KEY POINTS:
Perhaps the time has come for David Cunliffe to put the raw-meat-and-spinach diet on hold. Then again, maybe not.
There was laughter back in November when the new Minister of Health announced his arrival in the portfolio by pompously declaring: "I'm running this show."
No one is laughing
now. Certainly not the sacked chairman and members of the Hawkes Bay District Health Board. Cunliffe is running the show. He is the Cabinet's equivalent of Action Man brought to life.
His first four months in this difficult, frustrating and often unrewarding portfolio have seen the exercising of muscle in proportions akin to a body-building convention.
Before this week's drastic intervention, Cunliffe's tough talk and decisive actions had been working to Labour's advantage, notably in his dealing to the financially troubled Capital & Coast DHB.
The question is whether Cunliffe was just a little too decisive and just a little too uncompromising in the way he went about removing the Hawkes Bay board.
The backlash Labour has copped in the region is no reason to change his modus operandi, however.
This was a statutory decision for Cunliffe alone to make, not the Cabinet. Despite the political downside, within the Government the decision is considered to have been the correct one as it was the only realistic option. The appointment of a commissioner is the only guaranteed way of fixing the DHB's deep-seated problems.
Cunliffe kept the Prime Minister and other senior colleagues informed of his intentions. Helen Clark supported the move because the DHB was dysfunctional and a dysfunctional DHB is unable to offer optimal health care. Ongoing arguments within the DHB about who was right or wrong had simply become irrelevant.
Sure, Annette King must take some of the blame as a former Health Minister for the appointment of the board member whose alleged conflict of interest sparked the ructions that have seen the board at war with that member and the DHB's chief executive.
However, bringing in Sir John Anderson as commissioner is not some Wellington-based conspiracy to protect King. The infighting and personal animosities revealed in the pile of DHB documents and emails that Cunliffe released this week tell a torrid story of an organisation in chaos with fault residing on all sides.
The easy option - but the worst option - would have been some half-baked compromise that kept the existing board in place only for things to turn to custard at some subsequent point.
It is not Cunliffe's style to go for half measures. He is ultra-ambitious. In offering him the Health portfolio, the Prime Minister was punting on that ambition working to her advantage.
Such heavyweight portfolios are only offered to someone once. For Cunliffe, it was an opportunity to be grabbed regardless of it being a potential grave politically. Do the job well and further rewards would follow. Cunliffe could conceivably be Labour's next Minister of Finance. He could be in the running as deputy leader under Phil Goff when Helen Clark eventually steps down. Do the job badly and all that slips away.
Cunliffe knew what was expected of him: neutralise health as a political issue in election year.
He is also smart enough to know that being effective required a radical change in style in the way the portfolio was handled.
Cunliffe's approach has been in vivid contrast to that of his predecessor, Pete Hodgson. And presumably deliberately so.
In a portfolio where a political irritant at lunchtime can become a political headache by dinnertime, Hodgson had a tendency to stand back and wait for the relevant DHB to do something.
Cunliffe is far more hands-on and in-your-face. He is a new broom. He conveys a sense of urgency.
Just as well for Labour. For the floodgates opened after his appointment.
Apart from the shambles at the Hawkes Bay DHB, there has been the financial strife at Capital & Coast and ongoing crises at the Whanganui DHB.
On top of that, Cunliffe has had to cope with a torrent of official and media-generated reports pointing to serious faults and lapses of care in the country's public hospitals, while the health sector makes its perennial siren call for more funding to cover shortages of essential resources.
Given the length of time Labour has held office, there would seem to be nowhere for the Health Minister to hide from these report cards.
Cunliffe has not pretended the catalogue of mishaps and errors contained in those reports never happened. But they did not happen under his watch. He is painting himself as a break from the past rather than someone who got the job just because he was next in the queue.
And he is doing things differently, for example, breaking the unwritten rule that ministers keep well away from wage negotiations.
In talking tough, he has made the DHBs whipping-boys to some degree. They are going to take the rap when things go wrong, rather than the minister. The sacking of the Hawkes Bay board and Anderson's appointment thus serve also as a message to other DHBs about the limits of Cunliffe's patience.
This is fine for Labour politically when the DHB concerned cannot fight back - the case with Capital Coast Health, where the community's fears about the DHB's capacity to provide essential treatments far outweighed any sympathy for largely faceless board members.
It would seem to be the reverse in Hawkes Bay. The ousting of locally-elected board members by ministerial fiat has provided a lightning rod for dissatisfaction with Labour.
The strong community backing for the board and the accompanying backlash against the Government have obliterated any faint hope that Labour might have had of recapturing the Napier and Tukituki seats.
The main worry now for the party is what Cunliffe's wielding of the axe in Hawkes Bay will do to Labour's party vote not just in that province, but in provincial New Zealand as a whole.
However, rather than being Cunliffe's fault, the backlash springs from a fundamental weakness in the DHB model. DHBs are accountable to the Minister of Health for a simple reason. They are funded by central Government. Their assets are owned by the Crown. Yet they are supposed to be responsive to their local communities. At some stage the board of a DHB was bound to end up torn between having to be accountable to the minister but preferring to be accountable to its local community.
That has happened in Hawkes Bay. That tension has been in the DHB model since its inception in 2001. It is heightened by the minister being able to act as jury, judge and executioner with respect to a DHB's performance, while the community is relatively powerless. Beyond court action, the community's only comeback is at the ballot box.
The Hawkes Bay case is more the exception than the norm, however. When DHBs make serious errors there is usually little public sympathy for board members.
Cunliffe's strategy is to be far more assertive in siding with the public against DHBs even though responsibility ultimately rests with the Government as the holder of the purse strings.
Cunliffe's hustle and bustle in the portfolio is designed to disguise the latter connection. As long as the buck keeps stopping at the DHBs and goes no further this side of election day, he will have done the job Labour wanted from him.
