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Time For Health Minister To Step Up On Workforce Crisis

Late last year I urged Dr Shane Reti, then the expected incoming health minister, to get ready to run on two issues – the workforce crisis and health system culture – when he assumed the health portfolio.

This message was in my Otaihanga Second Opinion blog (7 November): Starting on the right foot is critical

It levered off my earlier Stuff column (1 November) on the same theme: Two urgent things for Dr Shane Reti to resolve.

On workforce that I advised that:

…are crippling our health system and harming the health of this workforce. Their severity is worsening by rising acute hospital admissions increasing at a higher rate than population growth.

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We need a mindset shift from seeing the workforce as a cost liability to an investment in both the health of the population and economic performance.

What is required is effective workforce planning and development backed up by targeted practical action plans focusing on the here-and-now.

Worsening impact of workforce shortages

Over three months later, the impact of these shortages is worsening. This became clear from figures released by Te Whatu Ora (Health New Zealand) on the increasing number of people waiting more than four months for hospital treatment.

In the quarter ending in December 2023, 68,000 people were waiting more than four months for a specialist appointment, up 8000 on the previous quarter.

This was discussed on Radio New Zealand’s Morning Report (28 March) in an interview with Vanessa Blair representing the Association of General Surgeons: Increasing wait times for hospital specialist treatments .

Vanessa Blair described this increase as being part of a slowly increasing trend. There was a “mass increase in acute demand” (patients whose treatment can’t be deferred) which meant that planned care (such as elective surgery) had to be cancelled or otherwise delayed.

She also raised a timely alarm bell over Te Whatu Ora suggesting that clinical follow-ups might have to be reduced (fudging it as a ‘new model of care’).

These follow-ups are critical in order to assess how patients have progressed since their surgery or other treatment. Dr Blair described this thinking as shifting the deck chairs on the Titanic.

Another consequence of workforce shortages is women being denied critical gynaecological treatment and left to cope in pain.

This was because of the need to prioritise even more urgent cancer patients. It was highlighted the same day by the NZ Herald: Women left in pain.

Health Minister recognises the workforce crisis

In opposition Dr Reti recognised that the workforce crisis was the biggest  issue in the health system. There is no reason to believe that he has changed his assessment. This is a good starting point.

He also accepts that this crisis existed before Labour formed its first government in 2017. It is to his credit that he acknowledges that the previous National-led government contributed to this crisis. This is also a good starting point.

Unfortunately through a combination of neglect, elitist arrogance and poor decision-making, Labour allowed the crisis it inherited to worsen.

However, after more than three months in the portfolio Dr Reti has provided no tangible evidence of seeking to address this crisis.

He has announced new health targets. But their success primarily depends on overcoming the workforce crisis. They will not alleviate it.

The minister is also advancing the third medical school at Waikato University for rural general practice.

However, the process is questionable while achieving claimed benefits is unclear. I discussed this in BusinessDesk (26 August): Caution and better process required for third medical school .  

Certainly making a difference on the severe medical workforce shortages is years away, if at all. At most the relief will be relatively small and much delayed.

Go practical and go visible, Dr Reti

There is no silver bullet but there are practical visible steps that could be taken. The health system needs recruitment and retention strategies for each of the numerous health professional occupations employed by Te Whatu Ora.

These strategies need to be backed up by action plans developed through engagement with the relevant health unions and professional associations.

Some will involve training more; some will involve retaining more; some such as medical specialists will require competitive remuneration and other conditions in order to compete with Australia in the international market.

In general practice he needs to be expeditiously and visibly working towards practical changes to the capitation funding system in order to begin to turn around the general practitioner workforce crisis.

I discussed this in my last Otaihanga Second Opinion post (24 March): Don’t decapitate capitation.           

And while he’s at it, don’t forget taking necessary steps to start to address the pay inequities between nurses employed by general practices and those employed by Te Whatu Ora.

There is goodwill from the workforce towards the new health minister. The workforce understands both that he is not responsible for the crisis and that there is no overnight solution. It will take time.

But the workforce desperately needs confidence. It needs to see that there is a planned direction of travel that makes good pragmatic sense; and not based on soundbites or jargon.

The longer they continue not to see this direction of travel, the more the workforce will lose confidence.

Instead of seeing Dr Reti as part of the solution, increasingly he will be seen as part of the problem. This would be a tragedy.

You are not in opposition now Dr Reti (apologies to Guatemala and Shortland St)!

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