Outgoing Southern District Health Board chief executive Brian Rousseau freely admits his stand on neurosurgery last year did not win him many friends in Wellington.
But do not expect him to name names or criticise anyone. That is not his public style.
His "stake in the sand" stance saw him offer appointments to two neurosurgeons last June when the row over the future of neurosurgery services in the South Island was beginning to heat up.
Only the Otago and Southland district health boards had steadfastly opposed a one-site model with outreach clinics. The one-site model would have resulted in all neurosurgeons being based in Christchurch.
Mr Rousseau said it was a tough decision, but he "knew deep down that it was the right decision".
The issue was "highly political" and with that level of politics "any decision becomes very difficult, but knowing what is the right thing to do is not difficult".
The neurosurgery row was "certainly a tense time with colleagues in the South Island and nationally", but it was not lonely, because he had tremendous support from chairman Errol Millar, the board, clinicians and the community.
As it turned out, the appointments did not proceed, but a continuing neurosurgical unit was secured for Dunedin on the recommendation of a Ministry of Health expert panel appointed to solve the impasse.
Mr Rousseau said he saw the role played by the Otago Daily Times' and Southland Times' joint campaign to keep neurosurgeons in Dunedin as "pivotal to the outcome achieved".
It was a very contentious issue and "very noisy" for politicians who "don't like noise".
Thousands of people marching in the street over the issue was a good reminder about the difficulty of trying to force change which did not have community or local clinical support, he said.
The effect of politics on district board chief executives "comes with the territory".
It was not so difficult if chief executives were upholding the status quo and doing nothing contentious, but otherwise it could become a "very difficult environment".
He admitted the conflict between what was technically the correct thing to do and what was "a political imperative" could be very frustrating.
He described his relationship with Health Minister Tony Ryall as "very good".
"At times I suppose he doesn't like some of the stuff I do, but I have always tried to do what's best for the patient and bat for the community. If that's crossed some of the lines which should not be crossed, then I apologise. I am always happy to justify why I need to do certain things."
The board had tried to run, in Dunedin Hospital, a pilot where top-up cancer drugs not publicly funded would have been offered to paying patients, and Mr Rousseau had been disappointed with the Government's stance on that.
It was a proposal oncologists felt was best for patients, but Mr Ryall ruled it out.
Former Otago chairman Richard Thomson was more blunt about the relationship between Mr Rousseau and health ministers in his speech at Mr Rousseau's farewell this week.
Referring to Mr Rousseau's penchant for fast driving (although he insists he has never received a speeding ticket), Mr Thomson said he was not sure whether a "road accident or a minister" would claim the chief executive first.
Asked about the $16.9 million fraud of the Otago board by former board IT manager Michael Swann and his associate Kerry Harford, which began in 2000 before Mr Rousseau arrived and continued until 2006, Mr Rousseau said it had shocked the senior leadership team "to the core".
"To have someone in your midst you trust and that trust is broken, that really shocked the team."
Health services worked on trust, with a "team-based approach to everything we do", and the fraud had been devastating.
It caused a lot of people, including himself, to question whom they could trust, he said.
It had taken four years for the organisation to rebuild after that and there were still people within the board who felt betrayed, he said.
Mr Rousseau said some people had little understanding of how fraud could occur.
Even with the best systems and processes to prevent it, that prevention could not be guaranteed.
This was the case for any organisation, particularly where senior people with accomplices were intent upon breaking the law.
Mr Rousseau said his one significant regret was that he had not been able to achieve a change in the way government funding was allocated.
He believes there are three areas where population-based funding is not working fairly: mental health, elective surgery and the amount paid for serving a rural population.
The board, which has been under pressure for years to break even, could do so if these matters were addressed and this would allow it to invest money in "quality initiatives", he said.
Mr Rousseau says he has enjoyed the job, although the last six months have been tough.
That time has included a hard-hitting internal report on Dunedin Hospital, a scathing report on hospital systems by a National Health Board team and a panel being brought in to review planning for health services in Wakatipu.
He feels criticisms of board leadership have been unfair, in particular suggestions he does not support clinical leadership.
"I've been a proponent of a management clinical team approach since 2003."
It needed to be remembered clinical leadership was "not about saying yes to everything everybody wants. It is about having sustainable services within the funding allocations".
While there was much of the NHB report with which he did not agree, he and the NHB had "agreed to disagree" and he was not going to "trawl over that". The board would be concentrating on the recommendations from the report.
The two district health boards merged last year. Mr Rousseau believed the NHB's expectations of how quickly board clinical services could change were unrealistic.
He had come to realise it could take two to five years.
"You can't come to work and say, 'From Monday, it is going to be different'," he said.
Asked if he felt he had stuck to his guns too much on some issues, he said it was "very difficult to pull back on things you are absolutely committed to and focused on".
The last six months had helped him realise it was time to move on "and as you are going through that process, it gets more difficult to do your job".
Despite "some rocks on the road", he still felt it was "one of the best jobs".
While he got some unfavourable correspondence, "when I get a letter from a patient saying how we've positively impacted on them and their family - and I get this regularly - it makes it all worthwhile".
BRIAN ROUSSEAU
• Age: 52.
• Salary: $490,000-$500,000.
• Born: South Africa, trained: as a pharmacist.
• 1994: Moved to Auckland with his family, undertook an MBA.
• 2000: Appointed chief operating officer Counties Manakau District Health Board.
• 2003: Appointed chief executive Otago District Health Board.
• 2007: Appointed chief executive of Southland board as well.
• May 2010: Becomes Southern District Health Board chief executive after two boards merge.
• September 2011: Leaves to take up position as inaugural chief executive of the Central Adelaide Local Health Network, which runs three hospitals. One, the Royal Adelaide Hospital, is undergoing a $1.9 billion rebuild.
Highs:
• Redevelopment of Dunstan Hospital.
• Controversial restructuring of laboratory services.
• Amalgamation of Otago and Southland primary health organisations.
• Merger of Otago and Southland district health boards.
• Retention of neurosurgery in Dunedin.
• Maintenance of "tremendous" services in the face of constant cost-cutting.
Lows/unfinished business:
• $16.9 million Otago board fraud.
• Funding for whole redevelopment of Dunedin and Wakari hospitals.
• Inability to secure fairer population-based funding.
• Inability to succeed with Integrated Family Health Centre in Queenstown, which he considered was in line with government policy.
• Moves to forge greater ties with the University of Otago - "I'd like to see the name at the front of this hospital say Dunedin University Hospital".
