Dr David Barry – Hawke’s Bay Hospital

Michael Fowler: Welcome everybody to the Landmarks History Group for November. [Applause] I’d like to introduce our guest speaker – last one for the year – Dr David Barry. David has been associated with the hospital for a wee while, haven’t you David? 1972, I believe, as a practitioner, and also many of you will know that he was also part of the Governance of the District Health Board for a while, so he’s intimately associated with the hospital from both angles. And of course he’s married to Joyce from Landmarks too, so … very important. So, I’d like to welcome you tonight, David, and we’re all looking forward to your talk on what is a very aptly named subject, ‘Fortuitous Journey’. Thank you very much. [Applause]

David: Thank you, Michael, and welcome everyone. I can be heard? That’s lovely. The title ‘One Public Hospital Hawke’s Bay’ – I thought for some time about what title I should give this and a few other titles suggest themselves to me. One was ‘A Tale of Two Cities’, but I believe it’s been used before, Charles Dickens or somebody used it.  [Chuckles] And Mark Fowler’s also used it in a presentation he gave about the transition from two hospitals to one hospital, so I thought perhaps this is more original. The other title that I thought about was ‘The Thirty-Year Gestation’, ‘cause I really think that it took about thirty years for things to happen, following the realisation by clinicians that we needed one hospital.

[Shows slides throughout]

Now here it is – it’s called the Hawke’s Bay Hospital Soldiers’ Memorial, it’s undergone a few name changes over recent times but that’s what its official title is now. The original title is “Hawke’s Bay Hospital” which wasn’t very descriptive, and probably not very respectful of the origins of the Hastings Hospital either. But you can see here the main entrance; the corridor going up to the cafeteria; behind that is the Theatre Block and so on.

Looking up from the Surgical and Medical Wards you can look down at the only original part of the hospital which is left which is the chapel there. Also, looking at the main entrance again, behind the chapel is the little courtyard to the right; further over to the right of the theatres, to the left are the outpatient facilities called Villas. So, that’s the Regional Hospital.

That’s the Children’s Ward – being a Paediatrician I’ve got to show you the Children’s Ward; the garden outside the children’s ward with the men’s and women’s medical and surgical blocks behind it – the big white building – and further in the background the Maternity Unit.

And this is to show you the other institutions that the Hawke’s Bay District Health Board has responsibility for. Top right-hand corner there is the building where the Board meets and where Management have their offices. Below that of course is the Medical Centre in Napier; below that again is the Central Hawke’s Bay Centre; centre at the bottom is Wairoa Hospital; and then the Chatham Islands. Some people forget that we also are responsible for the Chatham Islands medical facility there. So the Hawkes’ Bay District Health Board covers a big area … quite a few facilities. But of course that’s not all the District Health Board’s responsible for – it’s responsible for many of the health services that occur here including pharmaceutical costs. Much of primary care is paid for by the Government through the District Health Board and so on, so it’s a very big enterprise – around about $400 million dollars or a bit more a year it takes to run the services.

Now there are a whole lot of intertwining threads about this journey from two hospitals in Hawke’s Bay to one, and I’m trying to cover them using some of these headings as a guideline to take us all through. The historical basis – I’m really going to spend most of the history part talking about the development of the hospital in Hastings, because when there was only one hospital there was no problem about where a major hospital should be. But there are all sorts of events that led to two public hospitals being built here in Hawke’s Bay, and I’m going to cover some of the early historical events around that.

The medical change that occurred over time – in particular I’m going to be talking about critical care facilities for patients because, as time went by that become the most important lever as far as medical services went … in my view … that caused us to have to go to one major hospital. Political factors are always terribly important, and I’m going to cover briefly two aspects of this – the central politics … government politics; and local politics. And I’ve got to say that neither of them were very positive in terms of achieving a single acute hospital over time. They were generally acting in a negative way and I’ll explain how that came about.

The organisational changes in health – from late 1980s it was unbelievable the changes that were occurring, causing a whole lot of confusion and difficulties for people working in the health service. The community, ‘specially the Napier community – I think we must say something about that. They in the end lost their hospital, and a city – a proud city – that has no longer got a Public Hospital was a terribly big blow to a lot of people there. There was a lot of anger, angst, grief – and true grief about losing this. And I think that arose from the fact that the public, and I think a lot of other people in high positions who should’ve known better, had no idea about the way health had changed, and that we should have been looking at a regional health service and not at the building. Just because you see a building that’s impressive and situated in a prominent area, to think that that building held all the resources and help that was needed, was quite a mistake to make. And that’s a sad thing – I don’t think it was the medical community’s responsibility only, to educate the community as to the need for thinking about a health service rather than a hospital. I think it really belonged to the community, or the whole of the country as a whole, but it didn’t happen and it caused a whole lot of bitterness that continues unfortunately, still.

History – I’m going to talk a bit about people, facilities, events, demographic changes and medical advances. I’m going to deal with the bottom three quite quickly.

Important events – I mean there were a lot of important events, but the two that struck me when I read through some of the history of Hastings and Napier, and the development of the Hastings Fallen Soldiers’ Memorial Hospital, was the influenza epidemic 1919, when there was a huge amount of morbidity. A lot of people got very, very sick and Hastings people became very, very unhappy about the fact that the need for hospital beds … if the sick people needed a hospital bed it would have to be in Napier – there was no other hospital – and they felt very much left out at not receiving the services they should have been given.

And the other thing of course, in the earthquake of 1931 … a very important event in many ways for the development of Fallen Soldier’s Memorial Hospital … the whole of the Napier Hospital fell down. The Hastings Fallen Soldiers’ Memorial Hospital wasn’t damaged quite so much, and by then the population of Hastings had almost reached that of Napier. It was an … economic circumstances of Hastings had grown because it was becoming a very important agricultural centre, and a big push was made by prominent citizens in Hastings to re-site the Regional Hospital, and to say “look, this is the opportunity. Napier has shown itself to be unsafe in terms of earthquakes and what-have-you – let’s rebuild on a site that’s safer, more spacious and so on.” And that was really … an effort that was made, it was not supported by the Government – the central Government at the time was not acting through the senior medical person in charge of what was the antecedent of the Ministry of Health. But that’s probably one of the reasons why it didn’t occur. But it was a point at which a firm argument was made, not only for a bigger hospital in Hastings, but also for making it the Regional Hospital.

Democratic changes – I’ve already mentioned the population economic power of Hastings grew very much towards the end of the 1930s and early 1940s.

Medical advances I’ve already touched on – critical care services developed over time as you will see in Hastings. And in the end modern hospitals … public hospitals … were going to be really defined by the ability to provide critical care services for very sick people. And Hastings developed those services. Napier didn’t seem to be that … certainly weren’t against it, and didn’t seem to realise that this was where the modern hospital was going. You had to have critical care services to base everything else on.

Let’s have a look at some people.

Walter Shrimpton … Chair of Hawke’s Bay Hospital Board from 1909 to 1922 … a very important person because he was a Napier orientated man, as was the whole Board. He was very strong in resisting attempts by Hastings people to develop hospital services in Hastings. He did ease the argument a little bit by providing an ambulance service from Hastings to Napier, and also two public health nurses, one for Maori people and the other for the ordinary population, hoping to assuage the arguments and fighting and continual requests from Hastings for a hospital of their own.

George Ebbett, Mayor of Hastings from 1919 to ‘21, was a very powerful figure in developing an interest, and in fact raising funds for the building of a hospital in Hastings. He was perhaps even more influential in that particular aspect, as Chair of the Fallen Soldier’s Memorial Hospital Executive Committee from 1919-1929. In fact he would have been still Chair of that Committee at the time that the Fallen Soldiers’ Memorial Hospital was opened on ANZAC Day, 1928.

Cecil Duff – was a member of the Hawke’s Bay Hospital Board from ’29 to ‘37, and he no doubt had a great influence on helping to develop Fallen Soldiers’ Memorial Hospital from a small maternity hospital, which – the Hawke’s Bay Hospital Board tried to keep it that way, but – I’ll tell you about Henrietta Kelly’s money making a bit of a difference there – but I’m sure that Cecil Duff worked very, very hard to make sure that that didn’t happen, and that a small maternity unit developed into a full general hospital by 1937.

George Ebbett – nice picture of him. Mayor of Napier and Chair of the Fallen Soldiers’ Executive Committee.

This is what is written on the Memorial Plaque for Henrietta Lavinia Kelly. She’s … that’s this plaque, it’s in the Havelock North Cemetery. It was erected in 1936 by the Hawke’s Bay Hospital Board and this is the wording on it: ‘Born at Porangahau 1871 – Perished at Napier in Hawke’s Bay Earthquake 3.2.31 – Her generous bequest to the Hastings Memorial Hospital is an everlasting testimonial of her love and sympathy for the sick and the suffering.’ She died on the second floor of the Masonic Hotel in Napier where she was last seen by one of the serving staff at the hotel. Her body was never found and so this plaque was raised in her memory in Havelock North.

There she is, she’s second from left there. The other three women are her sisters – on the right is Albina, her older sister. They lived together in Knight Street for many years, here in Hastings. The other sisters were very prominent in providing legacies to St Matthews’ Anglican Church. When Lavinia was killed and her will came to probate, she’d left £35,000 to Fallen Soldier’s Memorial Hospital. This was a huge sum in those days – it was quite sufficient to provide the monies to change Fallen Soldier’s Memorial Hospital from, as I said, a small maternity unit to a general hospital – much to the chagrin of central Government and to the Hawke’s Bay Hospital Board. You get the impression that they did their utmost to try and freeze those funds for a long time … and they were frozen for about five years … and to try and stop this event, but it happened. There’s her plaque at Havelock North Cemetery, and on the left are her sisters and other family members. Her body of course, isn’t there because it was never found. It was kindly cleaned by James Morgan – James Morgan and Lily Baker were very helpful in allowing me to find out where this was – and James cleaned the surface of it and I was able to take a photograph of it. He’s very good at cleaning tombstones as well as everything else. [Chuckles]

Now there’s a card commemorating the opening of the Fallen Soldiers’ Memorial Hospital on ANZAC day 1928, and a picture of the opening day – a very big crowd. Some of the public meetings that George Ebbett arranged – they got two to three thousand people coming to them – they had huge meetings when they were trying to raise money and get this hospital going, so, it was a very, very popular move in Hastings.

The first resident Medical Officer of Fallen Soldier’s Memorial Hospital – and that’s Walter Reeve, and many of you will know Tony Reeve, who was a General Practitioner / Paediatrician here for many years. This is his father, and he was the resident Medical Officer 1937 to 1940, and by that time Fallen Soldiers’ Memorial Hospital had become a general hospital. That’s just a copy of the slide I showed you before, just to tell me where I’m up to.

Now I’m going to say a little bit about medical advances, because they were very important – particularly ones relating to critical care – and they developed as I mentioned earlier, in Hastings. Just going back into the history of this – I mean, it’s not that long since units of this sort first developed.

Peter Safar is given the honour, or the reputation of being perhaps the first person to get extremely interested in the ABCs of CPR. ABC of course is airways, breathing and circulation; CPR is cardio-pulmonary resuscitation. Now he’s thought of, certainly in the United States, as being the person who really got intensive care and critical care going, and tried to build a system of care from the accident scene where the ambulance arrived, to the operating room. You’re talking about trauma there. The whole idea was to have a unit where sick people, no matter what they were sick with, could be seen very, very quickly, and resuscitated. What we had up until then were very good physicians and very good surgeons, and they would see somebody who was sick, ruminate and stroke their chins for a while, and make the diagnosis and then get on with it – and did it very, very well. But if someone came in already carking it, and dying in a terrible state, you didn’t have an opportunity to do that – you didn’t know if it was medical or surgical or what. These units were the first units to recognise that if you resuscitated somebody, then you gave the clever people a chance to start finding out what on earth was going on, and if you kept their breathing and heart going long enough, they had a much better chance of surviving. And that was the whole idea. There were plenty of other specialised units before this – there were chest hospitals for instance; there were hospitals for the nervous diseases; there were all these special little units. But if you fell over there in cardiac arrest, nobody knew much about what you did – that was the end of it. So this was this different thinking, and in the same vein, William Silverman was one of those who first got the idea of doing this sort of thing for newborns particularly, neo-natal intensive care units. So these were the sorts of things that were going on.

Now it’s not all that long ago … because of my interest in Paediatrics I’ve given the timeline of neo-natal care. This is the timeline of neo-natal advances, and you’d get the same sort of timeline for an adult critical care too. There’s the Silverman I mentioned, in 1958, he discovered by a carefully designed study that if babies are very cold … or not that cold, but cold … then this led to decreased survival. Now people have known this for a hundred years, but nobody had done a proper study, statistical analysis, to show that that was really a very important cause of death. So this is the beginning of people looking at things, and looking at how you keep babies or adults or whatever, in a ‘parlour state’ … alive. So that was his contribution there.

Further down you can see – 1965, Louis Gluck was the first person that is seen to have formed a neo-natal intensive care unit, so providing all of these resuscitation and support systems to keep babies alive.

I don’t want to go through all of this list, it’s going to be too boring for you. I should mention 1972 though – Sir Graham Liggins, who died just a month or two ago. Many of you will’ve heard of him, a famous New Zealand Obstetrician, who discovered by giving steroids to mothers in premature labour, he was able to mature the lungs of those babies so they didn’t get the severe lung disease that babies otherwise got, and caused a huge increase in survival. A wonderful discovery. He was never sufficiently recognised for that – took about ten years for the rest of the world to adopt it … his methods … because after all it was discovered in New Zealand, and … who were they? Where did they come from? So you get all these things happening. But that was the sort of thing that were [was] happening – only in 1960s to 70s to 80s, so, things were … it’s a relatively new game, this idea of critical care.

This is just to show you – this is taken in the 1970s, and this is taken in our neo-natal Unit … our newborn unit we had developed here. And you can see the amazing amount of gear and stuff that these poor little babies had to be afflicted with in order to keep them alive from these various diseases. This machine here is a very primitive ventilator – it’s a machine that will breathe for the baby – the tubes are going into the baby up here. I’ll show you a close-up picture of the baby in a minute.

This is the Fisher and Paykel Humidifier here, to warm the gases that go into the baby so the baby doesn’t get cooled by the gases, and doesn’t get heated by them – it’s got to be the right temperature. These are monitoring equipments for oxygen levels; these are monitoring equipments for blood pressure and the like. So this sort of extensive intervention was what care was all about. Now I’ve got to tell you a little anecdote here – I can remember going over to do a ward round in Napier in their babies’ unit over there, and one of the senior practitioners came up to me and said, “when are we going to get our neo-natal intensive care unit here? We want one in Napier – you’ve got one in Hastings”. And I suddenly realised that a lot of people didn’t understand what was involved. This sort of baby required one nurse all the time, and we had about three of these going. So the sort of intensive care and equipment you can’t duplicate in a small population like ours. And I suddenly realised if doctors don’t realise what goes on in critical care, then how are the public expected to know that?

This is a close-up of the baby – I’ve got to pay a big tribute here to Dr Ted Ward, who helped very much in establishing this ventilation service … he’s in adult intensive care … to establish the critical care unit here. This is a tube … this is the baby’s nose up there you can see … the tube with the T-bars there. Huge anchor in there to keep the tube down the baby’s nose – why? Because there are only about two of us on call at any one time that can intubate babies. So if we were over in Napier – because we had two hospitals you had to go to Napier -and the tube came out there’d be dreadful problems, ‘cause nobody else could put the tube in – except if Ted was around in the critical care unit. So these were the things that used to go on, and used to … showed us, certainly in the 1970s, that this is ridiculous, having two hospitals and trying to run them in this way.

So critical care in Hawke’s Bay from the late 1970s – the best place for seriously ill patients by far, was at Memorial Hospital. We had the newborns, and the adult intensive care unit – who by the way had very good relationships with Paediatrics and also looked after very sick children. So they could do similar things to very sick children, like ventilate them and so on, as we were doing with the babies. So critical care was really in Hastings in the late 1970s.

Now by the time … of course we used to kick up a ruckus and tell all our managers and people – anyone who’d listen – how important it was that we went towards a single acute hospital. And eventually these clinical requests met a response, and Winston McKean put out a strategic long-term planning option in 1980, and he made these three proposals. He said: “look, over the next five to ten years we should develop a new single hospital for Hawke’s Bay, or;  we need to develop one of the existing hospitals as the acute hospital, the other remaining as a long-stay facility, or;  we should continue with two hospitals and rationalise services further.” We’d already rationalised services a lot by then, but things were always presented in options. You can never suggest anything to a Board and just give them one option – they don’t like it. But the option that you want of course, stands out like … and of course everyone wanted a new single hospital halfway between Napier and Hastings – why wouldn’t you? That seemed the obvious thing to do. Well, what were the reactions to the McKean proposal? Medical staff – yeah, definitely, they were all behind that. This is in 1980. Local government – screams and shouts – none of them wanted it. Why? I can assume that if you’re in Hastings and you lost your local hospital, that wasn’t a good thing. If you were in Napier and you lost your local hospital, that wasn’t a good thing. And if you were in the regional government I suppose you got voted in from both Napier and Hastings, so you’re on a loser. So it just shows the difficulty of … people who are elected have responsibilities to a small area, but don’t have regional responsibilities … that was my interpretation of it. Central government – what happened there? George Gear was the Minister of Health. “Too much!” he said. “It’s far too much. You can’t have a new hospital.”  Now, there’s one of the apocryphal stories I’ve got to tell you. The word was that George Gear also said, “those mad b…s up there – if they build a third hospital, they won’t close the other two, and we’ll have three hospitals up there!” I don’t know – he may not be too far wrong.’ [Laughter] But officially the reason was it was too expensive, and to look at rationalisation.

So that was very, very sad, and I think the Hospital Board was in its dying stages at that time, but not quite – and I think Winston lost a bit of oomph over that one. He certainly lost a bit more than oomph when we came to this – I’ve got to mention this piece of equipment. A computerised tomographic scanner had come on the scene and was recognised by everybody as being … it’s a wonderful piece of x-ray equipment. You get wonderful pictures of the head cavity, the chest cavity, of every cavity you can think of – it’s a marvellous picture, so much better than we’d ever had before, and everyone got very excited about it. The radiologists of course were extremely excited about it, but so were the clinicians – they could see great advantages for this. And then of course the next thing – we thought, ‘well, where are they going to put it?’ And those of us who were very interested in regional care of course said “well it should go where the sick patients are – for heavens’ sake, everybody knows that.” No. What happened? It was sited at Napier Hospital, because the radiologists thought, ‘wouldn’t it be nice to have a CT scanner, plus we’ve got the best ultrasound, plus we have the best this and that.’ So that they were thinking that you could have people from the CT scanner, to the ultrasound, to whatever.

Well, we couldn’t understand it. I think that this was the worst piece of health governance I’ve ever seen – I really do. The sickest patients were in Hastings, and the best bit of diagnostic equipment that we’d ever had went to Napier. And I was Chairman of Hastings staff at this … and I couldn’t believe it. I was overseas I think, at the time when this decision was made. I came back and I said to Winston McKean, “how can you justify this?” And he said “Oh, it’s only … the sick patients only have twenty percent of the usage.” I said, “Winston – they’ve got tubes down them, they’re on ventilators, they need about four people to bring them over to the hospital and go up a floor in Napier – it’s ridiculous! It’s crazy!” But it’s shown what … the ultimate fallacy of having two hospitals where you’ve got to have one regional service, because arguments about this happen all the time. It was a split vote in the Board as to where the scanner went, and they made the wrong decision.

Well just to add to our joy – the joy of clinicians anyway – was the organisational change in Health Administration. The Hawke’s Bay Hospital Board lasted a long time, well over one hundred years, 1876 to 1989. By the time they’d made the CT scanner decision, I thought it was time they went. I was happy to see them go. [Chuckles] Well, I was unhappy to see a lot of good people go, but you know what I mean – it’s really – they made a blue there.

So next one on the scene was the Hawke’s Bay Area Health Board – very short-lasting, three years only. And then we moved into the Regional Health Authorities and Crown Health Enterprises, which I’ll say a bit more about later – that was a government change. Change of government – remove the HFA and the HSS [HHS] – that’s the Health Funding Authority and the Health and Hospital Services. And then – change of government -District Health Board. So you can see what happens – you get very confused if you’re working in Medicine, and spent all of your life working in organisations that are run by people who change their names. You always distrust people that change their names all the time – you know that there’s something going dreadfully wrong with them usually. And this is a comment on organisational changes which I love and I like to show at every opportunity I get. It’s a comment by Petronius Arbiter in 210BC. He was having a bit of trouble with the Roman bureaucracy. “We trained hard, but it seemed that every time we were beginning to form up into teams we were reorganised. I was to learn later in life that we tend to meet any new situation by reorganising, and what a wonderful method it can be for creating the illusion of progress while actually producing confusion, inefficiency and demoralisation.” [Laughter] It’s been going on a long time [chuckles] – two thousand years at least.

Anyway, let’s pay due tribute to the Hawke’s Bay Area Health Board. It wasn’t there for long, but Peter Clarke and the Chief Medical Officer at the time, Dr Jones … Harry Jones … saw that – “look, this … the continued two hospital thing can’t go on.” I mean everyone knew that, and so they decided they would have a review. Another review. This time, a formal review. And I was still Chairman of the Staff at that stage, and Rodney Walker was Chairman of Napier, and we got together a selection committee to choose a specialist group who would review this topic: The Evaluation of the Feasibility of Consolidating Inpatient Acute-care Healthcare Services for the Hawke’s Bay Area Health Board. So we’re talking about acute hospital on one site – that’s what that garbage means.

Now, it was very interesting, the way in which they presented themselves. I’ve got to tell you a wee bit about the way in which the presentations were made. I think there were four or five consultants that were short-listed and were interviewed by us to be chosen, and one guy really – I thought gave a really brilliant presentation. And he started off by saying, “Do you want the $11 option, or the $400,000 option?” I think that was what they were going to charge for the consultation – it was somewhere ‘bout half a million, this consultation – not cheap. He said, “I’ll tell you what – I’ll tell the $11 option for nothing. I got a taxi up from the airport and I was driven up from Corunna Bay, up Main Street. And I said to the taxi driver, “where would you put a Regional Hospital for Hawke’s Bay?” And the taxi driver said to me, “do you think it’s sensible to have a hospital up a bloody road like this?” So the $11 option was Hastings, and it was made by the suggestions made by the taxi driver driving up Main Street. [Chuckles] So this is how he presented it, and I thought that was a pretty good presentation. In the end they weren’t the Consultancy chosen. We chose Booz Allen Hamilton. My reason for going for them – I’m not sure how the Governance Board went in the end – but they were certainly the ones that we favoured, and my main reason for it was because they were overseas. All the other companies had offices in New Zealand, and I was so concerned about what I’d seen over past times, I thought ‘anybody [who] can be got at, will be got at. If we get an overseas firm with a good reputation, they can probably not be got at so easily anyway, as a local firm might be.’ So I was very, very pleased when Booz Allen Hamilton were chosen to get the Lend Lease Corporation to do this study.  This is what they came up with:  ‘Yes, a single acute care facility should be placed in Hastings; all obstetric services should be placed in Hastings; all children should be located together in a children’s unit.’ We had a little bit to do with that. ‘Napier may retain clinics and long stay geriatrics, although probably located in town closer to the community’.  ‘Cause they felt that … and they gave very good reasons for all of this … there were financial advantages, there were geographic advantages … there were all sorts of advantages, and they itemised all of this. Well – you can imagine how this went down in Napier.

‘Former Mayor Speaks Out Against Proposal’ – it was put out for consultation, to be fair. So here we are – former mayor speaks out – this is Dave Prebensen.

Mrs Tolley, who has moved on from Health to Education now you’ll notice, [laughter] but she said the claims weren’t supported by the facts.

The Specialists say Hawke’s Bay Needs Two Hospitals’.  Well the specialist who said this … once the report came out, my dear colleague, Rodney Waterworth, had an epiphany, and [chuckle] whilst formally agreeing with the idea of a single hospital, and probably that it should be in Hastings, he got absolutely, I think, pressured by a lots of his colleagues at Napier Hospital, and others. And next thing we know they were presenting either two alternative plans, one for a single hospital on a different site, or for Napier Hospital to be the acute hospital and Hastings to be the other one. So all this sort of happened.

Here’s a picture of some of the people going on their tour … during the situation where the Booz Allen Hamilton proposal was being discussed, they had all these tours of both hospitals. There’s Andy Train who was Chairman at that time, of the Board;  Geoff Braybrooke;  Alan Parry-Jones who was the Chief Medical Officer, and others touring Hastings Hospital. It got very, very rough.

Mammoth Task of Board as Judgement Day Looms’ – ‘cause they were going to have a period of consultation and then going to make a decision – and our department featured here – ‘The other intriguing issue which has emerged, is the much-hinted hidden agenda being carried out by the medical Specialists … have been a major driving force behind the move to establish a single acute hospital. Suggestions have been made that these Specialists, such as the Paediatricians, are keen to see just one hospital because it would make their own lives easier and smoother.’ [Chuckles] Really did annoy us, but there we were – that’s the sort of stuff that was going on. Some of the doctors in Napier were saying the same things … that we wanted more staff and so it was a way of getting more junior staff, and all of these things – it got very, very bitter.

And in the end the board made no decision. In fact, by the … well, in a very short time they weren’t there any more, and a new government was brought in. And they created a new system altogether – the Regional Health Authorities and the Crown Health Enterprises. This is an entirely different model called the funder / purchaser / provider split. The funder was the Ministry of Health, or it might have been called the Health Department then. The purchaser[s] were the Regional Health Authorities, and the providers were those that they brought services from. Now the whole idea of the purchaser was – the purchaser would now purchase health services for the public from not just the public hospitals, but from anybody else who was prepared to offer them at a better rate. So it was very much a business model; it was profit-generating … it was supposed to generate profits … trying to get profits out of public health is pretty difficult. And there were going to be user charges for some services. So all this came in, and then there was an interim Board while all this was being established, and then Health Care Hawke’s Bay was established which was going to be the permanent Board. So all of this was started off under what was called an Interim Board, or I think the Transient Central Authority or something … Transient Health Authority or Temporary Health Authority … a very important Board. But the interesting thing was that it seemed to be that somewhere in … oh, before I go on to that I’m going to tell you what … Tom Scott produced this brilliant cartoon about the idea of the funder / provider bureaucratic health management. And he’s put this cartoon out: ‘When Treasury finally gets around to restructuring the human heart, we consider the relationship between the left and right ventricles far too cosy.’ Now the [chuckles] promoters of this system said “look, the relationship between the funders and the providers is far too cosy.’ So he’s just saying this sort of thing … ‘the relationship between the left and right is far too cosy. Our proposal is to separate the heart into four isolated chambers located in different parts of the chest. They would then tender independently for the right to pump blood to particular parts of the body. [Chuckles] Competition should improve the overall cost efficiency of the blood vascular system.’ [Chuckles] Oh, it was a really, I thought, a wonderful cartoon to show perhaps some of the drawbacks.

But anyway, to get back to Health Care Hawke’s Bay, they came in after the Transient Health Authority, and the Chair at that time was Peter Wilson. The Regional Hospital Task Force was chaired by Alistair Bowes who was CEO, appointed under this new scheme. And Alistair wanted to have the … [chuckle] he wanted to have the report out in nine months. Peter Wilson slowed him down a wee bit, and said, “no – we need to take a bit more care over this”.  And I think they got some consultants in – I think it was OCTA, as consultants. They also consulted with Sir John Scott, who was a very eminent medical man in Auckland; Professor Derek North, who was Professor of Medicine; Professor Alan Clarke, who was a wonderful man who was also a well known medical person; about where the Regional Hospital should be and so on. But they seemed to take it as read that the previous Board and the Transient Health Authority had already agreed that there was to be one Regional Hospital, so even though the Board had never actually been seen to vote on it before this, this was taken as a given. You try – I tried in vain to find out exactly where it was minuted that anyone had made this decision, or that it had been. Peter Wilson made a point that he wasn’t going by the Booz Allen report. Anyway, everyone rolls their eyes … “well the Booz Allen report is something that’s almost achieved now, so no – they were going to do something quite different”.  And the Regional Task Force was asked to look at things more or less from the beginning. Well what did they come up with? Well, surprise, surprise – Hastings Memorial Hospital would become the Hawke’s Bay Regional Hospital, and that was approved in July 1944. [1994]

Immediately, Napier City Council took Court Action, challenged the process, and said that it needed to be reviewed again. The Court agreed. The Napier City Council made a counter-proposal – I think it was for a separate hospital … separate from Napier and Hastings. This was rejected by Health Care Hawke’s Bay because the Court only allowed them another presentation to the Board, and didn’t overrule the Board’s power. And the Health Care Hawke’s Bay Board in March 1995 said “we’re going to have one hospital; it’s going to be in Hastings”, and that was that at that stage.

Then of course, there was the Health Funding Authority and Hospital Health Services – this is a new change. There’s a new government – the government only changed to the extent that Winston Peters came in, so there was a little tweak to the Government. They abolished user charges and the business model was going to be break-even, and not to make money. Well, I don’t know if any money was made anyway, but there we are. So that was the new model – that was the only difference.

And during all of this of course, developments went on towards establishing a single hospital. Another very interesting thing was that … I think that helped get this process underway … was that they were able to find $16 million dollars in the Health Budget for Hawke’s Bay, that had been isolated for purposes which were not entirely clear. And it was for redevelopment of Hawke’s Bay services, and some people in the central bureaucracy gave the opinion to the Board that it could actually be used for the development of the new hospital. $16 million dollars is not inconsiderable, and so that also helped an awful lot in pushing this project forward. But again – finding documentation … who made the decisions … it’s all a wee bit hazy.

Anyway, new government again in 2001 … Labour government came in. Back to majority elected members to the Board. The funder / purchaser / provider split was separated or modified, and we went on to have the Napier Medical Centre and Hawke’s Bay Hospital Soldiers’ Memorial both officially opened in 2000.

The transition through ‘95 and 2000 was very, very difficult. Peter Wilson … I can remember that I was in a certain situation at that time where I reviewed a lot of the literature sent to Peter Wilson and to Mark Flowers, and honestly! Some of the terrible things that were said to them and written to them by people who signed the letters – I couldn’t believe it! It was an extremely difficult time for them – I felt extremely sorry for them, I thought they went through hell, really, trying to get all this thing done. I mean it wasn’t as though it was anything personal, but they were treated personally. I can remember letters that I viewed – I was on the committee of the Regional Health Authority at the time – and we had to review all this stuff and I can remember seeing letters threatening people’s livelihoods, and welfare, and physical health and everything – it was dreadful to think that people could go to that stage. But there we were – that’s what it was.

So, that’s really the story as I’ve researched it. Now is it all perfect? Are we all happy? And everyone’s pleased with the result? For the most part I think most people are. There are still a lot of people in Napier who are very unhappy – they still don’t understand why we had to have one regional Hospital, I think. And I think that’s the reason. But only a few months ago there was another letter to the paper saying that Napier Hospital … ‘it’s still on the hill, it could still be opened … John Key could do it’.  He’s very good with hobbits and things [laughter] or they could … the letter didn’t say that, but that’s what more or less they implied [chuckles] – that it only needs John Key to get onto it and get Napier Hospital opened again. John didn’t answer that question – or certainly not in public.

So, there we are – that’s the journey, the thirty-year journey I think, to the establishment of a single hospital here. [Applause]

Michael: Thank you, David.

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