Ex-DHB Boss Breaks Silence | Newsroom


Canterbury DHB’s former boss says his decision to leave came down to integrity and ethics. David Williams reports

At least he laughed.

I’m on a video call with David Meates, the former Canterbury District Health Board chief executive, who beams in from southern England, just before Christmas.

I ask him if 2020 was one of the hardest years of his working life.

That would make sense because in August of that year he resigned after more than a decade in charge, following a showdown over plans for drastic spending cuts.

Pressure from the Ministry of Health, Crown monitor Lester Levy, and a board led by Sir John Hansen, prompted an unprecedented walkout. Seven of the DHB’s executive team, including Meates, resigned over six fateful weeks.

Former chief financial officer Justine White and Carolyn Gullery, the former planning, funding and decision support executive director, told Newsroom they left because of hard-headed officials and an unsupportive board.

“What was it like to be in that environment?” I ask Meates. His answer takes three minutes. (After which, I promise, there’s a laugh.)

“One of the beauties of Canterbury is actually over a whole decade we had some of the most challenging environments faced by any system or any organisation, certainly in New Zealand.”

After Meates took over in 2009, there were the Christchurch earthquakes, the terror attack at two city mosques in 2019, and, perhaps a little under the radar, Whakaari/White Island.  

“Canterbury and Waikato ended up with the biggest or the largest burden of burns from Whakaari/White Island.”

The DHB lost 44 buildings in the quakes, and did “not miss a beat”. Canterbury has, Meates says, what is internationally recognised as one of the most integrated health systems – with general practice and the hospital acting together in the same system – anywhere in the world.

“Those responses don’t happen by magic,” he says. “You just don’t make that stuff up when events occur. That’s really symptomatic of actually how well a system is responding, and how it’s able to weather kind of assaults that have been imposed on it.”

There’s a small personal admission – that a decade’s quite a long time in charge. But because the DHB was changing rapidly on so many fronts it was “quite stimulating”.

“Actually seeing a whole system being better together, and, delivering more, and making a really positive impact on the community by very much a joined-up approach.”

I can see why he’s a good CEO, I quip, because his response glosses over his own involvement. There’s a chuckle from the other end.

The protest outside Canterbury DHB’s offices in August 2020. Photo: David Williams

To be fair, Meates does give some direct answers.

Was he forced out? A difference in approach couldn’t be reconciled, he says – “that is neither good nor bad”. But in dealing with a capital-driven deficit in a way that would “result in a reduction of services”, or might “harm populations”, he faced a choice. His decision to go came down to integrity and ethics.

Did anyone explicitly say he should go? “Not that I’m aware of, no.”

Did the manner of his exit leave him bitter? “I’m not a person that gets bitter.”

(He adds: “When a community and a health system based in Canterbury had worked so closely and gone through so many collective trials and tribulations, there’s always a significant amount of you invested in that.”)

Meates also reveals that while he was at the DHB’s helm, he had multiple job offers from within New Zealand and abroad, in healthcare and other roles, but chose to stay on through the earthquake recovery.

“It was actually a commitment that I felt I’d made to a community.”

It’s easy to do window dressing, he says, but a lot harder to fundamentally change the way things are working. That goes to the heart of what drives him, he says.

His biggest verbal swerve is inevitable, given he received an exit payment from the DHB for “hurt and humiliation”.

In those tense final months – like clashes with Hansen and Levy at a meeting in March 2020 – did personalities come into it?

“That’s probably something not worth me commenting,” he says, diplomatically.

Perhaps comments on Meates’ performance are best left to others.

Tā Mark Solomon (Ngāi Tahu, Ngāti Kurī), a former DHB acting chair, addressed Meates directly at his farewell.

“David Meates: I’ve spent 25 years in governance, you by far would be the best chief executive officer I’ve ever worked with.”

Many people talk about values but few act on them, said Solomon, a former Ngāi Tahu kaiwhakahaere. “You’re a man of mana. You’re a man that carries your heart on your sleeve, and people respond to that because that’s what they see – they see the true man; the heart.”

His departure is something Canterbury will rue for decades to come, Solomon said.

Angry health staff make themselves heard outside a Canterbury DHB meeting. Photo: David Williams  

By Meates’ own admission, trouble didn’t start with the appointments of Hansen and Levy. There had been pressure over quite a number of years.

Stuff reported tensions between the DHB and Health Ministry have been evident since at least 2012, especially during the tenure of former Director-General Chai Chuah, a former Canterbury DHB staffer himself.

At Meates’ farewell, Solomon recounted his first encounter with Chuah – an induction trip to Wellington in 2016, after being appointed to the DHB board. It turned into an ambush.

Chuah told him: “You’ve got to get rid of the management, you’ve got to get rid of David Meates, he’s left a trail of debt and destruction.”

In 2015, Government ministers upbraided the DHB over its financial performance and management of quake repairs.

Then Health Minister Jonathan Coleman asked his ministry to review the DHB’s finances to “improve its financial sustainability”. At that point the deficit forecast was $18 million.

(Language is important here – one person’s “deficit” is another’s “underfunding”.)

A few years later the forecast was a $61 million deficit, prompting a ‘please explain’ letter from the ministry.

Treasury ended up accusing board members of being unable “or unwilling” to pull management into line, which was labelled a “Pearl Harbour style attack” on Canterbury.

In parallel, the DHB told a different story. Its deficit was a financial construction, driven by depreciation, capital charge and delays to the opening of the $525 million acute services building, Waipapa. Yet the ministry insisted on imposing business-as-usual financial strictures on it.

That hard-headedness continued despite multiple reviews rating the DHB’s (non-quake) financial and operational performance as among the country’s best.

Unsurprisingly, it’s a theme Meates warms to in our pre-Christmas interview.

He points to a recent clean report from Audit NZ, which rated the DHB as a good financial performer, and confirmed the ex-chief executive’s view its accounts had been significantly affected by the earthquake rebuild.

(Meates made that point in his final note to staff, adding that Canterbury was being short-changed by the population-based funding formula for DHBs.) 

When Meates was in the CEO’s chair, executives were being pressured to cut the deficit by $90 million in a single year, and return to breakeven within two years. Yet, two months ago, when the DHB’s latest annual plan was published, the projected deficit cut was only $27 million, down to $149 million, and a return to “surplus” won’t happen until 2024/25.

In comments that would have had every former executive choking on their cornflakes, Hansen, the health board chair, proudly pointed out the plan was the first to be approved by the health and finance ministers in four years – proof, he thought, the DHB was “moving in the right direction”.

That drive for savings comes amid a global pandemic, a shortage of hundreds of staff, and growing waiting lists for surgery. The plan is the DHB’s last, as under the Government’s health reforms they’ll be scrapped next year.

Using history as a guide

Scars run deep in Canterbury health.

At a noisy protest outside the DHB offices in August 2020, Susan Wood, the DHB’s director of quality and patient safety, clutched a copy of the 1998 Stent report – a review of Canterbury Health Ltd, as it was then, by Health and Disability Commissioner Robyn Stent.

Stent found a “grief-stricken health system” with a preoccupation for efficiency, funding and financial performance. Clinicians, meanwhile, were shut out of decision-making. It was a “miracle” more people did not die, the report said.

Turn the clock forward to 2020’s protest, timed for a meeting of health board governors, and Wood said clinical staff were concerned they weren’t being listened to. Concerns included planned cuts to nursing staff with expectations services would remain the same.

“The history of not being listened to in the world is usually results like this,” she says, pointing to the report. “The Stent enquiry, the Waitematā enquiry … New Zealand has its own Mid Staffordshires but we hide them, and they’re usually in the Health and Disability Commissioner reviews.”

In 2007, two years before Meates arrived, a lack of beds at Christchurch Hospital would regularly lead to gridlock in the emergency department. According to the book Rising from the Rubble, the system was fragmented and uncooperative. Overwhelming demand was hurting staff morale, who felt helpless.

Without changes, it was estimated a new hospital would have to be built, a 20 percent increase in GPs would be needed, and 2000 more aged care beds.

The DHB, the country’s second-largest by population and geography, serving more than half a million people, set about overhauling its services. Public, private and non-government organisations would work together for the patient. Clinicians helped to make decisions.

The mantra was doing the right thing, the right way, at the right time.

Trust was important. Trust in the capability of individuals, trust between managers and clinicians, and trust that another part of the system won’t undermine you.

Fundamentally, if the changes worked well, the DHB would regain the public’s trust.

Leadership courses were held, Project RED aimed to reduce waiting times and overcrowding in the emergency department. There was even a Dragon’s Den-style programme for staff to pitch ideas for improvements to the CEO.

The innovation drive was formalised under the ‘Canterbury Initiative’ banner. Meates took over the following year, 2009. Many of the planned improvements were accelerated after the quakes.

“In Canterbury, you’re 30 percent less likely to be admitted medically unwell compared with the rest of New Zealand.” – David Meates

In a 2017 opinion piece for Stuff, Dr Alistair Humphrey, writing as deputy chair of the Canterbury Hospitals’ Medical Staff Association, held up the DHB’s integrated patient management system as world-leading.

Life-saving patient information can be accessed by all healthcare providers, he wrote. A system called Health Pathways provides the gold standard of care for GPs and specialists to follow. These innovations have saved money, kept people out of hospitals, and been copied by health services in Australia and the UK.

Meates says there are big advantages to integration.

“Generally speaking, fewer people go to hospital. So in Canterbury, you’re 30 percent less likely to be admitted medically unwell compared with the rest of New Zealand. But on the flip-side of that, it also creates more capacity to do more elective services.”

Ironically, while Canterbury’s healthcare was being held up overseas as a model system, Meates was standing up against its unravelling through drastic – and some might say unnecessary – budget cuts.

That has sent him into the very arms of those wanting to embrace integration. A move to the UK was a bit of a no-brainer, Meates admits.

He’s now a strategic specialist health advisor for consultancy Lightfoot, which is working with health organisations or systems covering some 12 million people. (He’s also a senior associate at The King’s Fund, helping with leadership development.)

“The UK is in the process of setting up 42 integrated care systems – and they’re essentially the equivalent of district health boards.”

Yet, mid-next-year this country will abolish DHBs.

Meates believes New Zealand has an inferiority complex when it comes to healthcare – we’re always looking overseas for improvements. Yet, internationally we’re seen as reasonably cost-effective and efficient.

The performance of DHBs might be variable but he thinks they’re perfectly fine for delivering integrated care.

“People are seeing a structural change as a solution to that, when in fact the mechanisms that were already in place were probably not the wrong mechanisms, it’s just they hadn’t been brought to life.”

He’s happy to have a national conversation but is cautious when talk turns to Canterbury.

Meates says it would be inappropriate for him to comment on the direction taken by the DHB after his departure, and whether it will lead to the unravelling of the integrated care model. Even today, Canterbury’s clinical outcomes are among the “very, very, very, very best” in New Zealand and Australasia, he says.

While he’s enjoying working in England, despite the challenges of the Covid surge, he says Canterbury’s still home and he’ll end up back there at some stage. “I’m just not quite sure how or what that might look like just yet.”

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