Health chief's smile reveals more than parting words

By MARTIN JOHNSTON, health reporter

You have to watch Graeme Edmond's lips for a slight smile which might add to his answers.

The 51-year-old yesterday left his $400,000-a-year post leading the Auckland District Health Board, New Zealand's largest and most complex health-delivery job.

In his last Herald interview as chief executive, Mr Edmond was winding down with casual dress, but his mind was as active as ever, as were his fingers, destroying paperclips and scraps of paper.

He kept his silence on the underlying reasons for leaving after seven years, sticking to the script drafted when his sudden resignation was announced last month - an unspecified difference of opinions between him and the nine-member board chaired by Wayne Brown.

Mr Edmond has no plans to mark his departure with attacks on the health system, but an occasional, secretive smile in our interview, almost a smirk, hints at tightly corked views.

How would you rate the board's performance, Mr Edmond?

"I think our board has embraced our direction well." Slight smile.

Anything to add?

"No."

He maintains his relationship with Mr Brown is cordial - despite the Government-appointed chairman's occasional criticism of him and other managers at public meetings and the board initially ignoring management advice on renaming Starship and other hospitals.

Asked about the board set-up introduced by the Labour-led Government, Mr Edmond praises the focus on population health, but joins other departed health chiefs in questioning the skill level produced by electing most members.

"I think probably a majority of [Government] appointees with the rest elected is a better balance. It enables you to get a better balance of skills and experience."

He remains loyal to the board and Government line on eradicating multimillion-dollar deficits without service cuts and the need for hundreds of job losses to help save $40 million a year after the shift to the new Auckland City Hospital in two months.

"I think the Auckland District Health Board has a stunning future."

But the smirk sneaks back during talk of the board being underfunded.

"It still has a raw deal on a number of the high-cost procedures and in dealing with difficult, complex patients. Renal transplants cost $60,000 and we get paid about $15,000. There's acknowledgment ... but still no permanent correction to it."

He admits that, under him, the board did too little to unpick these kinds of issues for the Health Ministry, but predicts that solving them will prove politically difficult.

"If there's no more money in the national health pie, solving those problems comes at the expense of other district health boards. That raises the question: Is it better to have one big unhappy board or 15 small unhappy ones?

"I won't answer that." Smile.

He points to a ministry-led review of what prices boards like Auckland, which do the high-level work, can charge others for treating their patients. "That will be the test."

Mr Edmond has tried to start national debate on the level of medical specialisation New Zealand can afford, but it has never progressed.

He says New Zealand spends about what it can afford on health, but attempts are made to obfuscate any discussion about the trade-offs caused by a capped health budget.

Without naming her, he cites Health Minister Annette King's quashing of the Waitemata Health Board's attempt to withdraw from infertility treatment last year.

These decisions, he argues, must be made more openly so the community can "own" them. The alternative is "unhealthy tension in the sector, which bubbles out as a deficit over here, a crisis over there".

Mr Edmond says when he started the job, he intended to stay five to 10 years. He has no definite plan, but is interested in the biotechnology area, or possibly an overseas health job.

But first he wants to resume morning walks, and to read the Herald without worrying about what's on the next page.

Fact file

Name: Graeme Edmond

Age: 51

Job: Chief executive of the Auckland District Health Board and its predecessors from 1996 until yesterday.

Salary: Between $400,000 and $410,000 in 2001-02.

Previous job: Head of Midland Regional Health Authority 1993-96, following a successful business career.

Business interests: Include deputy chairmanship of Optical Holdings, which runs Visique eye-care group.