In conversation with Jonathan Coleman

The government has lost confidence in figures produced by the former leadership of the Southern District Health Board (DHB), Health Minister Jonathan Coleman says.

Dr Coleman also told Radio New Zealand there was a sense of crisis in the community prior to the decision to sack the board.

He made the comments in a wide-ranging interview yesterday, marking his first year in charge of the health portfolio, about his decision in June to replace the board with a commissioner, Kathy Grant.

Q: One of your first major actions as Health Minister was appointing a commissioner to run the Southern DHB, when the DHB deficit was $27 million and rising. What's been achieved and are you confident that the deficit will not continue to rise?

JC: Yes, the deficit number was moving around and that was one of the big problems. It was the variability in the financial forecasting. We basically lost confidence in the figures that were being produced.

Governments have tried many things over a number of years with Southern DHB. It had got to the stage where there was a sense of crisis in the community. When we announced that the board would be being replaced by the commissioner, that was greeted with universal relief...

Q: How did you view the $27m deficit and will the new team be able to decrease it?

JC: The figure was going to be much worse for the next financial year with the draft indication we had from the now removed board. I've got every confidence that we are going to see some progress in that deficit being reduced over time.

We're just waiting to finalise the annual plan for Southern [DHB]... but you could expect to see a decreased deficit figure in the first year and that will continue to decrease over time.

Q: The financial review of the Canterbury DHB - can you say when that will be public? And is the DHB, which had the lowest funding increase of all DHBs in the last budget, at 1.5 percent, adequately funded, especially given the demands posed by the earthquakes?

JC: The main thing in Canterbury is that service provision has continued, people are getting the services they need in Canterbury. We've supported the DHB with deficit support over time - $70m, that's gone in there. I'm soon to be briefed by PwC on the financial review, so I'm awaiting that report and discussion with PwC partners who've been leading it.

I think that the board has been well funded, and if you look at service provision ... on almost every dimension that's increased over time. But there's no question there have been challenges in Canterbury and one of the reasons we have asked for this financial review is actually to get a very clear picture of what's going on there in terms of its finances. It's to help the DHB and it's so we can move to a long term sustainable situation there.

Q: Is DHB funding in general adequate? There's a sense DHBs are finding it harder and harder to make ends meet.

JC: Funding has gone up under this government. The vote's gone from $11.9 billion to $15.9 billion per year. At the same time, service provision has increased... If you look at elective surgery, medical and surgical first specialist assessments - they've all increased... Free 'under 13' GP visits ... so health is always tight. It's always difficult making the money go round, there's no question about that, but it's been like that for decades and decades.

Demand is increasing all the time. 110 people are added to the population each day, we've got an ageing population and there's more and more we can do for patients. So I don't think we're ever going to reach a situation where people say stop sending us money in health.

Q: How have free GP visits for children under 13 gone?

JC: It's gone extremely well. We had a very high initial uptake - much higher than for under sixes - 97 percent of practices signed up on day one, covering 98 percent of children around New Zealand. There's just a handful of practices around the country who aren't signed up and they're all in urban areas where there's easily accessible alternatives.

So it's exceeded everyone's expectations. There's been very little overall criticism. We said we would take a look at it to make sure that the funding levels are adequate, but we're very determined to make this policy work.

Q: Tackling childhood obesity was a specific task you were given by the Prime Minister, John Key, in this health role. Where are you at with that?

JC: We've been working on a package, we're in the final stages of completing that. It's really going to show some positive action to start tackling the problem.

With obesity, there's a wide range of views on what should be done. Some people will want more done, some people will want less, but in the end, it's getting the ball rolling and it is going to make a difference and show leadership in this area and show that the government is serious about tackling it.

Q: Radio New Zealand has reported that the Health Ministry has required senior managers to sign statements swearing that they did not leak contentious proposals to reform the funding and make-up of DHBs. Is there a bullying culture in the ministry?

JC: There is definitely not a bullying culture in the ministry. Our political opponents will try and stir up that sort of mayhem and try to make trouble around that...

I think the ministry is extremely well-led, it's got a difficult work programme and people are focusing on getting on and delivering against the government's policy goals.

Q: How are relations between the ministry and DHBs?

JC: In general, I think very good, but you know it's tough delivering in health and obviously sometimes there have to be tough conversations, so it's obviously not always going to be all sweetness and light. But at the same time people are focused on delivering better outcomes, both at the individual and population level.