Doctor at war with red ink

By MARTIN JOHNSTON health reporter


Central Auckland's public hospitals survive in a state of financial crisis. The last time they were in the black was in 2000, when the former Auckland Healthcare Services, in the last full year of its life, made a $2.2 million net surplus.

Its successor, the Auckland District Health Board, went straight into the red and this year forecasts a $49 million deficit. The new Auckland City Hospital has massively blown its budget: by April it had gone $20.8 million over its planned $21.2 million deficit.

There has been management instability and an administration shakeup to save $16 million is under way. A streamlining of the top management in February saw the building programme's head, Nigel Murray, emerge to take the new job of Auckland City Hospital general manager.

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Former Army Major Nigel Murray knows how to handle nuclear weapons, possibly a useful skill in his new job running the sometimes explosive Auckland City Hospital.

But the fall-out at New Zealand's highest-tech hospital is from financial blow-outs and an alleged insufficiency of beds, rather than the risks he had to know about in Iraq.

Dr Murray has nursed the Auckland District Health Board's $500 million super-hospital and health clinic building plan from its infancy. He masterminded the business case which persuaded the last National-led Government to say yes in 1999.

He oversaw the main part of the building programme. And now, since March, he has been general manager of the new hospital in Grafton - effectively making him accountable for serving up the savings he promised it would make.

Those who know the history of Auckland hospitals' inability to live within their Government-determined means might think he faces an uncertain future.

So far, the statistics agree.

By April the hospital, just seven months after opening, was $42 million in deficit, $20.8 million more than planned.

The new hospital at Grafton and the Greenlane Clinical Centre were approved on the promise of $40- million-a-year savings, but the management has now revealed that the net savings, after debt servicing and other costs, are only about $5 million.

Yet Dr Murray, a married 49-year-old father of four, is adamant he can achieve the savings and make the hospital perform within its budget.

"It will work really well when it's all fine-tuned and bedded down and that all takes some time."

How much time?

"Think back to when we first started. The concept was eight years ago; a couple of years building it. We've still got $50 million to spend in the plan, out of $500 million. It will take several more years to get us into a stable, new Auckland City Hospital culture."

The plan was always to achieve the full savings over a five-year period, he said. "We are really in year two."

But some doctors argue that the hospital has already made big savings and that the real problem - Dr Murray disagrees - is having too few staffed beds.

At the last two monthly board meetings, Dr Murray and his officials have given answers on the minutiae of hospital operations, like the use of the transit lounge by patients being discharged, trying to convince board members they are doing enough to fix the deficit.

It seems mundane compared with much of his decade in the Army, where his posts included doctoring for the Special Air Service, for those hunting nuclear, chemical and biological weapons in Iraq, and for peacekeepers in Bosnia.

An occupational physician, he became the senior medical officer for New Zealand's northern military region. Earlier, he took on a project researching and developing high altitude parachuting.

He was promoted to Lieutenant Colonel to lead a field hospital but left, before he took up the post, for Auckland Healthcare. He wanted "to make a contribution" in the public health service.

Wellington-born, he speaks with an accent acquired growing up in the United States, where his cardiologist father took their family.

He returned to New Zealand, after stints with medical relief organisations in Africa, to do his undergraduate medical training in Otago.

Despite the difficulties of his new job, he said he intends to last the distance. "I made a promise to the staff I work for to stay as long as it takes to make it work."

Q AND A


Q. Are you the man in the hot seat?

A. I am accountable for the overall performance for Auckland City Hospital. So by definition it is a hot seat and so it should be as we spend nearly $800 million every year of taxpayers' money and care for New Zealand's sickest men, women and children.

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Q. Most difficult moment during the hospital building programme?

A. The most difficult challenge was to manage the substantial expectations of our clinical [staff] for new facilities within an affordable budget. A new hospital only comes up every 50 to 60 years and for most this was an opportunity of a lifetime to create the perfect configuration ... Inevitably this led to angst when we were finalising our plans ... We got through it and are now enjoying excellent facilities essentially designed by the users.

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Q. Most interesting/stressful part of your job?

A. Most interesting ... is working with so many passionate staff dedicated to public health service provision. An example of this commitment was the migration late last year of two hospitals into the new one. This was a colossal logistic effort. It was achieved virtually without a hitch. The stress comes when we have to postpone patients' operations due to resource limitations in our busy acute hospital.

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Q. Most tense meeting with board chairman Wayne Brown?

A. [The board conducts] regular probing and detailed questioning on our performance. I would expect nothing less.

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Q. Biggest challenge for the year ahead?

A. To maintain our staff's passion and commitment to the outstanding services they provide, while dealing with huge budget issues. The new CEO has challenged us to ensure that Aucklanders have better access to our services. To do this we will have to be careful in admitting only those patients from other district health boards that need access to our highly specialised services. We must also continue to focus on patients staying in hospital only as long as they clinically need to.



NIGEL MURRAY

Since March: General manager, Auckland City Hospital.

Since 1996: Senior management posts at Auckland District Health Board and its predecessor, Auckland Healthcare.

1996: Senior medical officer, NZ Army, with United Nations Protection Force in Bosnia.

1991-1992: Medical director, United Nations weapons inspection team in Iraq.

1990-1991, 1992: Group medical officer for NZ SAS troops.