In 2017 the Labour-led Government inherited a health system
in crisis, with severe workforce shortages.
While this was an inherited, the Government has largely
ignored it. Workforce shortages now range between ⅕th to ¼ depending on the
occupational group. Even before the pandemic these shortages were impacting
severely on access to planned surgery and other treatments, overcrowded
emergency departments, availability of hospital beds, and compromised capacity
to diagnose patients in a clinically timely manner.
Covid-19 accelerated this, but did not cause it.
The Government’s response was transparently pathetic. In 2018 it trumpeted the formation of a committee; in fact, it was a reconstituted committee with less authority than its predecessor.
The only Government responsiveness was towards nurses, who
comprise the biggest part of the DHBs’ workforce. But this was only due to
nurses persistent militant industrial action, and the dispute remains
Public hospitals are highly dependent on overseas
recruitment for medical specialists. Aotearoa New Zealand has one of the
highest dependencies on overseas recruitment in the OECD.
We are in fierce competition with Australia. But, whereas
the overall salary gap between Australia and New Zealand favours the former by
around 20-30%, for specialists the gap is more than 60%.
So why the political neglect? The Government has made a
conscious political call to ignore pressures on the health system, and instead
focus on restructuring based on advice of business consultants.
The statutory bodies responsible for the delivery of
community and hospital healthcare to geographically defined populations (DHBs)
are to be abolished and replaced on July 1 by a new additional national
monolith: Health New Zealand (HNZ).
Restructuring rarely succeeds in achieving sustainable
improvements. But the Government instead listened to external consultants who,
unsurprisingly, are the biggest beneficiaries of this restructuring.
Health structures were not the cause of the workforce crisis
and neither is restructuring the (or part of) solution. This is an ABC of
health systems, but one that the Government has failed to grasp.
Not only has this restructuring distracted government from
addressing the real crisis, its rushed nature has meant that the new HNZ is
ill-equipped to hit the road running.
Ian Powell was critical of the Government’s decision to
abolish DHBs, saying shifting decision-making to bureaucrats in Wellington
could have implications on the unique needs of populations – such as those in
HNZ will begin with most leadership comprising interim
appointments. They are largely those currently in DHB leadership positions.
Ironically, the health minister has scapegoated DHBs for health system’s
The ‘interims’ are capable people who will do their best,
but they will be keeping the system going rather than addressing pressures
caused by this workforce crisis. This means that there will be a leadership
vacuum for some time. Consequently, the workforce crisis will get worse.
In early 2020 National and Labour were neck-and-neck in the
polls. National had clawed back a clear lead by Labour that had been deservedly
earned by Prime Minister Jacinda Ardern’s impressive leadership in response to
the murderous mosque attacks a year earlier.
The Government’s impressive and world-leading response (at
the time) to the pandemic led to a complete reversal of electoral fortunate
seven months later
Labour’s strong polling continued Until late September it
still handled the pandemic response well.
Thereafter, the wheels came off as it resorted to spin
rather than scientific evidence to justify its evolving laissez-faire response.
Capping it off was National’s election of a competent and confident new leader.
Right now the polls show National a little ahead. Largely
this is because Labour has lost its favourable point of difference with
National over the pandemic response and is not strong on implementation of
various matters, including the health system.
Health is an important electoral issue because of its
extensive impact on so many New Zealanders. In the 2017 election health was
damaging for the National-led government. The workforce crisis since then has
There is no way ‘Team Interim’ (aka Health NZ) will turn
this crisis around so it makes a tangible difference to healthcare access
before the next election.
But what has made the situation doubly worse is the most
incompetent decision I’ve seen made by a government in health – in the middle
of a pandemic dismantling the system of provision and delivering healthcare in
communities and hospitals and replacing it with an untested alternative which,
for some time at least, will have an interim leadership.
By the time of the next election the government will be in
no position to blame the workforce crisis on DHBs or the previous government.
Labour is trending in the polls towards being under Damocles’ Sword. It will
certainly be under it by the time of the election.