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Quality Of Aotearoa NZ's Health Care System Affected By Turbulence Of Global Pandemic And Health System Transformation

A new report from Te Tāhū Hauora Health Quality & Safety Commission (Te Tāhū Hauora), A window on quality 2024: Turbulence, quality and the future | He tirohanga kounga 2024: He hūkeri, he kounga ki anamata hoki, highlights issues affecting the quality and safety of Aotearoa New Zealand’s health care system.

The four-part report explores the impact of the global COVID-19 pandemic and transformation of the health care system, changes in patient safety over 20 years, how the system has evolved since the pandemic and draws conclusions about priority areas of focus.

‘The health care system has undergone extensive change in the last few years, impacted by the global pandemic and the health system restructure,’ says Dr Peter Jansen, Tumuaki Chief Executive at Te Tāhū Hauora.

The ‘Window on quality’ report series highlights key issues affecting the system and makes suggestions for change.

The 2024 Window shows that access to primary and secondary care has worsened. The percentage of people who reported not going to a GP due to wait times being too long roughly doubled in the last 3 years, creating further inequity for Māori.

‘It is pleasing, however, to see that, although access has worsened, the care people receive is still high quality and their safety has largely been maintained,’ says Dr Jansen.

In secondary care, the number of people waiting longer than 4 months for a first specialist assessment has risen steadily since the COVID-19 pandemic, as has the number of people given a commitment to treatment but not treated within 4 months. The health system is trying to catch up but faces constraints in capacity and resourcing.

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There have been two major shifts within the health system since the pandemic, in the nursing workforce and telehealth, both of which have implications on the quality and safety of care.

Shortages in the nursing workforce led to a recruitment drive focused on internationally qualified nurses but many of those people who apply for registration are choosing to go to Australia.

‘Recruitment, support and retention of a nursing workforce is essential to our health system,’ says Dr Jansen.

‘We’d like to see better awareness and implementation of Te Mauri o Rongo - the New Zealand Health Charter, which gives us an opportunity to create a culture that both attracts internationally trained workers who want to come here and stay, as well as workers who are trained here and don’t wish to leave.’

The use of telehealth, which has the potential to help with access issues and improve equity for Māori and rural populations, has not been sustained following the pandemic. Data shows that, while telehealth was extensively used during the pandemic, its use was not as extensive as many believe, and we have returned to pre-pandemic behaviour where face-to-face appointments are the norm. Telehealth may provide opportunities for greater efficiency and ease of access for some populations, but those working in the health system need to better understand who telehealth suits best and barriers to its implementation.

The barriers to applying the telehealth model include capability and confidence with technology, and the resourcing and equipment needed to support the service.

The impact of the pandemic have been a challenge to all health systems, not just that in Aotearoa New Zealand. However, it is essential to continue to monitor the quality, safety and equity of our services and look to how we can make improvements in the future.

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