In the fourth of a series on influential members of the Government, health reporter Martin Johnston looks at the performance of the Minister of Health, Tony Ryall, and his first year in the Key Administration and explains why he rates him 9 out of 10.
Tony Ryall hardly had time for a test spin in his Beehive chair before the accolades started rolling in.
As the new Minister of Health and Minister of State Services, who would have a role in restricting pay rises, he might have expected a cool reception from health unions.
But for three years as an Opposition health spokesman - National's most effective since it lost office in 1999 - he had carefully crafted strong relationships in the sector. He travelled and he listened.
The result was that within three days of settling into his new job, a round of mutual back-slapping began after he told a medical unionists' conference that he would allow the profession to elect some doctors to the Medical Council, reversing a move of the previous, Labour-led government.
"Senior doctors applaud the decision ... ," said the Association of Salaried Medical Specialists, an affiliate of the Council of Trade Unions.
Mr Ryall followed that in March with a similar move for nurses. "We are delighted ... ," said the Nurses Organisation.
The minister put his decision down to National's commitment to "clinical leadership and this includes trusting nurses to elect some of the Nursing Council".
After the 1990s National Administration taught the sector that business-minded managers were in charge, terms like "clinical leadership" and "trusting nurses and doctors" have resonance. Mr Ryall's speeches are rich with them, reflecting his leg-work in Opposition and the evolution of moves started by Labour. He has instructed health boards to give clinicians more decision-making power.
Overseas he found that "clinical networks" - doctors hooking up across boundaries - make health services more effective. Enhancing the prestige of health workers may also counteract the pull of higher salaries overseas, helping to solve the health workforce crisis without massive pay rises.
So to the "real" constituency, the public. Mr Ryall won early support with the populist move to widen access to the expensive cancer drug Herceptin. But perhaps his best public outing was in fronting media conferences during the early, uncertain days of the swine flu pandemic. He looked in control.
With the groundwork laid, it all seemed so easy for him to sell his biggest policy change yet, the restructuring of the Health Ministry and the merging of district health board back-office functions. Incurring only minor injuries, he has negotiated the potentially explosive advice of former Business Roundtable chairman Dr Murray Horn and his Ministerial Review Group on to the policy agenda, in a reduced form.
The cost-cutting Horn committee, comprising some of a wider group of informal advisers Mr Ryall is said to consult regularly, came up with radical proposals like putting private and public hospitals on the same footing in bidding for elective surgery contracts.
This had virtually disappeared by the time the draft became a final report, but the idea of creating a National Health Board to stand above DHBs and alongside a much-reduced ministry remained.
Mr Ryall ran with the national board - plus the Horn report's back-office merger and uncontentious recommendations - but he backed off making it a stand-alone agency, an idea on which he had already been publicly wary in part because of election promises to eschew "another round of restructuring".
Instead, he is creating the national board within the ministry. Whether the whole package amounts to restructuring is moot, but voters will forgive National if Mr Ryall achieves the savings expected and spends them on more healthcare.
Again the praise rolled in from the now-usual quarters over the board-within-ministry plan:
"We are chuffed that the Government has listened to advice from us and others ..." - senior doctors' union. "We are pleased that the Government and the minister have taken heed ..." - Nurses Organisation.
"... NZMA today welcomed the announcement ..." - Medical Association.
Surely this dream run can't last for a man in a portfolio which traditionally involves nasty public scraps over strikes, treatment delays from under-funded hospitals, or deaths due to medical mistakes.
Perhaps he will be dragged into a messy pay dispute. Health boards are lining up for what Waitemata DHB has told Mr Ryall will be staff-cost growth "based on a zero per cent increase on all employment agreements expiring during 2009/10".
Mr Ryall's main stumbles - and they have caused little if any lasting damage - have been to appoint Dr Horn to chair the National Health Board, inviting taunts of a secret agenda; his claim of success after rapid growth in elective surgery statistics, without acknowledging much of the increase was due to Labour's late-term efforts; and his seemingly politically motivated sacking of Labour Party member Richard Thomson from the chair of the Otago DHB.
He has incurred the ire of public health practitioners over cut-backs to anti-obesity funding, but these are in line with National's philosophy that what we eat and how much we exercise are matters of personal choice and not socially nor environmentally determined.
He bats this issue away as National wanting "more HA and less HE", a double-play on the Labour-inspired HEHA (Healthy Eating, Healthy Action) part of the ministry, and his disdain for such bureaucratic terms.
* Tomorrow, transport reporter Mathew Dearnaley assesses the performance of Transport Minister Steven Joyce
