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OPINIONSocietyJuly 1, 2023

A health sector check-up, one year on from the reforms

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Image: Tina Tiller

This time last year, a new era for New Zealand’s health system dawned. Twelve months in, what’s changed for those working in it?

On July 1, 2022, DHBs ceased to exist and the new overarching health entity, Te Whatu Ora, came into being, alongside Te Aka Whai Ora, the Māori Health Authority. It signalled the biggest shake-up of public health in decades, with those in the sector cautiously hopeful that the problems that had plagued it would finally be addressed. So, a year on, what do those working in health have to say about the new system?

‘We remain hopeful’

Aotearoa’s emergency clinicians remain hopeful that the 2022 reforms will lead to more people getting the healthcare they need, faster. The issues in the health system are complex, and it will take time for solutions to lead to palpable improvements and for administrative processes to be clarified and streamlined.

We see the impact of inequity every day in EDs and believe the Maori Health Authority could achieve real change.

On the frontline, there has been no significant change in how we deliver care to patients in emergency departments. The welcome focus on addressing health workforce shortages hasn’t yet translated to improvements on the ground, and EDs continue to experience a lack of skilled staff.

Due to a lack of appropriate beds – particularly in mental health and aged care – we are seeing increasing amounts of people stranded in ED for overly long periods of time.

We are also seeing more violence and aggression towards staff. To keep EDs safe for everyone, every emergency department across the motu must have access to 24/7 appropriately trained and integrated safety and response staff.

We must also prioritise the addition of more staffed inpatient beds and remain focused on solutions that will ensure an appropriate emergency care workforce.

– Dr Kate Allan, Australasian College of Emergency Medicine (ACEM) Aotearoa New Zealand chair

Dr Kate Allan (Photo: Supplied)

‘Continuing to fail the people holding the health system together’

One year on, there is nothing of note to be joyous about. No one is impressed by the abundance of “fluff” that comes via email.

No doubt the intention is to keep the workforce informed, however the workforce would prefer that Te Whatu Ora would concentrate more on the workforce pay, working conditions, and safe staffing.

Recently we were asked to submit comments re the health charter that talks about the health and wellbeing of the patients and health workforce… an oxymoron if ever there was one.

Te Whatu Ora has focused on filling managerial positions and continues to fail the people holding the health system together. They need to start being a better employer and value the workforce. Start paying dollars instead of lip-service.

– A nurse working in a Te Whatu Ora clinic


‘More managers than ever before’

In the year since Te Whatu Ora NZ came into effect it feels as if things have gone from bad to worse. There seems to be even more managers than before.

Never have we had to run wards under such stressful conditions. For example, just today we had two nurses off sick with neither being replaced, which left one ward with one nurse and eight patients and another with five nurses and 17 patients. Our primary ward was then obligated to send a nurse to our winter overflow ward, leaving four nurses with the 17 patients and two more on the way from the emergency department. This is unacceptable for a paediatric ward with high acuity and vulnerable patients. 

In my 40-odd years of nursing, never have things been so bad, so short-staffed, so stressed. We are not able to care for our patients properly, we constantly care ration. I would never recommend nursing to anyone and that saddens me. 

– A paediatric nurse in Waikato

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‘The time has come to move from talking the talk to walking the walk’

I am pleased with the direction of travel to a destination of an equitable health system. The road to that destination is filled with significant potholes and dead ends that Te Whatu Ora seems unable to avoid. 

There has been a woeful absence of engagement and discussion with senior clinicians. This means we get a very top-down approach to change, which risks not improving anything at the grass-roots level.

I think [conditions for doctors] are worse, because the workforce shortfall continues. I see no evidence there has been significant recruitment to senior clinical staff roles. We are not seeing the change we need to see for our patients. Overall system capacity to treat patients is far too low to achieve any catch-up of delayed care. There is a lack of clarity as to how the districts will work together. 

Among clinicians, there is huge fatigue and a lack of feeling valued. There is burnout and a loss of goodwill which is causing some doctors to focus on surviving the workday instead of giving their all to their patients.

My biggest concern with Te Whatu Ora is that this is a huge piece of work that risks not gaining momentum to effect all the changes needed. If this happens, we will end up with a different but still markedly under-resourced and underperforming health system as previously. 

I would like to believe Te Whatu Ora will be given the tools and resources to make the necessary changes and that the previously identified deficiencies will be addressed in the next six to 12 months. 

ASMS members are currently giving Te Whatu Ora the benefit of the doubt but the longer that delays and inertia continue, that patience will diminish. Healthcare workers are excited about finally addressing the inequities in the health system, but the time has come to move from talking the talk to walking the walk.

We [doctors] are deeply sorry that New Zealand is facing long wait times. We have done all we can in the past to work well beyond our means to prevent waits as much as possible. We’re now at a point where doctors are unable to do anything more because we are stretched beyond our capacity. We are lobbying and have highlighted the need for improving recruitment to the people who can make these changes.

– Dr Julian Vyes, president of the Association of Salaried Medical Specialists

‘Things have changed for the worse’

I was generally hopeful things would change for the better. They have changed, unfortunately for the worse.

More fancy position titles at the top, little recognition or engagement with nurses at the coal face. Incentive payments for nurses doing extra shifts over their FTE have been cut while doctors get a minimum of $120 per hour. 

MECA (collective agreement) negotiations have been drawn out with Te Whatu Ora, not meeting many of our proposals.

Staffing on the wards and ED is unsafe and the worst I have ever seen in 30-plus years of nursing. Management put pressure onto the staff who raise health and safety issues. There’s no incentive for senior nurses, and a focus on recruitment, not retention. Morale is at an all-time low 

Many staff are off to Australia – I am planning on going in the next six months. People are suffering daily, and dying. I think this will get significantly worse in the next year with this government. 

 – An enrolled nurse in Hamilton

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‘Despair and frustration, but I do have hope’

For the medical laboratory science profession, this time last year we had just come through the absolute bedlam and despair of living as a profession caught firmly in the public and political headlights from the pandemic testing response. We had seen reports and recommendations on how best to move forward for our sector and had the political-level reassurances that our well-reported and identified workforce and system issues were to be worked through.

Roll on one year later and it is fair to say there is now despair and frustration resonating through the pathology sector that is no different from our other frontline colleagues. We have well-documented workforce retention and disparate funding issues for training and pathology service provision. We still have no operational independent pathology expertise in any national leadership position. There is no national pathology strategy in place yet. Like every other sector, we have sat discussing these issues and the direction we need to go in numerous “working groups” that, as of yet, haven’t resulted in any actual tangible operational frontline or training differences.

However, I do have hope – and that is because of the health leadership I have been fortunate to sit in rooms with or have correspondence with. Some have gone and new leaders have appeared but for someone like me, the message that is clear is the determination and drive to get us all to a better place resonating from each and every leader.

Yes, there is a huge amount of work to do in the middle management to change the old DHB mentality and “buddy” approaches to service provision, but as long as the expertise from within the health professional and operational groups are leading the impetus, good things can and will happen.

I will remain optimistic but as I do remind those same leaders the clock is ticking and time is most definitely not our friend here. The real operational mahi starts now.

Terry Taylor, president of the New Zealand Institute of Medical Laboratory Science

‘I still don’t know what my new role is’

On July 1 last year, an admin lady handed out new lanyards and we got new email signatures but nothing else changed. Gradually over the past year, most of the work I used to do – localised planning and reporting, which was DHB-specific – was moved to be done centrally in Wellington, so I now do project work for another team.

I still don’t have confirmation of exactly what my new job title or role is – we’re just sort of helping out at the moment. My team is among the lucky few because lots of jobs on my floor have been disestablished.

I don’t think there’s been much change in the provision of healthcare but it’s going to take time to bed in. With all the different DHBs, there was a fair amount of duplication on the non-clinical side, so I think the reforms were the right move.

– A former DHB employee working on the planning and funding side of healthcare

Keep going!