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Jonathan Milne

Former soldier takes on new battle to rebuild our health system

Te Whatu Ora chief infrastructure officer Jeremy Holman worked in the British Army building medical facilities in Afghanistan; now he's building hospitals and clinics in New Zealand. Photo: Jonathan Milne/Newsroom

Jeremy Holman was a senior British Army engineering officer overseeing the construction of community and medical facilities in war-torn Afghanistan; now he's building hospitals and community clinics in New Zealand.

When Major Jeremy Holman was assigned to oversee the reconstruction of Iraq's rail network, he knew little about railways. "I would be the first to admit that my knowledge of railways was scant," he admitted in a UK army engineers' journal. 

"In total it was limited to a one day briefing on the PET course, building my two year old son’s wooden railway set and some distant memories of a childhood Hornby ‘Double–O’ set we had at home."

But by the time he was put in charge of rebuilding New Zealand's health infrastructure, his resumé was looking somewhat more rounded. Yes, there is a wide gulf between building medical facilities in Afghanistan, and building hospitals in Whangārei and Nelson – but he says some of the challenges are the same. 

"Battle is not the word," he says. "There's a lot going on but I don't see it as a battle. We've got a lot of good people on our side."

READ MORE:Health infrastructure boss reveals rethink on regional hospital rebuildsHospitals and councils must sweat the big stuff, says infrastructure chief

Last week, Te Whatu Ora's chief infrastructure and investment officer sat down for an interview with Newsroom. He  disclosed that the big new health agency would be running a fine-tooth comb over the planned investment in three regional hospitals – Hawkes Bay, Palmerston North and Tauranga.

That's unnerved local leaders, but it shouldn't come as a complete surprise. 

Last year, former Te Whatu Ora chair Rob Campbell told Newsroom that the health agency would look to shift capital investment from large hospitals to primary care clinics, where it hadn't fully committed to the hospital construction projects. "The costs have escalated, while our future planning will be different to that in the past, most obviously by a higher proportion of healthcare delivered outside of large hospitals," he said. "There are many proposals at various stages of development which may not pass the tests."

Campbell is gone, in headline-grabbing style, but not before Te Whatu Ora's executive team appointed Holman to deliver on the board's expectations. So who is this newcomer, and how does 17 years in the British Army equip him to understand and address New Zealand's health needs? 

‘It seemed like a good idea at the time’

"I had a fairly bog standard childhood,” Holman says. "Scouts, and bicycling and camping and trying for the Duke of Edinburgh Award, which I never finished."

When he finished school at 18, he applied for both university and the army. “I've never actually sat down and thought what actually took me into the army. I've never dissected that part of my life. It seemed like a good idea at the time. It was just a career path."

There was no military background in his family. He attended a regular (also bog standard, as Tony Blair would have said) comprehensive school in Kent, and his father was a teacher. For him, the army neither rescued him from a troubled upbringing, nor plucked him from the ranks of the leisured nobility.

“Ultimately, the Royal Engineers was a relatively obvious choice, I suppose, because my father is a maths teacher. Maths, infrastructure, engineering, they all come together in the Royal Engineers, being the construction and the infrastructure arm of the military.”

The army had sponsored him through his mechanical engineering degree, and officer training at Sandhurst – the same place that William, Prince of Wales and his brother Harry completed their education.

“There’s no silver spoon in my mouth,” he says. “I've always enjoyed an outdoor lifestyle, and had varying sorts of leadership-y things as I grew up and ended up in the army.”

Training as a Royal Engineer, he learnt how to blow things up with plastic explosives and build bailey bridges and defuse mines and all those things. But the Cold War had ended, times were changing, and the Royal Engineers’ focus was moving from combat engineering to building infrastructure. That’s where he chose to specialise.

Every Royal Engineer soldier is ultimately a tradesman of some description, he says, whether a plant operator, bricklayer, carpenter, electrician, plumber, fitter or whatever.

Then, in 1997, he took a career break. That was unusual. ”That’s a slightly confusing way of doing things within the military, because they're not always set up for that. But ultimately I got married, took a career break of about a year and went on The Big OE as you do.”

“We haven’t bombed the track, we haven’t hidden the rolling stock, we haven’t shot the staff... They can operate their own railway, they want to. All they need is paying!”

During their OE, he and his wife Julia visited New Zealand. “My wife had spent a number of her teenage years based here, because her father was Air Force and he had been posted over here.”

The Royal Engineers' Journal took up the Major Holman's tale in 2003: "Realising that he made an appalling civvy," it said, "he applied to rejoin, which entailed a six month deployment to the Nato HQ in Sarajevo."

He was then seconded for about 16 months to infrastructure firm Kellogg Brown & Root in Sydney, now called KBR. Again, he and his wife took time out to visit New Zealand – before ultimately he returned to active service.

Iraq: 'We haven’t bombed the track'

On March 19, 2003, US President George W Bush declared war against Iraq. British Prime Minister Tony Blair joined the so-called Coalition of the Willing, and as the second-in-command of the newly-formed 528 Specialist Team Royal Engineers (Utilities), Holman was deployed to Umm Qasr in southern Iraq.

Initially tasked with reopening the port and restoring power, he was almost immediately volunteered to lead a territorial team of civilian railway specialists, to open the Iraqi rail network to allow the distribution of humanitarian aid.

"Nine members of the team arrived in Iraq looking somewhat shell-shocked; admittedly not half as shell-shocked as I was when I realised the importance of the task ahead. I did take solace in the fact that because we weren’t expected to deal with either snow or leaves on the line, and as long as nobody was planning to run high-speed services, I felt it was a task I could deal with."

Proving the Umm Qasr to Basra line with a shunting diesel. Photo: Royal Engineers

Holman and his team had been focused on restoring the railway network to a state where they could support the local Iraqi Republic Railway network to resume responsibility for maintenance.

But on visiting the operations HQ, he discovered there was "huge interest" from the army's main private contractor in investment opportunities and major upgrade works, rather than getting initial functionality restored. 

There was no talk of using the locals, the method to pay them or how to encourage them to return to work. It was almost as if they felt the local population didn’t exist, and that the military and aid agencies were going to have to run the railways and do everything on their own. Holman said he found this particularly frustrating, and made a passionate presentation to US-led Office for Reconstruction and Humanitarian Assistance. 

He summarised the state of play with: “We haven’t bombed the track, we haven’t hidden the rolling stock, we haven’t shot the staff, and you need the network to move the same volume of freight as it was doing before the war? They can operate their own railway, they want to. All they need is paying!”

On May 1 of 2003, Major-General Albert Whitley, the Senior British Land Advisor to the Commander the Coalition Forces, arrived in Umm Qasr – by train.

"I'm not a great fan of the phrase, but it's winning hearts and minds and building infrastructure for people. The idea of using British soldiers to build infrastructure for Afghans was not something that sat with me, because there are plenty of people in that country who can build their own infrastructure."

He came bearing news that he had been in Baghdad Central Station talking with senior Iraqi Republic Railway management and obtaining all the payroll details for the thousands of employees. Emergency payments were to be made as soon as the details had been verified. Trains were beginning to operate; the locals could start returning to work.

Holman's team was in Iraq for just seven weeks. It was, he said, a relatively short but very intense deployment, which was invaluable to both the humanitarian mission and assisting with the immense task of returning the locals to work, providing some semblance of normalisation and getting essential transport services running again.

But it was his work in Sangin in Afghanistan's Helmand Province that Holman remembers as his most rewarding.

Afghanistan: 'Winning hearts and minds'

In April 2007, the number of British troops in southern Afghanistan was increased from 3,300 to 5,800 men, for a series of large-scale operations to systematically clear the entire Helmand province of enemy forces.

Holman was in Helmand for about seven months, and says he set up the British approach to the Reconstruction and Development Program there.

"It is when things started to get a bit ugly around the Sangin area, and across Helmand, and our our deployment as a regiment was ultimately to go out there," he tells Newsroom. "I can imagine that for a lot of people, it would be considered hairy. I think at the time, that was what my life was, and you kind of just go with it."

"To see schools, women's centres, roads, bridges, medical centres, all those things get built by locals, for locals, was probably one of the most moving things I've ever seen."

"I'm not a great fan of the phrase, but it's winning hearts and minds and building infrastructure for people. The idea of using British soldiers to build infrastructure for Afghans was not something that sat with me, because there are plenty of people in that country who can build their own infrastructure."

So, he essentially transformed his unit into a contracting agent that used Department for International Development funding to contract locals to build community and medical facilities.

"There are plenty of skilled people out there with diggers. We became the contracting authority to spend that money. And so I was effectively standing up the industry and, and enabling people to rebuild their own infrastructure," he says.

"To see schools, women's centres, roads, bridges, medical centres, all those things get built by locals, for locals, was probably one of the most moving things I've ever seen.

"When you see these schools being opened, and kids have got proper classrooms, and even a playground where previously they were probably having to play with bombed-out tanks and bits of shrapnel, it's pretty moving stuff."

Holman of Helmand

In Britain, Iraq and Afghanistan, Holman held a variety of leadership roles in the Royal Engineers, delivering critical infrastructure and large-scale construction programmes. He was awarded a Member of the Order of the British Empire in the 2007 Queen’s Birthday Honours.

But the connections he and his wife had built in New Zealand endured. “And ultimately, that's how we sort of ended up back here,” he says.

His time in Afghanistan cemented his certainty that he needs to be making a difference. "I know it sounds glib, but it's not meant to sound glib," he insists. "You know, if you gave me a factory and told me to turn the handle and make widgets on a regular basis, it is probably not going to inspire me, but actually being able to improve something and set something up for the greater good – that certainly resonates with me."

“So, after 17 years in the Army, we asked, where do we want to be? What should we do? The boys are young and growing up – how about we continue the adventure but not wearing combat green or desert yellow? Because I was wearing increasingly large amounts of those.

“So we decided to head to New Zealand.”

"As an officer, you're posted to a unit, and that is the resources that you have. You can't suddenly restructure it and fire people and bring in other resources and go on a recruitment drive. You have to work with what you've got."

Arriving from the UK in 2009, Holman started with GHD as an infrastructure strategy consultant. He moved to the Downer Group, where as a general manager, he ran Downer’s water sector business throughout the country.

He held senior roles at Auckland Council and Air NZ where he worked alongside airport companies and other local stakeholders on the expansion and redevelopment of many of New Zealand’s regional airports.

His last role was as general manager for infrastructure delivery at Crown Infrastructure Partners, with responsibility for the delivery oversight of $6 billion of major infrastructure programmes. In December 2022, he took up his new role as chief infrastructure officer for Te Whatu Ora.

What is the most useful applicable thing he learned in the army? "It's leadership," he says, without pausing for thought.

"It's how to build a team. As an officer, you're posted to a unit, and that is the resources that you have. You can't suddenly restructure it and fire people and bring in other resources and go on a recruitment drive. You have to work with what you've got."

Political balancing act

Holman's job is probably, by his own account, the biggest infrastructure role in the country with the biggest merger that's ever been implemented in government. 

On his appointment last year, Te Whatu Ora's chief executive said she was pleased to have his broad experience in the managing and oversight of large infrastructure programmes.

Fepulea’i Margie Apa said Holman would be providing national leadership for the planning and delivery of capital projects across the motu – more than 100 projects representing nearly $6.7 billion in funding, with $4.9 billion of that approved for delivery and the remaining for projects in the pipeline and yet to be approved.

This role was critically important to leading work with the sector to complete the National Asset Management Plan and advising the Board and the Government on an approach to capital planning and prioritisation that takes a medium to long term view of population and health service needs while also ensuring the timely delivery of projects, she added.

The role would partner with iwi, construction sector partners and clinical and service leadership to ensure health assets were fit for delivery now and in the future.

News of the rethink on the regional hospital rebuilds come amid scrutiny of problems at Hawkes Bay Hospital. A damning health services report, completed in April, found patients had been harmed by "unsafe" and inefficient radiology medical imaging services, which had been that way for years.

Holman says: "All business cases submitted for approval, including as part of the Regional Hospital Redevelopment Programme, include advice on the services that will be supported by the planned infrastructure. This would include radiology, if applicable to the project." 

Tauranga City Council chair Anne Tolley, Palmerston North mayor Grant Smith and Napier mayor Kirsten Wise all argued for the continuation of their hospital rebuilds, while also investing in local primary care. "Hawkes Bay Hospital is absolutely in need of a redevelopment," Wise said. "We are a city of nearly 70,000 and the current service level we receive is unacceptable."

Holman explains Te Whatu Ora's executive has to start going through the prioritisation process, for the five hospitals in the Regional Hospital Redevelopment Programme. "We've got Nelson and Whangārei hospitals under way. Then, we're still working our way through the various bits of understanding the business case, what's the need, etc, etc, for those three others.

"Whether things change after is both a prioritisation issue and, I suppose, it becomes a political issue to some extent, as well as what the board and others want. We are having a good look at those, because the DHBs have done some really good work on them, but they were thinking in the context of their DHB, not thinking nationally."

The end state

How applicable is the experience building community and medical facilities in Helmand Province to building hospitals and community clinics in New Zealand? 

"You have to you have to bear in mind that what we were building there is very different to what you see in a in a European context," Holman says.

"These were what were described as quick impact projects. But they were designed by locals and built by locals to the standards they have, and they know very well how to build in their own country and why they do things certain ways and what materials they can get hold of. So you couldn't describe, some of the medical facilities to be similar to the medical facilities we're building here."

In his 2003 article for the Royal Engineers Journal, Holman concluded with some advice: "Define your end state," he wrote, "so that you know what you have to achieve. Don’t just look at the military objective, what is the political objective?"

Sadly, the end state in Afghanistan is grim. The fundamentalist Taliban returned to power in Afghanistan in 2021, as the last US troops fled Kabul airport. That was two years ago, this week. Women's centres like those built under Holman's oversight have been shut down. Girls have been excluded from the secondary schools.

And the medical facilities are falling into disrepair, according to the Institute for War and Peace Reporting. Khoshal Nabizada, the former head of the public health department in Kabul province, says the situation is "dire", attributing this to the mass migration of healthcare professionals, decline in aid, absence of policymaking and management institutions as well as an escalating demand for services. 

Last year, the Taleban administration drastically cut the health ministry's budget from around 30.1 billion Afghanis (US$344m) in 2021, to 4.5 billion Afghanis (US$49m). According to The World Factbook, Afghanistan’s death rate per 1,000 individuals in 2023 is estimated at 12.08, a huge rise from the 2021 figure of 8.79 per 1,000.

Does it break his heart to see kids being pulled out of school again?

"It is disappointing," he acknowledges. "I think one of the things that you can take from this is that, since 2000, there would have probably been a couple of generations of people that have been through an education system, so there was some benefit from it. But to see it now, yeah, I think a lot of people who've been over there would say it was disappointing."

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