Our two major parties’ health spokespeople say they know how to create a more sustainable health system. Labour’s Ayesha Verrall and National’s Shane Reti talk to Zahra Shahtahmasebi about the different paths they would walk.

Ayesha Verrall’s health philosophy is to invest in keeping New Zealanders well and out of hospital.

A former infectious diseases specialist, she knows people end up in hospital because of missed opportunities for care in the community.

So if Labour is re-elected come October 14, New Zealanders will see her philosophy in action with free dental for under 30s and free prescriptions, says Verrall.

Labour would also make cervical screening free for those aged 25 to 69; increase the age of eligibility for free breast screening from 69 to 74; develop an endometriosis action plan; and invest in infrastructure, with new hospitals in Nelson and Hawke’s Bay. The party has also promised to boost funding for Pharmac by $1 billion over four years.

For Shane Reti, the focus is on our health workforce. The National Party’s health spokesperson says a health system led by him would work hard to rebuild the sector both in numbers and spirit.

New Zealanders would see Reti bringing more people into the workforce via myriad plans that include establishing a new medical school, so they don’t have to wait as long for their appointments. He would devolve Labour’s centralised decision-making, giving control back to the regions, which he says know best, and would set health targets to hold the sector accountable.

With Reti a former GP, both he and Verrall say their clinical time has given them an intimate knowledge of what the issues are and how to solve them.

It’s a “rare, spare morning at home in Wellington” halfway through the campaign trail when Verrall speaks to The Spinoff.

She talks about how free dental care – annual check-ups, cleans, basic fillings and extractions – for under 30s, and continuing free prescriptions for all New Zealanders, would reduce costs, minimise unnecessary hospitalisations and ensure easy access to medications, from contraception to mental health treatment.

In contrast, Reti would scrap free prescriptions in favour of targeting the policy to the most vulnerable, including Community Services Card holders and those over 65.

“If people think that the wealthiest New Zealanders should receive the same co-payment relief as the most vulnerable, I dare them to go out on the street and shout that out,” says Reti.

A targeted policy frees up $300 million he would use to fund 13 cancer treatments identified by Te Aho o te Kahu, the Cancer Control Agency, as having the most significant clinical benefit.

Reti is a big fan of targets, it seems. On September 10, he announced five health targets National would prioritise if in power, centred around reducing wait times in hospital emergency departments and to see a specialist or for surgery; reducing how long it takes cancer patients to receive treatment; and a 95% immunisation rate for two-year-olds.

“Targets set a direction to travel – they bring focus, funding, accountability,” says Reti.

But Verrall is against them. She says no system could target the free prescription policy effectively, believing some of those in need would still miss out. As for Reti’s five health targets – they just don’t work, she says.

“Basically you take an overburdened system and you’re just yelling at the clinicians to work harder. And unless you provide more resources, a set of targets won’t do anything.”

Verrall provided funding of $100 million to hospitals so they could do whatever it took – whether it was outsourcing or operating on weekends – to clear the non-orthopaedic surgical waitlist by the end of this year. The waitlist started at 50,000, and now there are around 9,300 surgeries left to do.

“That is what you have to do,” she says, as otherwise, “targets themselves can just be virtue signalling, helping politicians shift the blame from themselves onto the clinicians, and I don’t think that is acceptable.”

There’s a lot Verrall and Reti don’t see eye to eye on – like whether or not New Zealand’s health system is in crisis. 

As he speaks to The Spinoff from his home turf in Whangārei, Reti quickly establishes his case that we’ve had a health workforce crisis on our hands for years. He finds the continued denial of previous minister of health Andrew Little, and now Verrall, astonishing.

“All this does is show that you’re out of touch, and it fails to bring the urgency that is needed.”

Not only do we need more people, but also to lift the spirit of the sector, who are hunting for clear leadership in among layers and layers of bureaucracy and no accountability, says Reti.

“The goodwill and cachet of the health workforce has been eroded by the virus and policy decisions… That sense of collective value is just as important as having more people.”

Reti’s mission statement is timely access to healthcare because he knows this is what New Zealanders value most, he says. Too often they’re not able to see their GP for days or weeks, they’re unable to enrol at a practice because it’s full, or they’ve been sitting on a list for years, waiting to have their hip or knee done.

This has a huge ripple effect on the whole health system – not least because these people then turn up at their local hospital’s emergency department (ED), says Reti.

“There are no winners if primary care fails and ED becomes your medical home… Primary care holds your life story, but when you turn up at ED, it overwhelms cases that may be more urgent.

Reti proposes various solutions to bolster the workforce, including special visas to bring more nurses and midwives in, ensuring a fair and equitable wage, particularly for nurses, to prevent them from heading offshore, as well as ensuring safer working environments.

Student loan relief will be offered to nurses who commit to five years of consecutive service in New Zealand, and Reti has a training plan in mind to help credential what he calls the “Uber docs” – international doctors who can’t get registered to work in New Zealand, due to a lack of hospital placements.

“So they end up driving Uber Eats and taxis in Auckland,” says Reti. “Why would we do that when we are in the middle of a health crisis?”

Finally, he is reigniting his bid for a third medical school in Waikato, which, compared to schools in Auckland and Otago, would have a focus on rural primary care and take on graduate students for only four years of study instead of six.

“In your last three years, every night you’ll be returning back to your family, to your community… we’ll bring the trainers to them,” says Reti.

“We know with the Australian and Canadian experience when you train in place, people stay in place, and this is how we’re planning to build our rural health workforce.”

Yet, Verrall says Labour will use the two existing medical schools, with “over 200 years of experience between them”, to train 335 more doctors by the year 2027. This is more than what National will achieve with its third medical school, resulting in an additional 220 doctors by 2030. 

“They [the National Party] will also have to pay all the expenses of setting up a new medical school and their plan has a $100 million hole in it, which they say Waikato will get from philanthropy.”

Verrall says she will create a sustainable health system that is well-staffed, well-resourced and appropriately funded.

Funding should be directed towards multiple outcomes – while she is keen to improve the affordability of primary care, improving accessibility so people can book a GP appointment on time must go alongside that. 

As to whether there is a health crisis, Verrall neither confirms nor denies, instead saying we are recovering: “The workforce was under pressure due to the extra work of Covid, but also because immigration was constrained. And now there’s a global shortage.”

After becoming minister of health in February, she set out three priorities to address this: workforce, winter and waitlists.

This has resulted in a national workforce plan, big payments to improve nurse retention, the non-orthopaedic surgical waitlists being worked on with Verrall’s extra funding of $100 million, and a new scheme that has provided more funding to pharmacists and GPs so they can offer extra services.

Theatre operations in hospitals have gone up by 6% – a sign that acute demand is being managed better, she says.

“There’s still work to go, but you can see how to get from here to the more sustainable position we want to be in.”

Finally, Verrall says she’s committed to creating a health system that is truly fair, by ending “the postcode lottery”, and making sure access to healthcare and procedures, like cataract surgery, doesn’t vary from region to region, like it does now.

For cataract surgery, Labour has committed to funding all of the catch-up operations so this  procedure can then be equalised across the country: “We want to look for more of those opportunities to make a truly fair health system,” she adds. 

Looking forward from Covid-19, Reti says: “The health system in my hands will be a learning environment so that each epidemic and event we have, we pick that up and take it forward to make our response more resilient and our system better.”