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Doctor in the House: An interview with Health Minister Jonathan Coleman

The first GP in 70 years to become Minister of Health is still working on a remedy for an under-pressure health budget.

Jonathan Coleman: “The health of the population over time is improving.” Photo/Ken Downie
Jonathan Coleman: “The health of the population over time is improving.” Photo/Ken Downie

Jonathan Coleman has a voice like a late-night drag on a dying cigar: a rich blend of authority and entitlement, carelessness and confidence. Crackling through the croaky delivery are sparks of mischief and a faux protestation of innocence. Who me? But make no mistake. This is a highly ambitious minister, adept at the dark arts of politics and smart enough to almost always get away with it.

Yes, there was trouble after he was rumbled smoking a cigar in the British American Tobacco corporate box at a U2 concert as a rookie MP. But that was 10 years ago. Today he’s the sixth-ranked minister in Government, just outside Cabinet.

Coleman is a hyper-achiever. He was head boy at Auckland Grammar, went to medical school, earned a post-graduate diploma of obstetrics and an MBA, set up a GP’s practice overseas and was a management consultant at PWC – all before ­becoming the first doctor in 70 years to take the health portfolio. Health is a matter of life and death in the John Key school of Government. The Prime Minister has long believed voters only really care about four things: health, education, law and order and the economy. Coleman is central to the fabric of the Government. And things are starting to fray.

He says the country’s 20 district health boards are under more financial pressure than ever, largely because of the population boom. He also reveals his doubts about whether the talent is there to take the half-a-million dollar jobs running the DHBs. None of this shakes his confidence, though. He’s a results man. How long do we live? How many operations are being done? Hit the targets. Don’t follow the money.

But this isn’t a cold-hearted technocrat. Coleman is a curious cat. He has a 170-year family connection to his Northcote electorate and “a bit of tangata whenua thrown in” to his bloodline. His father died when he was 12, leaving his mother to raise him and his two brothers, who now live in London.

He had a stint in the UK himself where his patients included drug kingpins in north London. Returning home, the blue-blooded Nat worked in Otara as a GP. He’s also something of a literary fiend who says if he wasn’t a doctor and a politician, his dream job would be a writer or a film director. Who knew that the Minister of Health and the Minister for Sport and Recreation was a frustrated artist whose heroes aren’t politicians but Ernest Hemingway and Pablo Picasso? Coleman, cautious of the limelight after his early singing from the media flame, might be a little more interesting than he wants you to know.

As a GP in Otara in 2005. Photo/Supplied
As a GP in Otara in 2005. Photo/Supplied

Big-picture numbers

With the ink barely dry on his second Budget in the health portfolio, ­Coleman can chalk up some significant wins, including the $124 million four-year boost for Pharmac, allowing it to fund a new-generation melanoma drug.

Some $16 billion is now spent on health, about 6.5% of GDP. But New ­Zealand is experiencing a population boom and so, on a per capita basis, DHB budgets are squeezed.

“They are going to have to absorb a record amount of pressure – no question about that,” is Coleman’s startlingly frank admission. “It means that, yes, they will get new funding, but they’re also going to have to reprioritise some of the funding they have.”

He says the 2016 health budget had to fund an extra 100,000 people. He got a nasty surprise recently when told that Statistics New Zealand had undercounted the population by 30,000 last year. “There is no question: there are not a lot of spare dollars floating around in health.”

He’s going to cop flak on health spending for sure. Labour claims National has “underfunded” health by $1.7 billion. Coleman, though, brings it back to results. “The real indicator is mortality and morbidity rates. We are living longer. Although we have challenges around diabetes and other non-communicable diseases, the health of the population over time is improving.”

Got a story about a friend or a ­relative waiting for an operation? Many of us have, but Coleman is ready with his numbers: more than 167,000 elective operations last year – 50,000 more than when National came to office. But what about the people referred to a specialist appointment who were then declined and sent back to their GP? There were nearly 7300 of those in just three months last year. Coleman says that’s why he launched the National Patient Flow project, so there’s transparency in the referrals process. Again he stands by the big-picture numbers: specialist appointments have gone from 432,000 a year in 2008 to 540,000 now, up 26%.

His confidence, though, is not as strong when asked about the performance of those running the DHBs. Indeed, he seems to have doubts. “The wider problem is that we’ve got this fragmented system and we haven’t had a good system for developing talent in terms of executive management. So when we need a new chief ­executive or a new CFO, they just advertise in the Otago Daily Times or the Dominion Post or whatever.

“There is not the training programme taking in smart young grads and developing them. Because these are great jobs. If you are running a major DHB you might be on $500,000-600,000.”

Despite these reservations, he has no appetite to change the way DHBs are constituted. A proposal from the Director-General of Health’s office, leaked last year, suggested reducing the number of board members and having two-thirds of them appointed by the minister. Most DHBs have 11 members, with seven chosen through local government elections. Coleman told the Listener it will stay that way.

“I don’t want to start a distraction around the election of DHBs when, frankly, most people wouldn’t have a clue what person is on their local DHB.”

Left to right, brothers Matthew, Richard and Jonathan in 1983. Photo/Supplied
Left to right, brothers Matthew, Richard and Jonathan in 1983. Photo/Supplied

Obesity data needed

Can you guess Coleman’s top health priority? I wouldn’t have, largely because I’d also identify it as the area where he has copped the most criticism: obesity.

“From the day I came in, this was No 1 on the work sheet. When John Key asked me to do this I said, ‘Well, I really want to do something about obesity.’” In October he released the Childhood Obesity Plan and true to form there was a target: 95% of children identified as obese in the Before School Check would see a health professional for “intervention” before December 2017. But surely a meaningful target would have focused on reducing the incidence of obesity? Ah, but Coleman won’t set a target he can’t control.

“We could have said we are going to decrease the rate of obesity by a x% over a given time, but then we can’t control what you are serving your kids each night.”

Also missing from the plan were moves to control the food eaten at school. “We don’t feel that regulating what is served in schools would actually have any effect, because the kids would buy it across the road at the dairy.”

It’s his belief that 90% of the obesity problem is in 10% of our schools and he’s asked for data to back up his theory.

“The kids who go to the school where my kids go are not overweight and I’m sure you find if you go to Mt Eden Primary or Maungawhau they won’t be.” That seems to be a concession that obesity is a condition of poverty, although Coleman maintains it is possible to eat well on a tight budget. As for a sugar tax – that’s a definite no despite the Prime Minister’s chief science adviser, Sir Peter Gluckman, saying it would send a strong message. “We have said that we will await the international evidence,” Coleman says. “I have looked at this really closely and there is no evidence that it decreases obesity.”

Coleman at home in his Northcote electorate: “I really feel I belong here.” Photo/Ken Downie
Coleman at home in his Northcote electorate: “I really feel I belong here.” Photo/Ken Downie

Killed by a phone message

We’re drinking beer on the deck of Coleman’s stunning Northcote home with spectacular harbour views. It’s light beer, mind you, and there are no cigars. The sun sparkles off the water, the bush snuggles in around the beautifully renovated villa and the legendary Northcote Tavern beckons from across the road. It’s a great spot, but he hasn’t moved here on a whim.

Coleman is North Shore aristocracy. Great-great-great grandfather William Nicholson came to the North Shore in 1846 and started a farm. When the local MP drives to nearby Esmonde Rd, he passes the place where his grandmother was hit and killed in a car accident. “They were the only people with a telephone. Someone across the road had a message rung through to the Coleman family. She’d gone across to deliver this message.” He is very proud of his roots in the electorate. “I don’t know that there would be another MP representing an urban seat with that long a family ­connection. I really feel I belong here.”

The statement could equally apply to his position as a powerful political player. “Politics is something that I’ve been interested in since my time at university,” he says, although initially the path wasn’t clear. “I remember going to a Young Nats thing in 1987 in Takapuna when Bruce Cliff was the National MP and I turned up and I thought, ‘I don’t really think this is my scene’, just from a social point of view, and I never went back.”

It wasn’t due to doubts about which team he was on. “I have always, always voted National,” he says. “A big part of that is philosophical. It’s partly tribal. My grandmother was a huge Sir Robert Muldoon fan. National was the party that people in my family talked about.”

His parents weren’t overtly political. His father Ron, a chartered accountant born and raised in Northcote, died suddenly in his forties. “He was a perfectly fit and well guy and at the age of 47 he had this thing called a berry aneurysm – a weakness in a blood vessel in the brain – and it just burst. He never recovered from that and died two weeks later.”

Jonathan is the oldest of three boys. “Kids are pretty resilient, but it was a huge shock and it had a huge impact on family dynamics.” His mum, Patricia, a ­primary school teacher in South Auckland, brought up the three boys on her own. The two younger ones became London lawyers, and remained in the UK. Coleman had a stint there too with a practice in Islington.

“You had a huge mix of patients from people working in the city as ­bankers to people who’d lived on a council estate for 40 years. There were a few organised crime families,” he recalls. “These guys were controlling the North London heroin trade. Big time. Some of them have since been arrested. No national insurance numbers, no bank accounts, but assets of hundreds of millions of pounds, so yeah, it was pretty interesting.”

Although he had a successful career as a doctor, he views even that as a ­training ground for politics. “You learn to deal with people from all walks of life. There is nothing anyone could tell me that would truly shock me.”

The Colemans: Sandra, Jack, daughter Madison and Jonathan this year. Photo/Supplied
The Colemans: Sandra, Jack, daughter Madison and Jonathan this year. Photo/Supplied

Up-and-out game

Coleman’s ambition doesn’t lie too far beneath the surface. “My aim right from the start was to get into Cabinet,” he says, recalling his entry to Parliament in 2005. “I remember setting myself that goal: I have to get into that top 20.” His goals have now been reset. “I’m not in that kitchen Cabinet,” he says. “It’s the top five and I’m just outside that.”

He’s very clear about the political significance of his job. “If health starts to slide, governments are in trouble,” he says. “I think a lot about the strategic role of the health portfolio.”

He’s equally clear that he’s not prepared to play the game of political snakes and ladders. “I think politics is an up-and-out game, quite frankly. I’m not interested in being the Opposition health spokesman you know,” he says, all confidence now with the sun on his back and a cool beer in his hand.

“Once you’ve done Minister of Health, you don’t want to go back and do that job in Opposition because it’s hard to be credible once you’ve done it.”

But Coleman nearly never made it. His political career could have been over before it began. When he was a new MP, the Sunday Star-Times pounced on the story of him being punched after blowing smoke in a woman’s face in a corporate box at a concert. Worse, he was the party’s associate health spokesman at the time.

“It was one of those things where it was a harsh but good early lesson where you suddenly get thrown into this vortex and you just don’t know which way it’s going to go,” he says of the media maelstrom that followed. “It was very naive to go along with BAT.”

The story got more coverage because it was seen as an early leadership test for Key, who had just taken over from Don Brash. Key stuck by him then in opposition and has promoted him handsomely in Government. They both have holiday houses at Omaha north of Auckland, but are not friends.

“He’s down the other end of the beach. John gets there a little bit but we don’t socialise,” he says. “I’ve never been for dinner at his place, he hasn’t been for dinner at my place and, frankly, I wouldn’t expect to impose on his time.”

Coleman does have mates in the National caucus – Gerry Brownlee, Sam Lotu-liga, Maggie Barry and Mark Mitchell are close friends – but weekends are mainly for family.

He coaches son Jack’s soccer team. He watches daughter Madison play netball and sits in on her violin lessons. He plays tennis with wife Sandra in the inter-club team every second Saturday.

He turns 50 this year and looks in pretty good nick. He goes to the gym, he does a bit of road cycling in summer and kayaks are at Omaha. It’s not a bad life then, is it, for Jonathan Coleman?

Outwardly, he’s conservative (he voted against gay marriage), and an occasional churchgoer (“I’m not deeply religious, but I am an Anglican and I try to send my kids to Sunday school”).

But my sense is that there is an inner brat, a naughty Tory not far beneath the surface. It’s light beers and good ­manners today, but you could imagine that a few real drinks in, and after the cigars come out, he might be a bit of a handful: cheeky, argumentative, a bit cocky and quite possibly a lot of fun.

My final question strengthens my hunch: what would you have done if you weren’t a doctor and a politician?

“I think being a really successful writer or director would have been incredibly interesting,” he says, adding his heroes aren’t politicians at all but hedonists and creative types. “People like Hemingway, Picasso and Henry Miller. People who have carved out a very individualistic path in life.

They may not have been the most politically correct, but you read about those guys and what they did: they are people who have lived life on their own terms.”

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