On sack cloth and sacking

The greater good here was the progress of the health reforms and the morale of the sector

The health reforms have hit a major stumbling block and it probably won’t be the only one to rear up on the road ahead.

The chair chosen by former health minister Andrew Little to lead the “big Little revolution” has turned out to be too much of a revolutionary.

He has been sacked.

I was sceptical when Rob Campbell, a former trade unionist who became a success in the corporate world, was chosen to govern the biggest public sector health organisation. At the time, Mr Campbell chaired the board of gambling corporate SkyCity – not a good look.

But the minister was seeking reform, not restructure, and he knew eyes from outside the sector were needed. And Mr Campbell dropped the SkyCity gig to prove his commitment to the reform role.

From a boardroom perspective, Te Whatu Ora is not your average public entity; it could be argued it needs more than your average safe pair of hands at the helm. The agency is new and is a moving beast, evolving daily, striving to meet the demands of some pretty staunch legislation demanding a new culture of collaboration to achieve equity in health and, above all, a new relationship with the Tiriti partner in health.

Mr Campbell soon saw the size of the problem and the long, cursed shadow cast by inequity upon the health outcomes for Māori. He became a passionate advocate for change to address that.

Then he was sacked for breaching the Code of Conduct for Crown entity board members, for getting too passionate about equity matters and criticising the National Party’s water services policy as “dog-whistle politics”.

I understand we need a Code of Conduct to ensure political neutrality so our public service agencies can withstand political machinations, but I think the greater good here was the progress of the health reforms and the morale of the sector. That sacking dumps on over 12 months of relationship-building by Mr Campbell in a sector that stands and falls on relationships; among those relations are the desired stronger links with iwi and Māori providers.

An observer of the rhetoric around his sacking could be forgiven for thinking that board members bound by the Code of Conduct are members of a silent monastic order. This is totally contrary to the revolutionary spirit needed to guide these reforms, which aim to break new ground, not only for health but the whole public sector.

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• Health chief Rob Campbell stands by water-policy criticism
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It must have been extremely galling for Mr Campbell that, having become attuned to the inequities that exist for health outcomes, you are required to stay within your little silo, when international research shows that 80 per cent of health is outside the control of healthcare itself.

Inequity cannot be unseen. A code that requires silence seems facile.

Sadly, it was not surprising to learn on his departure that Mr Campbell felt progress in the reforms was remiss for lack of involvement of primary care and communities (see Martin Johnston’s interview on page 16). A road to Damascus revelation earlier in the day would have been awesome.

The question is, were these observations made regularly to the board and do they factor in other members’ thinking? Or will they be slotted in the same in-tray as the Sapere report on primary care (under)funding?

By the time you read this, I expect Mr Campbell himself will have been consigned to health sector history as one of those experiments that didn’t work.

That puts him in the company of the Core Services Committee, which attempted to figure out what the public really wanted from its “public” health services but found it couldn’t. The committee got a name change and the 1990s reforms continued, choosing to overlook the hiccup of market reform without the goods for sale defined.

Another experiment from the same reform, the slightly longer-lived Public Health Commission, came to grief when it wrote embarrassingly honest reports on the problems in public health. Thank you very much and goodbye.

Other elements failed to even get to the starting gates – the much-hyped Health Care Plans held out hope of greater independence for iwi, and other groups, to take their slice of health funding and make their own decisions. No go.

Localities and primary care are in the long tail of the current reform. It is starting to feel that there won’t be sufficient revolutionary fuel in the tank to move the millions of dollars and other resources to the front line of primary and community care that Mr Campbell has said are needed.

Our readers have been saying this for years and he appears to have been the only one at the very top who was listening.