Andy Train – Hawke’s Bay Hospital Amalgamation

Cynthia Bowers: Andy Train – I’m sure Andy is very well known to many of you. Andy was born and bred in Central Hawke’s Bay in Waipukurau. He farms there and tells me that he has lived there all of his life and he intends to die there as well, but hopefully not for a very long time. [Chuckles]   Andy has had a long history with hospital services, about twenty-two years, he tells me. He was involved in 1980 when discussions about the amalgamation of our Hastings and Napier hospitals first started, and I think he there to see the plans come to fruition as well. He’s also been involved in ambulances, and rescue helicopters – he’s the current Chairman of the Lowe Corporation Rescue Helicopter. And before he starts I just want to make mention of the tremendous leadership that it takes to drive a change such as the change that we saw in the 1980s and 1990s with our health services. It takes courage, tenacity, but real leadership skills, and so we’re very privileged tonight to have Andy along to talk to us. If you could all join me, please, in welcoming Andy.

Andy: Good evening ladies and gentleman. As I was introduced to you – from Waipukurau. Most good authors declare their alliances early on, so if I upset anybody tonight; insult anybody or any of those things, a million apologies before we start. That’s certainly not the intention, but we don’t want to deviate too much from the truth, and sometimes the truth hurts.

Anyway, wonderful to be here … see a lot of old faces … my true love, Jean Hill’s here tonight – haven’t seen her for some considerable time. Best cook in Hawke’s Bay, I can guarantee that. [Chuckles] And we’ll go from there.

I suppose, “How would you describe yourself?”, you fellows would say. “How would you describe yourself?” Well I’d probably start it off in the Hospital Board days in ’73, probably as a [an] arrogant capitalist – might’ve been bordering on being a racist. Where am I now? I’m probably a bit of a socialist, and bordering on being a reasonably serious greenie, and the other word we don’t hear of any more.

So coming back to 1973, I was appointed to the Waipawa Hospital Board in those days, because one of the members died during his term in office. There weren’t such things as election[s] in Waipukurau, so the Council came along and said, “You’re it.” They said, “It’s only half a day a month, you know … no trouble.” So we started off there, and I went to the first meeting. Everybody there was older than my parents, and I actually wondered what I’d let myself in for. We had a couple of meetings, and the Chairman said, “I’ve been looking for somebody to get out; the election’s next year; you’re the Chairman, so serve your apprenticeship quickly.” So that’s what happened – became the Chairman eighteen months after starting with the Board. Never faced an election in Central Hawke’s Bay until we got to 1989, I think it was, so it was a bit of a sweet ride, I suppose you’d say. First meeting – you sat down there with everybody older than my parents, and you know, I’d absolutely swear the Chairman thought, ‘That boy should have a school cap on, and I bet he’s got shorts on.’ So we went on from there.

During that period I had a bit of time on the National Executive and a few other places, so I rubbed shoulders with … I was representing all the small Boards in the North Island at the time – Taumarunui and Gisborne, and a few places like that, so I was reasonably au fait that there was pressure from Wellington to get an acute hospital, or a regional hospital in Hawke’s Bay. While we were chugging along in Waipuk, [Waipukurau] the Board made its first attempt of [at] amalgamating all services in 1980.

Now most of you – fresh in your memories – 1980 seems a long time ago now. And they developed a plan for a new site, somewhere between Hastings and Napier, around about Clive. The Minister, George Gair, turned it down, because of the cost which is understandable, but I’m a bit surprised about that because the Chairman of the Hawke’s Bay Area Hospital Board in those days was Hallam Dowling. And Hallam Dowling had a bit of a reputation for getting things done his way. I actually remember George Gair coming to Waipuk to lay a hundred year service Memorial Stone outside the Hospital, and he came up to my place for a drink after that. And my farm drive left a bit to be desired, and he came up in one of the state cars, an LTD Ford that dragged the driver from the bottom of the road up to the house and back again – it really levelled off quite well for me. [Chuckles] But he ended up by having a few whiskies with me, and he was quite happy to pour them down, and I was quite happy to pour them. So it ended up that Hallam Dowling rang up before he’d even left to go to Hastings, to give me a bit of a flea in my ear that I was holding George up, and he had more important jobs to do in Hastings than he did drinking whisky at my place. So that’s the beginning of Hawke’s Bay’s look at acute … or regional hospital … I’d like to say regional hospital.

Just going through the history there – 1989, Helen Clarke told us that on the 1st of June that year that’s what was going to happen – CHB Hospital Board, Napier Health Unit and the Hospital Board were going to amalgamate to become the Hawke’s Bay Area Health Board. That year we had October elections. That was early in the year, and we had ten elected and five appointed members, and our first meeting was on December the 12th 1989. Now it’s quite interesting on the budgets – before that happened, Hawke’s Bay Hospital Board had a budget of around about $35 million in the days of Joan Velvin, and the first year that happened the budget went up to $100 million. That sounds like a lot of money. Now the Board’s getting $450 million – sounds like a lot of money, but the government are quite cunning. Of the $450 million they then take the GST back, and in this case it’s $67 million, I think it is at the moment. So they get $450 [million]; give $67 million back in GST – it’s not quite as generous, as it goes.

First meeting December the 12th – that was the first time that Jean and I got to know each other. And from that meeting on until the elections the next year, I kept harping on that I wanted the Board to look seriously at finding a site for a regional hospital, or finding a way to have a regional hospital. During the first few months from the 1st of June, when I was there, I wasn’t getting much headway. We had a Napier Chairman and a Napier deputy Chairman, and they had the skills to keep me reasonably well under control. But they certainly aired the point that we had to get on with it, and it was such that two of three of the Board members that had been involved in the 1980 decision decided not to stand again. They just couldn’t put up with the hoo-ha that went on with it.

Booz Allen Hamilton Report – The Board did agree in late ’89 that we would commission a report to have a look at the possible sites, with no bias or favouritism on any site. We called tenders and reports from the interested outfits that could do the job. Booz Allen Hamilton won it; I wouldn’t say decisively, but the report was setting us up for a $500,000 bill, so it actually [be]came quite serious.

Started on the 5th of July; we presented the report to the Board on the 12th of December 1990, and for those that didn’t like the report, everybody went reasonably ballistic. Booz Allen did a marvellous job on the presentation. It was virtually nearly a half-day thing. They were like, if I can put it nicely, some of the kaumatua on the marae – they talk about a lot of things and sort of lead you up the garden path a bit. And they led Napier up the garden path a bit talking about them first. We broke for lunch, and they were all going around slapping themselves on the back thinking that the deal was done in favour of Napier. Then after lunch it came back – finished up at afternoon tea time with the report coming out very strongly on the Hastings Hospital site, and that’s when things went a bit egg-shaped.

We had quite a … well, I thought we had quite a clear understanding with Board members early in the week, that no Board member would voice an opinion in public until the submissions had been heard in Hastings. That didn’t work out quite like that. Three days after the report was made public, the Napier Board members led the protest down the main street of Napier to the Sound Shell. I’ve got to be fair and say that that was probably one of the most disappointing things in my life. In today’s circumstances, that would have been considered insider trading, having that kind of information, and going out and exploiting it like that. But that’s the way it worked. Did it work in the long run? I don’t know. But it was quite a big march – certainly filled the papers up for a few days. And, went like that.

About the same time that this protest march was held, I’d prepared what I’d call a page of persons of interest, and … we’ve probably all forgotten about them now, I mean who can tell me the MP for Hastings in 1990 – anybody?

Cynthia: Jeff Whittaker.

Andy:  Jeff Whittaker. Just shows you how memory gets a bit hazy after a short time. We all think he did a reasonably good job.

But in my list of persons of interest, you know, the top of the tree in my view was Denise Watkins. She organised the march; had some fairly strong statements in the paper along the lines of suggesting that Napier Regional Council should resign ‘cause they weren’t there and didn’t get out publicly and support the project, and all the rest of it. We were actually trying to develop a programme that was going to be to the benefit of the whole of Hawke’s Bay. Keith Sellars wrote some fairly nasty letters about me, and a few other statements; Alan Dick – I’m not blaming him, he had a job as the mayor, but, you know, his first statement in the paper … “I’m going to fight this”. I mean, you know, maybe he should’ve just sat down and read the report and seen what it really had to say first.

The Board decided that we’d make a presentation to all of the MPs in our area. And there were seven of them and I can’t work out who the other two were – I think we might’ve had a half share in two Maori electorates at the time. So I went down to Wellington – we’d posted them down a copy of the report and agreed that we’d make a presentation later in the week; I can’t tell you what day it was. So I walked into the meeting room – first person I see is Geoff Braybrook, so I go up and say hello. And I said, “What do you think of the report, Geoff?” He said, “I haven’t read it but I know what’s in it. But it will only happen over my dead body.” I thought, ‘Shit, how are we going to have a serious discussion with an attitude like that?’ Anyway, I’ve never particularly liked him, but it doesn’t matter. [Chuckles] Geoff Braybrook … claim to fame in Parliament is that he is the only MP in New Zealand that has lost two hospitals in his electorate. [Chuckles] That’s the Public Hospital and Princess Alexandra. And I’ve talked to him about this, and he just … he used to go a bit huffy.

But we also made the presentation to Jeff Whittaker, John Falloon, Michael Laws, and Michael Laws was reasonably receptive. About a year later when I became Commissioner, he rang me up one day and said, “You cannot make a decision on this on your own. You are not an elected member. You will present the information back to me in Parliament, and the Parliamentarians in Wellington will make the decision.” I was a bit highly strung for a while. [Chuckles] But I notice that the same issue has cropped up in Christchurch this week with the mayoress … lady … [Lianne] Dalziel, who was saying that the Water Commission in the Canterbury Plains has been appointed by the government because Canterbury City Council couldn’t handle it – they’re saying exactly the same thing; they have got no right to make decisions because they are not elected members. And I’ve been thinking about this a fair bit, and so what happens to all List members in Parliament? They’re not elected. You know, you might say, “Well they are elected because they get in on the List”, but they’re not really elected in a direct form. We don’t know their faces … don’t know their things, so I mean – you can all shoot me down afterwards, I’m used to taking it. [Chuckles]

And one of the persons of interest at that time was Lester Chisholm, who represented the Napier City Council for quite some considerable time in the legal battle that went on after all of this. And it’s quite interesting that he turned up in the last month or two, and has sat in and led the thing in for the Ruataniwha Dam. No reason that he’s not straight up and down, I don’t doubt that for a minute – I think he’s a very good lawyer. But he’s still got connections with the Bay, which is really good.

In 1991, most of the Board sat in on the public submissions, and there were three hundred and thirty-three of them, and they took three days of the thing, and it was jolly good – I thought it was jolly good. The people of Hawke’s Bay, and the groups of Hawke’s Bay got together, and they actually put forward some very valid facts. But it was a bit short-lived, because on budget night that year, all the elected and appointed Board members were discharged of their duties … it’s a nice way of saying they were sacked. But that’s what happened, and that was by Simon Upton and Ruth Richardson at the time.

The twenty-two years I’ve had in the Hospital Board I’ve had eleven Ministers of Health, so they seem to have a fairly high turnover. And all of them want to just change the direction a bit left or right, and it’s jolly hard for the Boards to keep it all going.

From that night on, I was the Commissioner for a while. And in December of ’92, Crown Health Enterprise Establishment Boards were formed, and the Minister appointed a new Chairman. And I was on the Board for a whil, and that’s … footnote: it’s only a bit of advertising seeing I’m the Chairman of the Rescue Trust … [Laughter] But it does show you how long we have actually had a dedicated helicopter service here. March 1992 was when the hangar in Omahu Road was opened, and we were there for nine years before the space was needed for pressing things. And the new hangar, as you all know, is over in Orchard Road. In 1992 I underwrote that for $85,000 – that’s all they needed for a year’s operation. Now we need two and a half million dollars to make it go, and it’s a bit like a hay baler … hay baler goes along and the straw goes in there; helicopter goes along there and the money goes in there, and out the back the doors open and some very grateful person gets out limping, staggering, or on a stretcher. So you know, it’s that good. Beauty.

So on July the 1st 1993, Healthcare Hawke’s Bay commenced, going on from the last committee with all appointed members – all appointed. And it staggered on for a while. So 1994, the planning for the acute hospital kept going, and the Napier City Council request for a High Court review stalled the decision, so we were put off while Court proceedings were going on.

1995 – Napier City Council request for a High Court review was finalised, and the company, Healthcare Hawke’s Bay, reconfirmed it’s decision to site a regional facility in Hastings. And virtually nothing had changed from the Booz Allen report that came in in December 1990, so … five years. Five years, the Napier City Council kept us on the back foot for a while. All that went up was the bill, and detailed planning for the regional site continued and the first contract was let in ’96, so you can just see how long some of these things take to go.

There are lots of things as a layman that you look back on and wonder about – whether you got it right, or half right, or any of those of kind of things. One of the most important stats that have [has] always been with me since I left, and having sympathy with the people of Napier who’ve lost their ‘on the site hospital’ was national statistics as you’re going to go to hospital once every fourteen years … once every fourteen years somebody from Napier’ll have to come over to Hastings. That’s on stats, but it’s still not that far, is it?

With the possible amalgamation of the whole East Coast Regional Authorities, there seems to be a fair bit of feeling about Wairoa and Central Hawke’s Bay representation on a bigger body. I’ll have to share with you that Wairoa made the final decision on me becoming Chairman, and Wairoa made the final decision on the Hastings site. So if you’ve got the right people with the right skills, there’s nothing to worry about being there, just … people respect ability and that’s all you’ve got to have – ability. That’s all you’ve got to have.

Don’t think there’s much else I can tell you. I’ve just freshened your mind up on who was the MP for Hastings in 1990. [Chuckles] Right, I think that’s about all.

Cynthia: Questions?

Andy: Yeah. Is that how you remember it, Jean?

Jean [audience member]: It sure is, and it still continues.

Cynthia: So in hindsight, Andy, are you probably still disappointed that it took so long? What would you change about it – anything?

Andy: Well, I actually wonder if the Board hadn’t’ve been sacked, whether we would have got this far. You’ve all been to meetings where somebody moves an amendment to the motion … you like the motion, but somebody moves an amendment to the motion. The Chairman has to accept it to get it through, but it normally means that the motions been watered down in one form or another, and I actually believe if the Board had ticked on its form that it was in then, that we would have had a heap of motions. Now the medical people will tell you that all being in one base [has] got a few pluses; being able to run training schools for junior staff has got some pluses. From my point of view, one of the good things about being associated with the health system was that virtually everybody in the system has a university ticket of some kind, so they’ve got academic leanings – I suppose I could put it like that – which means they actually think about your questions, and they actually answer it with a reasonably well-formed opinion, which is pretty important to try and drive these things forward, that the staff are with you.

The biggest job we have in Hawke’s Bay is changing the culture, and that’s what we’re up against with the amalgamation of the Councils, is changing the culture of the people that … just have a bit more faith in doing things on a bigger scale. There’s no doubt about that, but that’s not an easy thing to do. I mean the medical staff, I’ve always believed are fabulous. And one of the interesting stats with the medical staff, is that while they’ve got the longest university time to get their ticket, there seems to be less of them in jail than there is accountants and lawyers. [Laughter] So I don’t know whether they have longer to brood on it over a beer or not. [Laughter] I apologised before I started [chuckles] … a million apologies.

Question: Eighteen years on, what’s your view of how successful the amalgamation and the development of the regional hospital has been?

Andy: Well, pretty good – I don’t believe that the government … well, the government wouldn’t’ve funded us carrying on with two sites. We had to get real. Now the government always love two communities fighting ‘cause they don’t actually have to do anything. “You fellows go back and sort it out, and when you’ve sorted it out come and see us, and we’ll get right onto the job.” While the research from Booz Allen was going on, both sites acknowledged that they needed a bit of an upgrade – earthquake and fire, and all the rest of it. So both sites needed about $36 million spending on them just to bring them up to the upgrade. To do both sites was going to be more than the total … one shift, so the economics were actually pretty good. So we went from buildings that had quite a high maintenance cost yearly to buildings that weren’t brand new, but certainly seriously upgraded. And of course one of the things we never really solved is where the next earthquake’s going to strike, you know, there’s been a few close by, but at the hearings you hear it’s one in a million years or one in a hundred years, and the earthquake thing had been taken out of proportion in my view. Our local church in Waipuk’s been shut down. Now the chances of an earthquake at nine o’clock on a Sunday morning with eighteen people inside are pretty bloody remote. [Chuckles] So we’ve got to be careful we don’t overdo it. [Chuckles] Does that answer your question?

Question: Well in regard to the medical care, is it better than it was eighteen years ago?

Andy: Oh, yeah – a lot of young doctors now.

Question: Between the cities, and waiting lists, what’s happening with the one hospital now?

Andy: Well, you think about you going to hospital as a boy with a broken leg, you know, you were in there for two or three days, a week, sometimes in traction with plaster on your leg. Now you fall off your bike, break your arm, go in there – they put fibreglass on there and you’re back riding your bike in the afternoon. Everything happens a lot quicker.

David?

[Dr David Barry]: Andy, can I just make a comment about the clinical side of the story? By the late 1970s the only place for really sick people to go was Hastings Hospital, because the adult Intensive Care was there, and the special care baby Intensive Care unit was there. So the clinicians certainly in those circumstances, Intensive Care and special care or neo-natal Intensive Care … before it was terrible to have two hospitals. We still had people going to the wrong hospital; they had to be transported to Hastings if they were really sick and needed to have intubation, ventilation – all of those things. The idea that two hospitals could develop these services … impossible. They cost thousands and thousands of dollars a day just to keep one single patient. So the clinical story behind it was that the Intensive Care services were in Hastings from 1976 for babies and older adults and children, and Napier did not have those services. They had very good ordinary surgical services; ordinary medical services; but if things went wrong they could be transported to Hastings, and that was a major clinical driving point for us; most of the medical staff wanted one single hospital – acute hospital.

Andy: Summed it up better than I could. [Chuckles] Yeah. I mean before all this started, the ambulance drivers used to ring in and find out which hospital was working at night. You know, if they picked up a guy … might’ve picked him up on a Napier street, but the orthopaedic surgeon on call was in the Hastings Hospital, so you’d got there, or the other way round. I mean, it’s only seventeen ks [kilometres] between the two areas.

One of the things that Wairoa made in their submissions, if you’re coming down from Wairoa in the helicopter – in those days you couldn’t land a helicopter on the Napier site – if you’re coming down from Wairoa in the helicopter you’re going along at a hundred and sixty ks an hour; it’s a minute and a quarter to get to the Hastings site, you land right outside theatre. And they came out strongly in favour of it. And I don’t know whether … now that we’ve got twin-engined helicopters … whether we’d be allowed to land in Napier. They do in Wellington, but I don’t know the answer to that. But that was one of the things that worked in Hastings’ favour – and the car parking, even though if you go down there now, you’d wonder where its all gone. [Chuckles]

Question: I’m new to the Bay. Was the Waipukurau Hospital … I went past it the other day, it’s an interesting heritage style …

Andy: Yes – if you want a brick path for your garden, we can do it …

Question: … was that part of the amalgamation or not? Or was that a separate issue altogether?

Andy: No, it was compulsorily amalgated by Helen Clarke in ‘89. It’s amazing how things have changed – it was the biggest employer in Waipukurau when I started in 1973. We had three hundred on the staff. I doubt if we’ve got thirty on the staff at our health centre. But everybody’s had to give a bit – I mean Wairoa’s given a bit of money back to the centre, and Waipuk’s given a bit back to the centre. Some of our forefathers took about $4 million out of Wairoa, and promised them a helicopter service.

But things have changed – like, I remember my first day on the Board, we were having a drink after the Board meeting and an old doctor, family friend of mine, said, “You know, boy – best thing that ever happened to medicine was motor cars and tarseal roads.” And if you think about it, it’s probably right. I mean nobody dreamed of helicopters in those days.

Question: Andy, I don’t know whether it was in your term or not, it might’ve been since then – all the land across the road from the hospital was sold, and that was done in seven or eight years …

Andy: I can guarantee it wasn’t done in my term. [Laughter] I can absolutely guarantee that. That’s one of the most stupid things I’ve ever seen. [Audience murmurs] Yeah, I’m a land hoarder. If I’ve got my name on the title nobody gets if off me. [Chuckles] And … I mean I agree with you – I can’t believe it, and now we’re a bit short of space at the Hastings site. You’ll never be able to buy it back. Anyway, without being cheeky, it was done by an accountant. [Laughter]

Question [Jim Newbigin]: Andy, what’s your feeling about the Cunliffe debacle that happened at Hastings – were you there?

Andy: No, I wasn’t there. No, I wasn’t. But just a bit of a light-hearted thing – the Hawke’s Bay Board, or the Hawke’s Bay Hospital members, are the most sacked members in New Zealand. [Chuckles] They were sacked before Waipuk got to Hastings, and then the year after the Area Health Board started they were sacked; and then they were sacked again in 1980. There’s not much job security in being a Hospital Board member. [Laughter] Yes.

But I believe the Board were right to … what they stood up for; they stood up for openness, transparency, all those kind of things, and I think that was important. But he is a bit inclined to go verbal easy. He would’ve seen when he couldn’t go to view the site of the Ruataniwha dam in Hawke’s Bay because the farmer had given two months’ notice that he would be calving cows in that paddock, and didn’t want them scared off by Wellingtonians in shiny suits. [Chuckles] That’s the way it goes. [Chuckles]

Joyce Barry: Andy, it’s fantastic. Any more questions?

Question: You were saying that you’ve got a lot of young doctors on the staff there now – are they from New Zealand or overseas?

Andy: Young being compared with you and me. [Chuckles] Yeah … yeah. So it’s the way you use the word. You really want to talk to somebody on the payroll, but they look pretty young, but so do the traffic officers when they speak. [Chuckles] “Here, have you been drinking, Mr Train?” [Chuckles] They look pretty young too. [Chuckles] I’m being flippant, but the answer is I don’t know.

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