The story of Bill English, before he became a nice guy

by Branko Marcetic

With only four weeks out from voting day, the parameters of the 2017 election have already been set: it seems this year’s election will be decided on the basis of trust, stability and personal character. Metiria Turei’s admission of past personal foibles has already both knocked her out the race and potentially ended her political career, while Jacinda Ardern has revived Labour through sheer force of her own personal appeal.

Meanwhile, Prime Minister Bill English is presenting himself as the steady and stable, if not particularly exciting, “rock” that will steer New Zealand through the next three years. And so far it’s been successful — a recent poll found he was still the politician most trusted to do what he said.

Yet the New Zealand public still know little about English’s political history. When English took over as Prime Minister back in December, the profiles of him hit the usual beats: his closeness with John Key, his years as finance minister, his initial failed Prime Ministerial bid against Helen Clark. But for much of the voting public, English may as well not have existed prior to 2002.

This media-imposed amnesia has served to erase one of the most consequential periods of English’s career from public discussion: his steering of the country’s health sector as the head of Crown Health Enterprises and, subsequently, health minister while an up-and-coming National MP in the mid-to-late 90s.

English’s tenures were turbulent, to say the least. As head of CHE, he defended and advanced National’s free market healthcare reforms. But it was his time as health minister that engulfed him in arguably the most controversial period of his career.

While English did soften the more radical direction of health under Jenny Shipley, he continued to steer the sector in a decidedly market-oriented direction. More importantly, English oversaw the continued deterioration of New Zealand’s health system — avoiding action on several slowly unfolding impending health crises and attempting to paper over the way National’s reforms contributed to them. Perhaps most alarmingly, English largely ignored a deepening mental health crisis, despite widespread public demand, an issue that continues to haunt the country today.

“We might have gone a bit far”

English’s involvement in the health sector began in the aftermath of the most painful period of the Bolger government’s health reforms, widely perceived as intending to pave the way for a privatisation of New Zealand’s health care. Don Brash gushed in 1996 that “the most radical welfare reforms have occurred in health care.” Funding was separated from providing, with regional health agencies made to compete to purchase health care services. The Area Health Boards previously responsible for public health care were replaced with Crown Health Enterprises (CHEs), which were to be run like private corporations, right down to running a profit.

English at the time was a “rising star” within the National Party, a young (only 35 years old), promising, Southern-bred MP billed as a future leader. English’s rising fortunes led him to be promoted to Cabinet in a March 1996 reshuffle, becoming CHE minister, only six years after entering Parliament. It was a crucial post that signalled confidence in English — at the time health, along with education, was viewed as the Bolger government’s biggest roadblock to re-election due to the unpopularity of National’s reforms.1

English’s role, as the Evening Post put it, was to “take the offensive against the ongoing public perception … that National has abandoned hospital services, and delivered them to private insurers.”2 English talked up a softer approach, telling the Dominion he wanted “to work to gain the support of the doctors and nurses and others who work in hospitals.”3

“They have been through a pretty stressful time and under some pressure,” he acknowledged.4

A March 1996 profile for the Sunday Star Times offered, optimistically, that far from being an ideologue, English “comes down on the side of doctors and nurses.”5

“We might have gone a bit far with giving management the responsibility and the control,” he said.6

He would later make a symbolic break with National’s previous reforms, declaring that “managing a public hospital is not the same as managing a commercial enterprise,” and that the “pure business” approach to running CHEs had ended.7

English’s actions once in the post quickly shattered that notion. Although National had gotten the ball rolling before English’s appointment, once made CHE minister, he stoically denied there were any problems. When Labour obtained CHE figures showing that surgical waiting lists had ballooned by 50 percent since 1993,8 English dismissed them as “fiction” and claimed there were more operations being done than ever.9 He would later similarly claim that more people than ever were receiving hospital care, even as a bombshell report recounted “nightmare” stories of nurses caring for 23 patients in one night and leaving a patient lying in his own faeces for three hours.10

Despite English’s claim to be on the side of doctors and nurses, nurses lost jobs and staged protests in opposition to the policies. English declared that “staff morale is important” and that he was “supportive of [hospital] staff because over the last three to four years they’ve been the subject of an awful lot of criticism — almost all of it unjustified.”11 He then publicly contradicted a survey that showed the number of community-based nurses had declined, before admitting his more rosy figures were based on an increase in part-time and casual nurses.12 By December, nurses at Taranaki Healthcare had contacted the press to declare the chaos caused by funding and job cuts had led nurse morale to plunge — “an absolute mess,” said one.13

English resisted calls to spend more to reduce waiting list figures, saying he didn’t want the money to get lost in bureaucracy.14 Yet it was later revealed that CHEs had spent $52 million on non-medical consultants since 1993.15 He endorsed deficit-addled Capital Coast Health’s decision to cut the number of beds in two hospitals,16 then stayed silent as its chief executive received a nearly $30,000 performance bonus,17 eliciting outrage from doctors and nurses,18 just one of many such extravagant bonuses paid to hospital bosses.19 (Though he was silent, English wasn’t directly at fault in this case — it had been the 1995 Cabinet that elected to fold bonuses automatically into chief executives’ base salaries).20

Much of this information was only found out through parliamentary questions. Yet English complained that the questions were “far from constructive” and an example of “time-wasting.”21

“It is just possible, of course,” wrote the Evening Standard, “that Mr English’s definition of ‘far from constructive’ might be affected somewhat by his jealous championing of the health system the government has created.”22

Speaking of bureaucracy, one CHE head resigned in August citing the “bureaucratic nightmare” of the health reforms.23 He was the 15th CHE boss to quit, with three leaving in a single month.24 Despite this, months later, as the 1996 election approached, English warned that a Labour victory would mean “administrative chaos.”25

Perhaps none of this should have been surprising. According to the Dominion, despite his rhetoric, English was a “pro-market thinker who supports the thrust of the reforms and is excited about many of the changes that are unfolding.”26

English did deserve credit for successfully arguing over the objections of Shipley for a $170 million package to reduce waiting lists.27 And English did announce the appointment of medical professionals on CHE boards, viewed as a sign of backtracking on reforms.28

But these were crumbs in the grand scope of the reforms. The Coalition for Public Health noted that the latter was merely window-dressing that was undermined by the commercial goals of the reforms.29

In December, following National’s re-election, English took Shipley’s place as health minister. His chaotic nine months as CHE minister presaged his much more controversial tenure at the helm of New Zealand’s health sector.

Bill the “Moderate”

As head of CHEs, English was complicit in, but couldn’t shoulder all of the blame for, the chaos engulfing New Zealand’s health sector. The same couldn’t be said once he took over as health minister.

English’s years as health minister were characterised by a determined effort to ignore the various gradually building health crises, and to stubbornly keep the health sector running in a commercial direction, despite the public’s distaste for the reforms. At the same time, English worked to undermine public scrutiny of the failures of National’s reforms, all the while signalling to a weary public that the government was reversing course, despite all evidence to the contrary.

Much was made of English’s appointment over the uncompromising Shipley. He was viewed as a “moderate.”30 He admitted to the public that the government had not always gotten reforms right,31 and newspapers asserted that he would “dismantle and soften” the reforms.32

“I found him to be approachable,” says Derek Wright, then the general manager of Waitemata Mental Health Services, who would meet with English on a regular basis as part of the Mental health Coaltion. “He seemed to genuinely care about health and mental health compared to Jenny Shipley.”

English’s break from free-market orthodoxy was overstated, however. Even before the election, he insisted the reforms had “been absolutely necessary.”33 Once health minister, he accepted34 the recommendations from an advisory panel that the government keep running hospitals as businesses, even as it warned of “reform fatigue.”35 The move was criticised as a betrayal of National’s coalition agreement with New Zealand First, which had been interpreted as a signal that National’s commercial-focused reforms were done with.36 And even that agreement left in place “a lot of the health policy [Shipley] vociferously defended,” as the Press noted,37 while English signalled his lack of commitment to it by claiming its promises had been “plucked out of the air.”38

Neil Kirton served with English as associate health minister as part of the tempestuous New Zealand First-National coalition government formed in late 1996. At the time a 40-year-old first-time MP, Kirton rubbed the Bolger government the wrong way with his vocal criticisms of the government’s health care measures, and was eventually sacked for his rebellion, soon after which he resigned from New Zealand First. He believes English’s reputation as a moderate was exaggerated.

“You’ve got to appreciate that Bill had come from Treasury,” says Kirton. “He was very much a child of Treasury thought — that the market ought to dictate how the sector operated.”

To be sure, English did go some way to smooth the sharp edges of National’s reforms. After a two-year delay, he introduced a free mammogram program for women aged 50-64.39 He challenged “greedy drug companies” running a misleading ad campaign against efforts to curb the national drug bill and ordered an investigation into drug advertising.40 He also quietly increased doctors’ involvement in running hospitals.41

As Ian Powell, the executive director of the Association of Salaried Medical Specialists, puts it, he was “ideologically driven, but constrained by fiscal prudence,” making him more pragmatic than Shipley.

It’s inarguable, however, that the major shifts English and the Bolger government made were ones they were forced into by entering into coalition with New Zealand First. These included an extra $1.71 billion of funding over three years,42 removal of regional health authorities in favour of a more community-based model, and the introduction of free health care for children under six (though National flirted with abandoning the policy a year into its introduction, with English noting that “fiscal circumstances” had changed,43 before doing another about-face).44

“If we hadn’t been in government, the model would potentially remain in place until today,” says Kirton.

Powell agrees.

“It was not so much Bill English but the coalition with New Zealand First,” he says. “If anything, that tempered things a bit.”

Moreover, English’s seeming public renouncing of the reforms is less impressive when one considers that not only were the reforms hugely unpopular, but the Treasury had informed English when he became minister that they had actually weakened the pace of hospitals’ performance improvement.45

One of English’s most vaunted changes — supposedly dropping the requirement for hospitals to turn a profit,46 seemingly a symbol of his non-ideological approach — was likewise overstated, argues Powell. The idea that the word “profit” had been removed from legislation was “a bit of a myth,” he says, because it was never there in the first place. Rather, the wording was tweaked from requiring them to be run as businesses, to being run in a “business-like” fashion.

“How are businesses run? They’ve got to make a profit,” he says. “So you don’t need the word ‘profit’ to have a profit driver in the legislation.”

Nevertheless, even with this well-publicised pivot, English couldn’t entirely shake off suspicions of encroaching privatisation. He suggested more than once that the private sector build public hospitals that it then lease back to the government,47 even as the British Medical Association and others called for an end to the practice in the UK, where private investors racked up massive cost overruns and decided the number of beds in facilities without medical input.48

Another time, he pushed for a deal that would leave the Crown owning the bricks and mortar of a Wanganui hospital while its services were contracted out to the private sector.49 He also came close to approving a three-year, $20 million contract for a cardiac service in Canterbury to a private consortium, a deal that only fell through once it was disclosed its director had been involved in a failed health venture that owed more than $3 million to creditors, one of which was a government entity.50

Nor did his pivot end headline after headline about health job cuts, hospital closures, bed shortages, budget cuts, rationing of care, and other factors illustrating the steady deterioration of New Zealand’s health system under National’s policies. Mothers were being paid to leave hospitals early after giving birth, concerns about which English waved away as potentially politically motivated.51 Patients were being rushed out of hospital early to meet budget figures.52 Medical staff pleaded with English not make further cuts,53 and took out ads in local newspapers warning that they would put lives at risk.54 Strikes and protests abounded.

“It was a change in degree, not a change of kind,” says Powell.

English’s response to anger over cuts was to insist that taxpayers couldn’t keep “feeding the monster,” and that if hospitals couldn’t reduce their deficits fast enough, they would have to be restructured or have “someone else” run some of their services.55 When Kirton [pictured left] publicly released information showing layoffs, amalgamation and closed services were planned for five North Island CHEs, English complained that it showed “total disregard for the democratic procedures of Parliament and Cabinet,” and claimed it was irrelevant, months-old advice. Kirton called that “a complete lie.”56

Glenda Alexander, then an organiser for the New Zealand Nurses Organisation and now an industrial advisor with the union, believes the health sector has never recovered from the cuts and layoffs under English and his predecessors. Nurses left the country, became educators or even real estate agents, and it became harder to recruit new nurses. The net effect was to drain the health sector of its organisational intelligence.

“We were predicting in the 1990s that we were going to suffer by 2020 a significant shortage of health professionals,” she says. “It’s no comfort to be proven right.”

The Health Gravy Train

While English demanded ongoing cuts and layoffs, the health sector transformed into a bottomless hole for money — so long as you were a bureaucrat. The extravagant waste of the health care bureaucracy contrasted with the austerity imposed everywhere else.

English took a $24,353 trip to Calcutta to attend Mother Teresa’s funeral.57 A new health agency paid a PR firm $18,750 a month despite employing 13 full-time communications staff.58 The number of bureaucrats more than doubled between 1993 and the end of 1997, even as health workers lost jobs, reaching a ratio of one manager or administrator for every five medical staff by March 1998.59

English claimed this was justified by greater community consultation.60 Yet that claim was undermined when later, one fellow minister and others were surprised to find out a hospital in his electorate was being closed down.61

It wasn’t just the number of bureaucrats — it was their price. Personnel costs at the HFA nearly doubled to $30 million between 1994 and 1997.62 Twelve Health Funding Authority (HFA) managers had salaries over $120,000.63 The debt-ridden Capital Coast Health paid five consultants, some part-time, close to $300,000 for less than five months work, while its chief executive at one point received a salary of nearly $500,000, which the Dominion called “preposterous.”64 Absurdly, its own executive chairman was paid consultant’s fees for advising on its restructuring, receiving nearly $200,000 in fees that had been personally set by English.65 (By contrast, as prime minister, Jenny Shipley received $199,000 a year).66 By 1998, the cost of running the Health Department had quadrupled since 1992 to $105 million.67

English said he was fine with this.68 Yet he also argued against giving health workers a 1 percent pay rise, calling them “inflated pay packets,”69 and insisted that nurses’ pay rises be fiscally neutral.70

“Hospital wages and salaries are one of my big concerns,” he said at one point. “Some groups have had huge increases in the last few years but the reality is, they are working for organisations which are insolvent.”71

“There was certainly a hypocrisy there,” says Ian Powell. “And that continues today.”

“They were doing all these studies that had a pre-determined outcome, arguing that health professionals were not being efficient in their work, that they could work harder and faster, and that we didn’t need as many of them, “ says Glenda Alexander.

As Alexander recalls, the money being lavished on health bureaucrats was compounded by the frequent overhauls of the health system structure — the merging of the Regional Health Authorities in 1998, for instance — which siphoned further funding from the provision of services.

“If you put more managers in, you take health professionals out of the system, and you’re not putting the money where it needs to go: the delivery of services,” she says.

While English gave health bureaucrats the nod to receive sky-high salaries and bonuses, he was less lenient to those left behind by the ongoing reforms. When a man’s Alzheimer’s-stricken wife died after two and a half years in a Kaitaia hospital, English wrote him a letter demanding he pay the $58,000 left on the hospital bill (he had already paid off $20,000).72

Another typical iniquity produced by the reforms was the case of 64-year-old Rau Williams, who died of renal failure a few weeks after being denied treatment. Likely to have lived another few years with dialysis treatment, doctors at Whangarei Hospital decided his numerous other ailments disqualified him from further treatment and sent him home to die.73

The case sparked outrage, protests,74 a court challenge, and even brought three diverse politicians — Labour’s Dover Samuels, the Alliance’s Frank Grover, and then-National MP John Banks — together to fight for him.75 English’s response was to argue the decision was that of the doctors,76 and to call for an end to “insensitivity” and to give the family “some privacy.”77

Burying the Bad News

English’s go-to response to bad news was often to pin the blame on health workers. When GPs at Wanganui and Gisborne hospitals alleged the treatment of patients was “cruel, dangerous and disgusting,” for instance, English responded that the problem was poor communication between GPs and hospitals and that hospitals simply “book all patients to turn up at the same time.”78

At other times, he blithely dismissed inconvenient evidence. When a Statistics NZ report stated that health spending cuts were one of the causes for Kiwis’ floundering personal savings, English replied that Kiwis spent more on alcohol and cigarettes than private health care.79 After a multi-country poll showed New Zealanders were more unhappy with their health system than any other English-speaking people, and that a quarter of them were foregoing medical care due to money worries, English insisted the public’s perception was wrong.80

English’s impulse to paper over the damage done by National’s reforms is best embodied by the inquiry into patient deaths at Christchurch Hospital in 1996. For months, medical staff argued that cost-cutting had directly contributed to the deaths.81 English at first acquiesced to months of calls by the hospital’s doctors for an independent, public inquiry, which was expected to be conducted by ex-Labour MP David Caygill.82 He then quickly dropped those plans when Health and Disability Commissioner Robyn Stent announced her own inquiry, one that would not be public.

English’s decision sparked outrage. Suspicions abounded that English was deliberately preventing scrutiny in order to hide the damage reforms had done to the hospital.83 Doctors called it a government cover-up, and Christchurch Hospitals’ Medical Staff Association chairman charged the situation was “approaching the level of a scandal.”84

“There is real concern whether [English] has gone far enough in seeking to find the truth of what occurred” with a private inquiry, wrote the Press.85 He had “let down staff at the hospital and the families of patients who have died there in apparently contentious circumstances,” charged Palmerston North’s Evening Standard.86 Christchurch Mayor Vicki Buck lamented the way the public inquiry had been “snatched away” and called the timing of Stent’s announcement “very strange.”87

Stent’s involvement heightened these fears. Months earlier, she had stated her belief that health workers were “exploiting people’s fears about hospital safety as a tactic in industrial negotiations,” stoking fears she was far from impartial.88 Stent announced she was not intending to interview the families of the deceased, angering them.89 Her first public meeting on the subject was described as a “fiasco,” during which she was unable to answer questions about why she was leading the inquiry and why it was private.90

After what seemed like endless delays,91 the inquiry’s report was finally released in April 1998, months after it had been completed and more than a year after it began. Days before it went public, English released a more positive report carried out by Auckland Hospital’s emergency department clinical director, who had spent a week in the Christchurch facilities.92 He didn’t want its message lost amid “claim and counter-claim about historical events,” he said.93 He was accused of trying to undercut the findings of Stent’s inquiry.

Despite initial concerns, Stent’s inquiry ultimately went “far further than anyone would have expected (or Bill English would have liked),” as journalist Sandra Coney put it.94 It argued that the system of contracting set up by the reforms had failed to provide patient safety, and that the business plan set up to dig the hospital out of debt had further undermined it. English responded by blaming Canterbury Health for the failings,95 even though he, Shipley and Bolger all apologised to family members.96 One family member called for English and Shipley to resign.97 In any other country, the Evening Post noted, they might have.98

Booking Bedlam

English also bore responsibility for implementing the chaotic “booking” system that was meant to replace waiting lists, something he had promoted since being CHE minister.99 Meant to resolve the matter of the 145,000 people stuck on waiting lists,100 some of whom waited so long they developed new health complications,101 the new structure used a point system to rank patients at different levels of urgency that determined when they would receive care. Once in place, English claimed, everyone who needed surgery would get it within six months.102 Those who didn’t qualify would simply have to wait to become ill enough.

There was scepticism about the system from the beginning, with health groups viewing the abolition of waiting lists as a way to eliminate a source of political embarrassment.103 Alister Scott, the spokesman for the Coalition of Public Health, believed the only way it would work was “for people to die on waiting lists,”104 while Taranaki Healthcare’s chief executive feared hundreds of people waiting for surgery would simply miss out with the system in place.105 “I believe a large percentage will fall off the list,” one anonymous GP said.106

The critics were ultimately more accurate than English. A trial of the system ended up putting patients with cancer below those with less serious illnesses.107 Two months before it kicked off, the HFA revealed 20,000 patients would be denied operations, who were told to go through private health care.108 Five months in, more than 100,000 patients were still waiting for their first specialist assessment,109 and Waikato Hospital sent letters to thousands of patients warning they probably wouldn’t get operations.110 Some healthcare workers admitted to gaming the system to get their patients the requisite points.111 English, once again, blamed doctors for the system’s failings.112

One of the early victims of the booking system as it was being rolled out was Colin Morrison, a 42-year-old dairy farmer in Riverton who died after waiting for months for a triple-bypass operation. The way it was set up, Morrison had enough points to qualify for surgery in the North Island, but not in the South Island, where he lived. As Labour’s health spokesperson Annette King put it, the “health system created by Mr English meant an accident of geography effectively condemned Mr Morrison to a premature, avoidable death.”113

Five weeks before he died, Morrison’s family met with English, knowing that he could have a heart attack any moment, pleading with him to do something. According to Morrison’s sister, it was like “talking to a brick wall. He said he couldn’t take up individual cases. He kept on giving us political-type answers.”114 Morrison’s GP called on English to resign over “his disgraceful abnegation of responsibility here,” holding him in part morally responsible for the death.

Besides all this, English also used his position to try and foist anti-abortion propaganda on the public. A practising Catholic, English told attendees at a pro-life function at the close of 1997 that he would look at cutting the funding to doctors certified to assess women for abortions, and redirect what he called the “wasted money” toward supporting women to keep the children or consider adoption.115 Documents obtained by the Auckland Women’s Health Council showed that English later went against the advice of his own ministry and ordered the reinsertion into a pamphlet on abortions of information about foetal development, photographs of foetuses at various stages, and a list of possible negative side effects of abortion, such as a higher risk of miscarriages, premature birth and breast cancer.116

Before the election that threw him into the health minister’s role, English had told an audience that while the National government may not have gotten all the reforms right, it at least deserved credit for making hospitals “more like a service and less like a Polish shipyard.”117 By the time his helming of the health sector was done, there was little confidence this claim was tenable.

“Rightly or wrongly, neither Health Minister Bill English nor Bolger are able to convince us the health system is anything but in complete disarray,” wrote the Sunday News less than a year into English’s tenure.118

Anatomy of a Mental Health Crisis

The state of mental health under English deserves special mention. Mental health has occupied much of the discussion leading up to the 2017 election. While today’s crisis certainly can’t be traced back to English’s late-90s tenure alone, his determined inaction on the matter — mirroring his role as passive caretaker of the crumbling health system as a whole — contributed to it.

English wasn’t entirely indifferent to the issue. He acknowledged the government’s “insufficient progress on mental health services,”119 and expressed concern for how Māori in particular fared under New Zealand’s mental health services, criticising the “traditional, paternalistic models” that “too often haven’t worked for Māori.”120 He launched the first government strategy to address health issues affecting Pacific Islanders, including their high rate of suicide,121 and launched a set of new mental health care standards that all providers would have to meet by 2000.122 Perhaps most importantly, he issued tens of millions of dollars worth of extra funding for mental health.123

But these were either cosmetic measures, or were inadequate to deal with the problems plaguing the sector. As CHE minister, English had told a public meeting of voters that mental health facilities were disgraceful and that his government would “fix them and rebuild them.”124 But for the most part, English’s tenure was characterised by a roiling mental health crisis that he made minor gestures in addressing, but mostly spent time finding ways to stall having to do much about.

The extra funding English allocated for mental health was “nowhere near” the sum proposed in a major report on New Zealand’s hurting mental health sector, according to its author, the retired judge Ken Mason.125 Meanwhile, the new mental health standards English set up meant little when the funding cuts that led providers to continuously fall short of those standards endured. For instance, Kirton again leaked information, this time a report produced for English that showed CHEs planned to cut mental health services to meet budget targets.126

The Mental Health Commission found that, in order to save money, mental health services were allowing facilities to fall into disrepair.127 Additionally, the number of psychiatric beds was dwindling,128 while a patient at one hospital’s psychiatric unit reported having to spend four nights sleeping on a mattress in a telephone room due to overcrowding.129 Female psychiatric patients ended up in filthy, damp boarding houses for lack of beds.130 For his part, English endorsed a plan to put psychiatric patients in motels to free up hospital beds.131

The country was reminded of the woeful state of its mental health services by periodic high-profile occurrences of crimes committed by psychiatric patients. One man, who was taken to a hospital and described by his partner as a “time bomb,” was released and later killed and raped an elderly Christchurch woman.132 Another man, a paranoid schizophrenic, nearly killed his friend with an axe, which his wife blamed on the local hospital’s failure to provide adequate care.133

But if there was one episode that epitomised both the failures of the mental health system and English’s determination to ignore them, it was the Jacko Paki case. Paki was a 30-year-old sickness beneficiary in Levin who suffered from addiction problems and bipolar disorder.134 Though he had been committed for six months of inpatient treatment, the hospital discharged him the next day.135 Over the following weeks, he made 16 recorded attempts to be readmitted136 — “increasingly desperate” ones, according to one paper137 — but was mostly turned away. After failing to be readmitted, he went on to rape a woman.

English’s response was to call for an inquiry, prompting howls of derision. On the face of it, there would seem to be little wrong with his decision. But English’s inquiry was the 68th carried out in 10 years.138 As the Coalition for Public Health’s rural spokesman put it, it was “an appalling waste of time and money when the evidence is already available,” and proved that “none are so blind as those who do not wish to see.”139 “There have been enough inquiries and enough solutions offered already,” wrote the Dominion.140 The Evening Post charged him with the image of “fiddling while Rome burns.”141

In fact, the aforementioned Mason report released in 1996 had already laid out a comprehensive set of recommendations for the mental health sector, which the government had vowed to implement but ultimately largely ignored.142 Judge Mason, who led the inquiry, had said that if the recommendations of the 66 other inquiries carried out since 1987 had been acted on, a mental health crisis wouldn’t exist.143

“What we need is action,” said one member of the inquiry team in response to English’s call for yet another inquiry. “It is almost a year down the road since our report was tabled. Why are we still talking about it instead of doing it?”144

Even so, English’s Health Ministry at first elected again to keep the report produced by the latest inquiry, which was beset with delays, hidden from the public,145 prompting one major newspaper to call it “a bare-faced bid for a cover-up on a matter of great public concern.”146

In addition, hours before a documentary on Packi and other high-profile mental health failures was due to screen on TV, English announced that the Health Ministry was laying complaints against the psychiatric staff who discharged Packi.147 It was an unusual move, given that health minister didn’t typically announce complaints.148

It was also widely criticised. One Palmerston North Nurses Organisation spokesperson called it “a deliberate ploy by the minister to try to cover up the failure of his own department.”149 Health professionals accused him of scapegoating specialists and avoiding “any responsibility for himself and his predecessors, in terms of setting funding levels for mental health.”150 The chairman of the College of Psychiatrists said that the wider system needed to be subjected to the same scrutiny as clinicians.151

It wasn’t just health professionals. Newspapers made similar charges. Palmerston North’s Evening Standard said that “the spotlight must continue to fall on Mr English’s health system” and that “accountability must start at the top.”152 “There have been too many mental health disasters to put the failures down to lapses in professional standards alone,” said the Dominion.153

English correctly diagnosed that the country was in a “cycle of tragedy” that led to investigations, “recommendations which appear to make no difference,” frustration and blame, “and finally a further tragedy to kickstart it all again.”154 But English didn’t lift a finger to change this, other than introducing a bill that mandated that victims be notified when people detained under the Mental Health Act escaped or were released, and that families be consulted as part of treatment.155

Mental health remained underfunded. Inquiry recommendations continued to not be acted on. Services stayed overcrowded and described as akin to Third World conditions. A lack of staff and services made the mental health system a “ticking time bomb,” as one newspaper charged.156 Or as another put it toward the end of English’s tenure:

If there is to be any respite in the problems plaguing mental health services, it seems increasingly unlikely to come from Health Minister Bill English and his government. The crises just keep coming. If real progress was going to occur, it would have started some time ago.157

For Neil Kirton, the inaction over mental health — both during the early ‘90s and English’s tenure — stands out as a particularly significant failure, one he says is being repeated now, two decades later. He compares the 1990s mental health crisis to if the Cape Creek disaster — in which 13 students and one DoC officer died after a faultily designed viewing platform at a national park collapsed — had repeated year after year.

“That’s the scale of the calamity of mental health,” he says.

But English was saved from having to properly address this calamity. By February 1999, he was bumped up to a new role as Treasurer. The buck for New Zealand’s failing health care system was passed to someone else.

“Bill English and his colleagues need to accept a measure of responsibility for dropping the ball when they should have been alerted to the dangers and taken earlier action,” says Kirton.

Whose Foibles?

Two decades out from the tumult of the mid-90s reforms, opinions vary on English’s role. Glenda Alexander believes English got a “hospital pass” with the health ministry appointment. Derek Wright thinks he was New Zealand’s best health minister in his 25 years in the country because he was the “most human” and “willing to listen.”

For his part, Neil Kirton doesn’t doubt that English was genuinely devoted to improving New Zealand’s health sector. The problem was that he was wedded to an ideology diametrically opposed to doing so.

“Bill is a very committed, dedicated individual, and he’s very smart,” says Kirton. “But thinking outside the Treasury square was beyond him.”

With the 2017 election rapidly approaching, and with New Zealand First once more tipped to be kingmakers, the episode also brings up another question: just how would a second coalition with National function 21 years after the original left both parties battered, bruised, and less popular than before.

“Winston’s much more likely to go with Labour given a repeat of ’96,” says Kirton of the man he once called party leader. “He’s more likely, with a young, inexperienced leader such as Jacinda, to have greater influence there as opposed to going with his old buddies who shafted him last time around.”

Yet even that decision will depend on the will of the voters. The public presently view English as stable, steady, and dependable. But far from stable and steady, English’s time at the helm of New Zealand’s health sector was chaotic and precarious.

Whether that history matters to voters in 2017 is another question. The relatively meagre skeletons in Metiria Turei’s closet led many to deem her as unfit for both party leadership and the office of an MP. It’s an open question whether English’s hand in the disastrous health reforms of the 90s should be considered as disqualifying. At the very least, it deserves more public scrutiny than the zero it’s received thus far.

Footnotes