Point of Order: When all that money is being pumped into health (as the PM insists), we may wonder why the system is so badly strained

Opposition Leader Christopher Luxon has shown he is a fast learner. Where earlier he often ended on the receiving end in exchanges with the Prime Minister in Parliament, now it is the Prime Minister who who can be seen back-pedalling,

Take, for example, pressures in the health system which are causing so much anguish to New Zealanders.

The National Party has turned the spotlight on emergency departments which are facing high demand and staff shortages, with at least one district health board delaying planned surgeries for weeks.

Luxon had laid the groundwork for his questions with an earlier statement that he would commit to delivering and improving health outcomes.

The government

“… confuses and conflates spending announcements with actually securing outcomes”, Luxon said.

“This government cannot get anything done, it doesn’t matter which portfolio you pick up, they’re actually spending more money, hiring more bureaucrats and getting worse outcomes.”

Health waiting lists were an example, Luxon said.

“We’ve gone from 1000 people waiting more than four months to see a first specialist before Covid to almost 15,000 and now post-Covid we’re at 37,000 New Zealanders haven’t been able to see a specialist to get their first specialist appointment within a four-month period.”

Measures, targets and delivery of services were what made a difference to people, Luxon said.

Thus he had limbered up quite nicely when he clambered into the ring at Question Time in Parliament yesterday. Here’s how Hansard recorded the exchange when he asked if the PM agreed with her Health Minister that the system is “coping”.

And if so, why were thousands of people waiting longer than six hours in the emergency department and elective surgeries being cancelled?

Rt Hon JACINDA ARDERN: What, of course, the Minister will be reflecting is that we often in New Zealand see over the winter periods pressure in our health system.

But, as we flagged at the beginning of the year, we anticipated that this period would be worse than most, because those things that exacerbate pressure in our system include, for instance, seasonal illnesses, and influenza has not been present circulating in New Zealand for two years and is now circulating in Australia and New Zealand with a vengeance.

Flu is outstripping, for instance, COVID-19 hospitalisations when it comes to respiratory illness in our Auckland hospitals. But we are encouraging and working alongside the health sector on innovative solutions, such as those you’ve seen in Counties Manukau, and, of course, an increase in the availability and subsidies around flu vaccines, all in an effort to ease those pressures.

Christopher Luxon: Why, then, did the Government exclude nurses from the fast-track, straight-to-residency immigration pathway when we have a nursing shortage of more than 4,000?

Rt Hon JACINDA ARDERN: I’ve seen some of the Opposition’s statements in this area which are completely misleading and wrong. The most important factor here is that New Zealand needs new nurses, so for the first time we are fast-tracking them to residency on the basis that they are willing to be a nurse. Now, if the member thinks that the best option is for us to remove the criteria that they continue to be a nurse, I don’t see how that helps our nursing shortage.

Christopher Luxon: What message does it send to the overseas nurses we are trying to attract when Australia offers them immediate residency but this Government refuses to do so?

Rt Hon JACINDA ARDERN: Again, misleading. Our message is “Come to New Zealand and you will be fast tracked for residency.”, and our only ask is that you continue to be a nurse. So, Mr Luxon, if your proposal is that we don’t ask people to be nurses when they come in, it will hardly support our efforts.

At that point Deputy PM Grant Robertson joined the fray, obviously aiming to pin Luxon to the mat by asking the PM which approach she thought would help address issues in the health system: consistently increasing the funding for the health system or not funding it enough for population growth and demographic changes?

Rt Hon JACINDA ARDERN: The member is correct. Of course, one of the most significant issues that we have raised by our health workforce is the fact that we have had under-investment over a number of years in health, and that includes, of course, at an operational level, but it includes at a capital level as well. We have worked to rectify both. We’ve increased the number of nurses by thousands, but we still carry vacancies and need to continue to recruit. We’ve funded the ability to do that, and we are recruiting offshore and, for the first time, fast-tracking—not something I saw the National Government do, because they didn’t increase the number of nurses either.

But Luxon had plenty of fight left in him and asked:

Why, despite all this spending, have health outcomes like emergency department wait times and faster cancer treatment got worse under this Government?

Rt Hon JACINDA ARDERN: Of course, we’ve put hundreds of millions into the catch-up campaign following the global pandemic that is COVID-19.

The appropriate point of comparison would not be New Zealand against itself but globally on the impact on the health systems because of the pandemic, where prolonged lockdowns in other countries led to delays in planned care. Yes, there has been an impact in New Zealand but, relative to other countries, not nearly what it would otherwise have been.

Christopher Luxon: Why did her Government decide to scrap the national health targets, including the target for emergency department wait times, which University of Auckland research found had saved thousands of lives?

Rt Hon JACINDA ARDERN: Because we saw that some of those measures caused distortionary behaviours in order to be seen to meet the targets. What our health system needed from the National Government of the day was investment; that is what it lacked.

Christopher Luxon: Does she accept that if her health minister spent less time focused on building the health bureaucracy in Wellington and more time focused on the front-line health workforce in our hospitals, people wouldn’t be waiting as much as 32 hours in the emergency department or having their surgeries cancelled?

Rt Hon JACINDA ARDERN: The member has displayed his complete lack of understanding of what Health New Zealand is designed to do.

One of the issues that we have is we essentially run 20 distinct health systems, almost, in New Zealand. We are not a country that can sustain that, and we’ve seen the impact of that.

What we need is the ability for our health network—particularly tertiary care—to work together. We’ve seen the signs of the benefits that can bring when those providers have worked together through COVID.

We need the ability to move our health workforce around where the need is. We need the ability for different tertiary institutions to focus on the specialist care that they can provide nationally. We need to make sure that we are funding our community-based provision and ensuring that we have health resource in the places people access it when they need it and not a nine-to-five. These are failings we cannot overcome unless we move to a more national service. That is what Health NZ is.

The member continues to call it a bureaucracy; he clearly doesn’t understand the reforms.

But listeners to the exchange would have been left wondering why – despite Labour’s dumping DHBs, creating a centralised system and spending hundreds of millions more on health – the country has worse outcomes than previously. Wouldn’t they?

Point of Order is a blog focused on politics and the economy run by veteran newspaper reporters Bob Edlin and Ian Templeton