secondary care and he’s “a bit perturbed” to see people turning up in hospital who should clearly be treated in the community.

Returning to the fray has given him perspective, and he sees progress in some areas, particularly the capacity to keep people alive and the emerging role of data analytics. He is still worried about the stubbornly poor outcomes for Māori and Pasifika and how the focus in the Ministry of Health drifted away from these issues over the past few years. “Now, it’s back on.”

Lester Levy was sometimes dogged by perceived conflicts of interest between his many roles in and outside of the health sector. It’s not something Mr Snedden is losing sleep over. “As an experienced public sector director, you’re alert to that stuff. It’s foolish if you don’t pay attention to the stuff that might trip you up.”

He looks back on his political activism as an important part of his education – and that of the wider country – especially in terms of Māori land claims.

“That was a while ago now,” he says, when reminded of his arrest at Bastion Point in 1982. “But it was hugely influential to me. It was like a calling card in Māori circles. People thought you were serious about what they were talking about. I got myself educated about it.”

He recalls the advice of his lawyer father who told him if he wanted to be an activist, he should become an accountant, meaning it’s sometimes a more effective guise in order to get things done, when people see you as normal, respectable – uncontroversial. “I think that’s worked.”

So is there anything he’d be willing to get arrested for today? “It’s a different environment today,” he demurs. “I think if I was living in America, I would probably have a view about that. We don’t have that kind of polarisation in New Zealand.”

The realisations of activism are often “post the moment” anyway, he says.

I ask him if it’s possible to have a moral purpose, a sense of social justice – ideals – in the business of health.

“Well, why not?”

“I’m asking.”

“Of course it is.”

Without insight into the human condition, you’re likely to be a decision-maker who does a lot of wrong things, he says.

He leans forward, more animated now, gesturing towards the hospital entrance, painting a picture of a patient arriving by ambulance at the emergency department. “Right at that moment, that is the most democratic access in New Zealand society for any individual; doesn’t matter who you are, you come in there absolutely at the front of the queue and you are dealt with.”

New Zealanders see the health system as their metaphor for wellbeing, he says. “At the moment of acute risk, everyone is dead equal in terms of who gets what. That’s a priceless gem in the New Zealand system. The further into the process you get, the more you find the discrepancies about how people get access to care multiply.”

He sees his job as a steward of the system. And don’t suggest we can’t or won’t be able to afford this kind of commitment. Of course, we can afford it, he insists. We just need to do things smarter.

But the measure still comes down to equity.

“If you can provide it for the person who is the most vulnerable then, generally speaking, you can provide it for everybody.”