Turia: Budget Debate- Health Workforce
Budget Debate : Health Workforce
Hon Tariana Turia, Health Spokesperson
Wednesday 28 May 2008
Tena koe Madam Speaker, tena tatou katoa.
I would like to say thank you to Labour and National for giving me this space. Tena korua.
The World Health Organisation has revealed that we have broken another record.
New Zealand has the highest ratios of foreign born and foreign trained doctors in OECD countries, and amongst the highest for nurses. As well as that, it reports that retention of health professionals is a key issue, because attrition rates for doctors and turnover rates for nurses are so high.
But it gets worse.
The numbers of New Zealand born health workers have also deteriorated, as they leave our shores for other lands.
In fact, the number of New Zealand born nurses living in other OECD countries is matched by the number of foreign born nurses in New Zealand.
It is not just those who are currently in the system that are our concern.
The 2005 study ‘Doctors and Debt: The Effect of Student Debt on New Zealand Doctors,’ revealed that two thirds of respondents in the study also stated they would consider leaving New Zealand within three years of graduating, such is the level of pressure in the health workforce.
The effects of a system under stress are felt in many forms.
We have heard the desperate shortages that are affecting waiting lists up and down the country. In the Auckland District Health Board, for example, the average wait for treatment for heart disease has increased from 27 days in 2002/03 to 64 days now.
We recall the litany of ‘sentinel events’ -- major medical mishaps or incidents -- mistakes which in some cases cost patients their lives. The report of 182 serious and sentinel events showed us that if you enter a public hospital, you have a 15 per cent chance of suffering an adverse event.
In maternity health, we know that fifteen of the twenty one District Health Boards say their communities are at least 85 midwives short.
All of this context leads the World Health Organisation to conclude that New Zealand faces serious challenges, with demand from health professionals set to outstrip supply by 2011.
So what can we do?
Three years is not much to overturn the health system.
The 2008 Budget contained a mere sixty million dollars to improve the health workforce – not much in the context of the additional two billion allocated to Vote Health.
The Budget also included a specific allocation for Māori nursing workforce development and Pacific health provider and workforce development.
I want to be quite clear that we in the Maori Party welcomed the initiative to increase the numbers and skill base of Maori nurses and to develop and encourage secondary students to take up a health career pathway.
We were also pleased to see the support for Pasifika health providers included – but our concern remains with the analysis put forward by the World Health Organisation, and I quote:
“Despite the key role of the health workforce in the health system it has not been at the core of the various health system reforms in New Zealand”.
Such a concern was mirrored by the comments of the New Zealand Medical Association who were extremely disappointed that the Budget “failed to provide comprehensive funding to address health workforce shortages”.
We ignore, at our peril, the advice of our medical specialists, our health professionals.
In March of this year, a pan professional medical forum was called which concluded that the New Zealand medical workforce is in crisis because of its inability to train and retain enough doctors to provide the health services that New Zealanders deserve.
And we think too of the criticism from the New Zealand Nurses Organisation, that the Budget failed to include wage increases for Aged Care workers – those workers who fall to the lowest paid part of the health sector – or for Maori and Iwi Primary Health Care providers to be funded adequately so that workers will achieve pay parity with DHB health professionals.
Madam Speaker, it is little wonder that the World Health Organisation warns that our health system is vulnerable, and that Government needs to take urgent action to address the chronic workforce shortages.
There are some particular crisis points for Maori and Pasifika health workers. We know that Maori and Pasifika health workers are concentrated in less senior and less well-paid positions; such as the community worker, health promotion and health education fields.
The Ministry of Health suggests that half of the full-time public health workforce earn less than $43,000 per annum – and most of these are Maori and Pasifika workers.
Pay is important, as are conditions, but it is also vital that the health workforce is viable and has patient safety at its core.
There is no shame in admitting we are in a crisis and that we must call on all parties to turn the situation around.
So where to begin in addressing an already stressed workforce?
I think this is an area where we can look to our communities – and particularly to tangata whenua - for leadership.
One of the areas in desperate need is that of recruitment.
I have been extremely impressed by the programmes offered at Victoria University - Te Rōpu Āwhina Pūtaiao and Te Rōpu Āwhina Waihanga Hoahoa - the whānau support systems for Māori and Pacific Nations students enrolled in science, technology, architecture and design.
There’s the work being led by AUT with Ngā Pae o te Māramatanga (the Centre of Research Excellence, University of Auckland) in expanding our knowledge about participation and retention in the Māori health and disability workforce.
For those practising doctors, there’s the intensive clinical training programme offered by Te Ohu Rata o Aotearoa (Mäori Doctors’ Association) and the Royal New Zealand College of General Practitioners to enhance the number of Mäori doctors training as GPs.
There’s the network known as hauora.com which brings together Maori health professionals, health providers and health workers to strengthen the capacity and capability of the workforce; or the excellent work being led by Healthcare Aotearoa.
Another Maori-led collaborative venture focused on workforce is Te Rau Matatini which is singularly focused on enhancing the capacity of the Maori mental health workforce in order to improve the health of Maori communities.
In short Maori are providing huge leadership in the area of health workforce development, it is one that maybe the Government could look to.
There are many excellent initiatives already in place which must be called on to recruit and retain staff.
It is evident to us all that the health workforce is under increasing and relentless pressure in our hospitals, and accordingly the quality of the service provided is compromised.
I know from my experience as Associate Minister of Health, how willing Maori health providers and Maori health professionals are to share their networks, their experience and their expertise to making the change happen.
Calling on their leadership would be a big start in turning the crisis around.
And perhaps then, we will come to a time when the health workforce will be placed at the core of the health system.