Health system targets met, says departing chief

Three health ministers, one flu pandemic, a recession and a ministry restructuring are more challenges than most people would expect to face in a one-term job.

However, outgoing Director-General of Health Stephen McKernan appears far from burnt out.

After a Ministry of Health farewell yesterday, he flew home to Auckland, leaving one of the highest-paid public servant roles in the country.

A successor for the $500,000-a-year job has yet to be chosen, sparking speculation that nobody wants what is a notoriously difficult position.

Questions have been raised about the reasons behind McKernan's decision, with some suggesting political pressure from Health Minister Tony Ryall and a difficult relationship with National Health Board chairman Murray Horn.

McKernan denies this, saying his decision was based mainly on wanting to spend more time with his family.

For the past four years he has been commuting from Auckland, where his wife, 14-year-old twin boys and 12-year-old daughter have spent Mondays to Thursdays without him around.

He says it made sense to keep the family in Auckland, where he spent Fridays working from a ministry office. "The way the job is, there're lots of meetings at night, so they probably wouldn't have seen me," he says.

"It was better I just absorb myself in the job and do the commuting thing and try to be a bit more precious about the weekends."

He never knew how many terms he wanted to serve, but feels he has achieved his targets.

"It's been a big last 18 months implementing substantial change. The National Health Board, shared services agency – these things are up and running. It seems like a sensible time to move on," he says.

He describes the job as "hugely challenging but hugely rewarding".

McKernan started his 30-year health career working in Northland public health before becoming chief executive of the Hutt Valley District Health Board.

He admits he was naive about politics when he arrived in Wellington. He recalls the first time a parliamentary question came through and having no idea what to do with it.

He presumed a huge pile of folders on his desk on his first day must be three months work. It turned out to be just that day's work.

He regards his biggest achievement as a new health targets regime that boosted elective surgery levels by 20 per cent over the past two years and increased immunisation rates by 20 per cent over the past three years.

A highlight was representing New Zealand on the World Health Organisation executive when director-general Margaret Chan praised New Zealand for its quick response to the swine flu pandemic.

Among the challenges facing health systems worldwide, including ageing populations and the rising costs of technology, McKernan cites public expectations of health as New Zealand's biggest.

The internet age means patients can do their own research on the latest drugs and therapies, he says.

"They're hugely expensive, but people want and demand those. The impact on life and life extension can be very small, but it's still hope."

Managing those expectations involves making sure decisions about how money is spent are made in an open and transparent way, he says.

Future health services, he says, will look very different from today, but people can still expect a high level of care.

"At primary care, there'll be lots more contact with nurses, community health workers and multi-disciplinary staff, and the GP may be doing much more complex work currently undertaken in hospitals," he says.

"I would expect you would be largely managing chronic disease at home through technology with a link to your primary care."

McKernan will make an official announcement next week about what he is doing next. What he will give away is that the job is Auckland-based, in health and involves working overseas.

- © Fairfax NZ News