Editorial: Hospital gets the hard word

It was only a matter of time before the chairman of the Auckland District Health Board, Wayne Brown, offended the doctors in his charge. Mr Brown speaks his mind and is not much given to dressing his thoughts in delicate phraseology. Doctors, on the other hand, are trained to do exactly that. They seem particularly disturbed at some blunt comments he made when he was profiled on television.

The editing deprived the remarks of much context but they gave the flavour of the man. He seemed to doubt the value of some of the work of junior doctors, now a greater expense for hospitals, and believed nurses could do better. And while doctors worked hard, he said, so did many other people. Pouring concrete for example. Try doing that all day. That was hard work.

Medical professionals are accustomed to a high degree of respect for their work - from grateful patients, from supporting staff, from the public which holds them in high esteem, from politicians who do not dare challenge that mana and, normally, from administrators who defer to their expertise. They are not used to a health board chairman who seems determined to remove their mystique and scrutinise their performance as he would any other organisation. And he has led many.

Mr Brown, an engineer by trade, has also been chairman of the Land Transport Safety Authority, the electricity lines company Vector, Northland Health and, until somebody checked the regulations, the Tairawhiti District Health Board. Despite his gruff manner - or perhaps because of it - he seems to be in demand. Evidently only a regulation prevents a good, keen man from heading two district health boards at the same time.

The Government must have known when it made Mr Brown chairman of the country's largest health board that he did not deal gently with sacred cows. Inheriting a $72 million deficit in board operations, he took aim at the Starship children's hospital, among other expenses, questioning its need of a separate neurosurgery unit and its very name.

Now many doctors have seen him on television and the Association of Medical Specialists wants him sacked. He, in turn, is aggrieved to be criticised by professionals he has never met. That, too, is a sign of how he works. Mr Brown deliberately keeps himself at a distance from the organisations he is appointed to oversee. He lives in the Far North, commutes to Auckland for board meetings and says he does not even keep an office at Auckland Hospital.

None of this will endear him to doctors, whose need of hospital offices he is now also questioning, but the public should suspend judgment. District health boards are obliged to see that the services they administer produce the maximum value for the funds available. They must constantly scrutinise the way services are run and chairmen such as Mr Brown are probably more effective if they keep themselves removed from the organisation.

Staff in any organisation prefer to think their directors are led by someone who speaks their language, shares their attitudes, understands the particular pressures of their work and appreciates their efforts. Ideally, a district health board chairman would find the words to reassure doctors and other health professionals of his sympathies even as he or she keeps the pressure on them to reduce waste, improve services and restrain their rising costs.

And ideally doctors would realise that every organisation can benefit from detached scrutiny and a challenge to its self-regard. Taxpayers need strong, independent public health overseers as much as we need sympathetic doctors and timely services.

Feature: Our sick hospitals