Few community services have the potential to galvanise public action like health, and in Marlborough particularly the top-heavy population brings health-related issues quickly to the boil.
It's a fact all too well known by Nelson Marlborough District Health Board chief executive Chris Fleming, who faced the wrath of senior residents after only a week in the job.
Chief reporter Ian Allen sat down with him to reflect on a busy nine months since getting his feet under the desk and to find out more about the man behind the chief executive........
Sitting in front of 1000 angry people at a public meeting in Blenheim, the region's new health boss struck an uncomfortable and lonely figure.
He nervously sipped from a glass of water while the other panellists looked more relaxed.
They were nodding and smiling to familiar faces in the crowd who had, at least, left their pitchforks at the door.
TV news crews were setting up as the Marlborough Convention Centre staff opened up more space for the growing crowd, concerned about possible service cuts at Wairau Hospital, in Blenheim.
On several occasions, Mr Fleming flicked a glance for help to board chairwoman Jenny Black, sitting in the front row.
None was overly forthcoming.
Here was a man, only seven working days into the job, seemingly hung out to dry by his new board - asked to front up for their mistakes.
A man who, three months earlier, was rushing to his daughter's high school graduation when he got the phone call that the chief executive's job was his. But he kept the news a secret, not to overshadow his daughter's big day.
Mr Fleming admits that public meeting in Blenheim in March, organised by campaign group Save Our Services, was a difficult start to life in the region.
"Some of the questions I couldn't answer because I didn't have the details," he said.
Nevertheless, he spoke well and attempted to backtrack on the infamous board discussion paper that mooted a possible reduction in general surgical and orthopaedic services at Wairau Hospital.
Despite the public outrage, which claimed a culture of home bias from a Nelson-heavy health board, Mr Fleming said he enjoyed the meeting.
He valued listening to the concerns of a "sizeable chunk" of the community, he said.
"It sent a loud message and was more effective than, say, if 100 people turned up. I still recall one comment from a woman who said she looked at health, education and employment before moving here - it was the whole package."
Mr Fleming was pleased the meeting was well managed, though, and didn't descend into a rabble.
The proposed cuts were revealed in January when the board was headed for an $8.3 million deficit by the end of the financial year.
In his first four months, Mr Fleming had reduced the arrears to $3m and the board is expected to break even this year.
But the savings came at a cost and Mr Fleming said in June he expected between 30 and 40 jobs to disappear as part of the recovery plan.
In his defence, he hasn't shied away from making cuts at the top end, reducing his executive leadership team by four with savings of $500,000.
"I've been pretty firm on tackling the deficit but it's not an invigorating environment to be in," he said. "Staff are prepared to face the financial challenges in the short-term but when it becomes a way of life it becomes very demoralising."
Months on from that public meeting in Blenheim, the modest chief executive looks far more relaxed sipping his trim flat white at the Wairau Hospital cafe. He plays down his role in bringing the board back from the financial brink.
"I wish I could say it was all because of my wisdom and skills but the organisation had started before I got here. My leadership reinforced the expectation that we deliver on our commitment to complete the reviews that we start."
To abandon the proposed surgical reshuffle would have been the easy option in response to the public meeting, he said.
"But, actually, people raised significant concerns about the clinical sustainability of services. The worst thing for the community would have been to walk away from it . . . but it would have been the easiest."
Did he know the full extent of the financial challenge when he accepted the job while rushing to his daughter's graduation?
"Probably not . . . but I would have still jumped at the chance. I saw it as a challenge and thought I could add some value in terms of working through those issues."
A chartered accountant by profession, he was asked during the recruitment process how he might tackle the deficit, which was a fairly typical question for a chief executive's position, he said.
It culminated in a lengthy interview process with the full health board and sessions with members of the executive leadership team, senior health professionals, doctors and GPs.
"They simply wanted to know the type of approach I would be taking to address some of the challenges and performance issues. I think any of the final four [candidates] would have been capable of doing the job. [At that stage] it's not about your ability, it's about the dynamic and the fit."
Mr Fleming moved to the top of the south from Timaru, where he had been chief executive of the financially sound South Canterbury District Health Board for five years.
Even the move to Nelson was relatively hectic.
The family didn't move into their new home until July. They left all their "worldly possessions" in their Timaru house to help push through a sale there, he said.
"I finished my last job on the Friday and my son wanted to start the new [school] term on the Monday to meet friends."
It was one of the tougher moves on his family, who had previously followed Mr Fleming to Montreal, Canada, and Sydney for work.
"This time was tougher because my daughter was heading off to university and my son was 15 at the time. There were a lot of changes all at once."
He had enjoyed his time in Timaru but was ready for a bigger challenge - the Nelson-Marlborough region is about three times the size of South Canterbury.
His move into health 22 years ago had been fairly accidental.
"The honest reason, I was working for Telecom in Hamilton . . . they were going through a significant restructure and it would have meant a move to Wellington. That just wasn't right for me and my then fiance," he said.
"Health was going through the process of wanting to bring in a more business focus and that fitted my skills."
Working in the health sector had a profound impact on him though, after spending much of his early years reliant on the health system.
"For the first decade of my life, I wasn't growing and needed growth hormone treatment," he said. "When I left school I was about the fourth shortest person in the whole school. My kids still make fun of me because they have seen the photographs.
"It's good to be able to laugh about it in hindsight. But it's left me with a degree of perspective. You have to be open and transparent because you are making decisions that are going to affect both the life of the individual and the wider family.
"My parents had to make some decisions about the treatment I would get."
Whether you worked as a doctor, nurse, in IT, accounts or as a cleaner, you were adding value to your community, Mr Fleming said.
The biggest challenge was trying to get more out of the funding provided, he said.
"The district health board gets $420 million a year in funding; I'm sure I could spend $800m if you gave it to me.
"You are always striving to see what you can do better. That gets into you . . . as opposed to a traditional route for an accountant - ‘how do you make more money'. You could enhance the service delivery in mental health, develop more community-based services, enhance aged-care."
It was rare to get a proposal that he did not see merit in, he said.
"You have to make some tough decisions. Do you buy another anaesthetic machine or a CT scanner? Or what about new furniture for a disabled support house?
"How do you compare the need for an anaesthetic machine and insulation for a house where intellectually disabled people live. You have to make a decision but they are almost impossible decisions."
The board couldn't go running to central government for extra funding, he said.
"It's our obligation to find that money rather than leave it in the too-hard basket. So how do we do that, what do we prioritise?"
Without question, Mr Fleming has made great in-roads into tackling the deficit in his first nine months but the board isn't out of the woods yet.
The people of Marlborough are likely to judge his early tenure on the results of the top of the south health review - prompted by the public meeting in March.
Mr Fleming has since repeated his commitment to "One Service, Two Sites" based on 24/7 acute and elective services in both Wairau and Nelson.
He will need to deliver on that promise when the review goes out for community consultation or engagement next year . . . or, this time, the pitchforks might not be left at the door.
- The Marlborough Express