The need for a culture change at the Accident Compensation Corporation has prompted the departure of the chairman, two board members, the chief executive and several officials. With the decks cleared, much of the responsibility for turning the ship around will lie with the board appointees announced by the ACC Minister, Judith Collins, this week. Unsurprisingly, the interim chairwoman, Paula Rebstock, will reprise her fix-it role at the table's head for the next three years. Other new appointments see Trevor Janes in the deputy chairman's chair and Professor Des Gorman and Kirsty McDonald, QC, on the board.

Ms Collins says these choices "underline the Government's commitment to genuine culture change, and will lead to a more balanced and comprehensive approach to the governance and operation of ACC". It is on that basis that the appointments will be scrutinised. Labour's ACC spokesman, Andrew Little, was quick to talk of "a sharp lurch to the right" and to zero in on Professor Gorman. The professor, head of the Auckland School of Medicine, had, he said, been a senior medical adviser to the ACC for many years, and "given some of the most retrograde advice on claimants' files I've known". He said the professor had been the subject of many complaints over his advice about occupational overuse syndrome in the 1990s.

That raises questions about the precise nature of the culture that will be implanted at the ACC. The first priority, in the wake of the privacy breach which saw details of 6700 ACC claimants emailed to Bronwyn Pullar, is no longer said to be cost containment. Rather, it is trust and confidence. But the criticism of Professor Gorman over OOS advice has had a recent echo in the stricter enforcement of the ACC's policy of declining to pay for surgery for "pre-existing conditions". To save money, the ACC seized on age-related degeneration of claimants' bodies to unjustifiably reject their claims for surgery after an injury.

On appeal, too many rejections of such claims were reversed. Understandably, this led to accusations that the ACC was too hard-nosed. The corporation, after an internal review, conceded as much, yet comments this year by the previous chairman, John Judge, suggested nothing much had changed. The ACC was still not getting the balance right in its decision-making.


An early task for Ms Rebstock must, therefore, be to respond to the criticism of Professor Gorman's appointment and to spell out exactly what it signifies. When the stricter policy for pre-existing conditions was introduced, there was no public notification of why it was necessary or how it would be applied. That lack of transparency is not sustainable. More broadly, the new culture must include a clear explanation of exactly where the ACC is headed under the new board.

The corporation should be involving claimants' surgeons more in its decision-making and applying extra expertise where necessary. It should also be explaining the reasons for its decisions more clearly to people. The "almost cavalier" attitude identified by official inquiries into the Pullar case cannot continue. But the changes to the way the ACC approaches its job, notably in keeping costs under control, should be kept in proportion. There can, for example, be no question of unworthy claims for surgery being approved with few questions asked.

The lessons of the Pullar case are that the ACC must be more sensitive, fair and open in its dealings with people. That culture change will not have to be as drastic as that needed at the top level to achieve it.