• Primary Health Care for All

    I decided a few weeks ago to step down from my role as Chair of the Board of EBPHA, the Eastern Bay Primary Health Alliance. As I confessed to my friends and colleagues at a farewell they had kindly organised for me this week, I had known very little about how the health sector actually worked when I had been asked to take on the role eight years ago.

    Like most people, I had been vaguely aware that primary health care was about visiting the doctor when you felt unwell or needed health advice, and it also provided a range of other nursing and specialist services, all designed to keep you in good health so that you did not need to go into hospital.

    What I hadn’t realised was how complicated were the arrangements that made all this possible. I rapidly learned that primary health care depended on the skill, experience, commitment and sheer hard work of a dedicated team of qualified people, working as a team under the expert leadership, first, of our foundation Chief Executive, Steve Crew, and then of his successor, our excellent, able and young Chief Executive, Michelle Murray.

    My job was the relatively simple one of chairing a Board, comprising clinicians and representatives of iwi and of the wider community, and enabling them to provide to our
    excellent executive arm the strategic vision and leadership that would enable them to perform their important work to the best effect.

    I was fortunate in leading a Board that naturally gelled and was united in its determination to get the best possible results for the community we served. As our title indicated, our focus was the Eastern Bay of Plenty – with a particular emphasis on the “Eastern” – and the particular issues faced by our region were, for us, always front of mind.

    We have in the Eastern Bay a high proportion of Maori patients and we constantly struggle to eliminate the unacceptable disparity in health outcomes between Maori and pakeha. We also have a greater incidence of poverty and of the problems that it throws up. Factors such as these combine to create difficulties that are greater here than elsewhere.

    Poverty often means damp, overcrowded and unhealthy housing, and poor diet, from which flow a number of health risks. It can also mean that people are less able to travel to get medical care and, with less access to modern electronic media, are more difficult to contact. Cultural issues can mean a resistance to immunisation for small children and to breast and cervical screening.

    We have learned that there is no point in simply bemoaning these factors. We have to accept them for what they are and need to work with them and at times to use them to our advantage. We have come to understand, for example, that health care for Maori is greatly more effective if it is made available and delivered in a culturally appropriate way and – as often as possible – by Maori themselves.

    Does any of this matter? Yes, of course it does. If we can reduce the incidence of conditions like diabetes and rheumatic fever, if we can improve the mental health of our young people, if we can enhance the care available to the ill and elderly, then we not only lessen the burdens on our hard-pressed hospital services, but we greatly lift the quality of life of our own people.

    As I give up my own responsibilities, I am absolutely confident that I leave behind a team of friends and colleagues who are totally committed to providing the huge blessing of good health to our whole population. I wish them well in the important and valuable work that they do.

    Bryan Gould
    5 September 2018

  • A Good Man

    Writing a weekly column requires that one should keep a close eye on, with a view to commenting on, the major events of the past week. President Trump’s latest travails or mis-steps, the latest ups and downs of domestic politics, the risks posed by major developments like global warming, the deficiencies of major organisations – these are usually the stuff of a weekly column.

    But every now and again, events much closer to home – more personal and emotional – take precedence. And so it was last week, when I attended the funeral of my much-loved brother-in-law, Douglas John Weir Short.

    Doug died after a long illness as he approached his 82nd birthday. He was a dairy farmer and kiwi-fruit orchardist who had lived and farmed all his life at Te Mawhai, just outside Te Awamutu, until he eventually retired to Tauranga.

    In his earlier years, he had been a very good sportsman, playing rugby for Waikato at junior level and was also an excellent tennis player, as I learned after many hard sets against him on his family’s tennis court.

    As a young man, he took over the successful dairy farm developed by his father, Jack, and as a farmer and orchardist, he was superb. He had a lively and enquiring mind and was always seeking better ways of doing things. He was in many ways an engineer manque, and he took great pride and pleasure in the successful engineering career of his son, David.

    He was also the hardest worker you were ever like to meet. As a young man, he would spend the summer hay-baling for the farms in the district, putting in many long, hard, hot days when he would rather have been at the beach. He did everything at top pace and optimal commitment.

    But Doug was most of all a family man. To him, family was everything. As his children and grandchildren movingly testified at his funeral, he was a wonderful father and grandfather, always supportive and loving and, most of all, fun. His love and concern for family extended well beyond the nuclear family and embraced all those within the wider family; my son, Charles, on his “OE” in New Zealand from the UK, was taken under Doug’s wing, and my own grandchildren recall with pleasure and sadness the fun they had, when little, as they prepared him, by scattering herbs over him as he lay on our sofa, to be “barbecued”.

    I had been his best man when he married my sister, Ngaire, and it was undoubtedly the close relationship that my wife Gill and I, back home on holiday from the UK, developed with Ngaire and Doug, on memorable touring holidays together in the South Island, that was a major factor in our decision to come back to New Zealand to live.

    My excuse for writing on this theme is not just a wish to pay tribute to a good, kind and decent man. I think the story of Doug Short’s life and of the contribution he made and of how much he meant to his family and community has a wider significance.

    It is people like Doug, up and down our great country, who have been the bedrock on which New Zealand society has been built over generations. We all owe him, and people like him, a great deal, and that debt requires us to go on building, in their memory, the good society they helped to create.

    Unlike me, Doug had little time for politics, but he provided an object lesson for us all – on how to lead a life that was worthwhile and well lived. His last years were tragic, in that he could hardly move though illness. But it will be Doug Short in his heyday who will live on in the memories of all those who knew and loved him.

    Bryan Gould
    29 August 2018

  • Teachers’ Strike

    Workers who go on strike, and thereby cause some inconvenience to the public, cannot usually expect much by way of public sympathy.  But last week’s striking teachers, like the nurses before them, seem to have been met with a great deal of understanding.

    This was, I suspect, because it was seen that their protest was not just on their own behalf as individuals, but was also directed at securing a better education for our children.

    I know from my own brief experience as a teacher that teaching is a much more difficult and demanding occupation than most people realise – and a recognition of that fact seems to have at last penetrated the public consciousness.

    Yes, the goal of the strikers was to secure better pay and conditions for each individual.  The sentiment that teacher s were under-paid was no doubt prompted by a sense of unfairness – that they were under-valued by comparison with other workers of comparable skill and responsibility, and that the way to remedy this was to put more money into individual pay packets.

    But the teachers were able to persuade most observers that their concern was not just for the size of individual pay packets but was also for the future of the profession and therefore for the future of education.  They were able to show that the consequence of paying less than teachers deserve was that it is proving increasingly difficult to persuade new recruits to join the profession, and then to retain them once they have joined.

    A shortage of teachers, and particularly of good teachers, is of course very bad news not only for the current generation of school children but also for our future as a nation.   We cannot afford to see a profession on which so much of our future depends in a state of such low morale and short of basic capacity.

    Yet, while the reasoning behind the strike may be widely accepted, there is still a puzzle at its heart.  As the strikers made clear, the problems facing teachers have not arisen overnight.  Indeed, they made a point of reminding us that it is 24 years since they last found it necessary to strike – their current plight has been building over much of that 24 years, and more particularly over recent years, when any attempt to avert the current crisis was abandoned in favour of cutting public spending.

    The puzzle is this.  Why did they not strike, or take other appropriate action to draw attention to the growing crisis, during the term of the government whose policies were largely responsible for creating it?  Why wait till a government more sympathetic to their claims was in office?

    The answer to that question is presumably that they feel that putting pressure on the new government is more likely to produce results – and that is probably true.  A Labour-led government has generally been better disposed to public sector workers, and teachers in particular, than governments further to the right.

    Yet the puzzle remains.  The strike will be widely seen by voters as a count against the new government, wherever the responsibility for its causes may lie.  The strike, in other words, is likely to deliver a political bonus to the political party whose government held down teachers’ salaries and created the current crisis in the first place, and it thereby makes it more likely that a government of similar persuasion will be elected at the next election.

    In education, as elsewhere, the new government is having to pick up the tab for the cuts in public spending perpetrated by its predecessor – and that tab is not merely a financial one (though the financial cost of making good the backlog is certainly significant).  But it is also the case that the new government must, in the national interest, face and meet the need for restoring necessary standards in a profession that has been underfunded and prevented from doing its best over a long period.

    Yes, the strikers’ case is a pressing and persuasive one.  But some strategic thinking would not come amiss.  It is in no one’s interests, least of all for teachers, that a leg up should be given to a party that would, returned to government, as the record shows, plunge us back into crisis.

    Bryan Gould

    16 August 2018

  • Professionals Do It Best

    The ruthless and self-serving use of the powers of patronage has been one of the hallmarks of the Trump Presidency. His purpose has sometimes been – as in the case of his appointments to the Supreme Court and other courts – to extend his political influence beyond the legislative sphere and into the judiciary and from the present into the future; at other times – as in the case of his appointments to ambassadorships – he has sought to bind his supporters to him by rewarding them for their loyalty (and often for their financial contributions) and so that, no doubt, others will be tempted by the prospect of a similar pay-back if they follow suit.

    The downsides of this practice include the real possibility that completely unqualified and unsuitable people are appointed to positions of responsibility – and there is another risk. The power of the executive in a modern country is already great enough without placing in their hands a further means by which they can control decisions taken by individuals – the hope of preferment could well inhibit a Congressman or an MP, for example, from defying the government whip.

    But these techniques are not unique to Donald Trump. Many governments across the globe – and New Zealand is no exception – have found it useful to use diplomatic appointments as rewards and inducements, and as a means of ensuring that loyalty to the cause – whatever it may be – can be guaranteed. Rather more justifiably, political appointments from the senior ranks of the governing party are sometimes made in order to assure the recipient country that the envoy enjoys the confidence of the appointing government.

    Reports that the term of former National cabinet minister, Tim Groser, as our Ambassador in Washington is not to be renewed suggest that this particular instance of a political appointment to a top diplomatic post has not been judged a success. The decision may reflect an assessment of Groser’s personal suitability for the task or of his lack of success in performing it – he failed to gain exemption for New Zealand from Trump’s tariffs on steel and aluminium, for example – but it may mean that there are at last second thoughts about the wisdom of appointing people with little or no professional expertise to take on such important responsibilities.

    Tim Groser had admittedly served at one point (without any previous diplomatic experience) as the Ambassador to Indonesia and was an experienced trade negotiator – and he was eventually an unsuccessful candidate for the post of Director General of the World Trade Organisation. His appointment as Ambassador to the U.S., however, seems to have reflected the view of the then foreign minister, Murray McCully, that professional experience in the sometimes arcane world of diplomacy was not a necessary quality in the holder of this important post.

    McCully made no secret of that conviction and, indeed, went further – proposing that it was actually preferable to appoint to ambassadorships almost anyone other than a career diplomat; it was a view that, it may be surmised, did not go down well in the Ministry of Foreign Affairs which McCully purported to lead.

    We now have, of course, a new government and a new Minister of Foreign Affairs. The decision on Groser’s renewal suggests that Winston Peters may have a more favourable view of the abilities of the senior professionals in his department than did his predecessor, though we will not know that for certain until a new appointment is made.

    If there has indeed been a change of heart, it should be applauded. I should immediately confess that I write from the viewpoint of one who served for some years in the British Diplomatic Service and who had the opportunity of observing at close quarters the demands made on the skills and experience of top diplomats. Representing the interests of your country requires more than a bit of glad-handing and wining and dining your hosts.

    It is not, however, just professional fellow-feeling that leads me to the conclusion that a country would be foolish to entrust its diplomatic representation to anyone other than the best qualified people. Protecting and advancing our national interests in the international sphere demands the best skills we can muster. This is no job for amateurs.  A more hard-headed approach is long overdue.

    Bryan Gould
    7 August 2018

  • Taking Up The Reins Again

    What should we make of the domestic political situation as normal business is resumed? As Winston Peters hands the reins back to Jacinda, and Simon Bridges considers the fallout from the National party conference, who has reason to feel pleased and who should be worried?

    It is a reasonable bet that Jacinda Ardern has the strongest case for satisfaction. She has, after all, achieved the first and (in personal terms, no doubt, most important) steps into childbirth and parenthood, and has returned to head her government with its unity and sense of purpose intact.

    Her brave effort at multi-tasking has so far succeeded, and has been generally commended – apart from a bizarre attack in print from an Australian feminist who berated Jacinda for devaluing motherhood by making it appear too easy!

    The other politician whose fortunes might have been compromised was Winston Peters. Serious misgivings were expressed by his critics about his taking over the reins of government but – as befits an experienced minister – he hasn’t put a foot wrong and has even distinguished himself by calling out the Australians on their immigration policies.

    With the support of his fellow-minister, Andrew Little, he has – not before time – held the Australian government to account for their shameful denial of human rights in their treatment of immigrants (including large numbers of Kiwis), and particularly of those below the age of majority, when they are held in detention in inappropriate conditions and denied access to legal advice, medical treatment and – in the case of school-age children – education, and are then deported without any legal process and merely by decision of the relevant minster – a minister who, this case, seems to think that young Kiwis with no convictions for any offence constitute a threat to the safety of Australians.

    It cannot be said that, in standing up for the rights of Kiwis, and for the international obligations Australia has undertaken to protect human rights, Winston Peters will succeed in changing the policies of the Australian government; but he has at least made it clear that their deficiencies in this respect risk doing serious damage to Australia-New Zealand relations – with the corollary that any failure to remedy the situation would lay bare the little value the Australians apparently now place on the Anzac partnership.

    While the coalition government can now feel that it has successfully negotiated what could have been a tricky period of uncertainty and lack of direction, the leader of the Opposition will have faced quite different challenges. It is a truism to say that a newly elected party leader will find his first party conference to be a difficult hurdle to clear. He will be expected to reinforce his authority, see off any potential challengers, and satisfy his supporters that they have made the right choice. He will also want to land some telling blows on the government and persuade the wider public that he is a Prime Minister in waiting.

    How did he fare? No too badly, but not as well, perhaps, as he would have liked. He suffered an unlucky setback when he referred to his deputy as “Paula Benefit” – a slip of the tongue of the kind that could befall anyone, but that inevitably caused some amusement – but it should, perhaps, provide an object lesson in the dangers of using a private nickname for one’s colleagues.

    His real problem, however, remains unresolved. He is constantly urged to make himself better known to the electorate, and he has worked hard at doing so; but the polls show that the voters have not warmed to what they know and see of him – and changing one’s persona is not easily achieved. I recall that Margaret Thatcher managed it, when she took voice lessons to change her hectoring tone to a more dulcet sound and thereby made herself more acceptable. The risk in making such an attempt, however, is that the voters are quick to detect and punish any perceived lack of authenticity.

    To sum up, then – Jacinda’s parental leave has been and gone without changing the underlying political balance too much. We have yet to see what, if any, response there might be to the emergence of little Neve Te Aroha into the public consciousness.

    Bryan Gould
    1 August 2017