1 00:00:06,400 --> 00:00:06,800 Speaker 1: Kiota. 2 00:00:06,880 --> 00:00:09,800 Speaker 2: I'm Chelsea Daniels and this is the Front Page, a 3 00:00:09,880 --> 00:00:18,160 Speaker 2: daily podcast presented by The New Zealand Herald. Chaos, overstretched, 4 00:00:18,320 --> 00:00:20,759 Speaker 2: and a blood bath. These are just a few of 5 00:00:20,760 --> 00:00:24,000 Speaker 2: the descriptions of New Zealand's health sector in recent days. 6 00:00:24,239 --> 00:00:26,640 Speaker 1: It's as the sector faces its third. 7 00:00:26,560 --> 00:00:31,000 Speaker 2: Resignation of its top brass Director General of Health Diana Sarfati, 8 00:00:31,080 --> 00:00:34,360 Speaker 2: will finish up this Friday, ending her term two years 9 00:00:34,440 --> 00:00:38,159 Speaker 2: earlier than expected. Her resignation came soon after Health New 10 00:00:38,240 --> 00:00:42,080 Speaker 2: Zealand Chief Executive Marjie Arper, followed by Public Health Director 11 00:00:42,159 --> 00:00:45,959 Speaker 2: Nicholas Jones, who quit just a few days later. We're 12 00:00:46,080 --> 00:00:49,239 Speaker 2: constantly being told the system is in crisis, on the 13 00:00:49,280 --> 00:00:53,239 Speaker 2: brink of failure, spending beyond its budget, waiting times are 14 00:00:53,280 --> 00:00:58,000 Speaker 2: getting longer and suffering from widespread staff shortages. But the 15 00:00:58,080 --> 00:01:01,840 Speaker 2: decades old question is how do we actually fix it? 16 00:01:02,040 --> 00:01:05,200 Speaker 2: Today on the front Page, University of Otago Professor of 17 00:01:05,240 --> 00:01:08,319 Speaker 2: Public Health Peter Crampton joins us to give us a 18 00:01:08,400 --> 00:01:16,759 Speaker 2: rundown on our health system. So, Peter, it's no surprise 19 00:01:16,880 --> 00:01:19,520 Speaker 2: that the health system is in crisis. In fact, it 20 00:01:19,520 --> 00:01:22,800 Speaker 2: feels like we're constantly being told this what kind of 21 00:01:22,880 --> 00:01:25,160 Speaker 2: challenges is it facing right now. 22 00:01:25,560 --> 00:01:27,840 Speaker 3: Well, the word crisis has been used quite a lot 23 00:01:27,880 --> 00:01:30,959 Speaker 3: over the last twelve months. It's a word I would 24 00:01:31,040 --> 00:01:34,160 Speaker 3: use with a great deal of caution. In my professional life. 25 00:01:34,200 --> 00:01:37,759 Speaker 3: I've been observing this closely for at least thirty years. 26 00:01:37,920 --> 00:01:41,640 Speaker 3: I don't think I've seen so much pressure and uncertainty 27 00:01:41,680 --> 00:01:44,119 Speaker 3: in the health system as I see now that there 28 00:01:44,160 --> 00:01:47,400 Speaker 3: are new factors led upon old factors. In terms of 29 00:01:47,720 --> 00:01:50,280 Speaker 3: the stress is being brought to bear in the new 30 00:01:50,360 --> 00:01:52,760 Speaker 3: zin and health system and also all around the world, 31 00:01:53,040 --> 00:01:56,080 Speaker 3: I'd say number one as the fact that healthcare gets 32 00:01:56,160 --> 00:01:59,400 Speaker 3: more complex and more expensive by the day. And in 33 00:01:59,440 --> 00:02:03,240 Speaker 3: a country such as New Zealand, it's driven by the 34 00:02:03,320 --> 00:02:06,120 Speaker 3: aging population. We get sicker and we get older, and 35 00:02:06,120 --> 00:02:10,840 Speaker 3: we're living longer, and we drive the costs of healthcare delivery. 36 00:02:10,919 --> 00:02:15,960 Speaker 3: And that means that well, for example, increasingly individuals as 37 00:02:15,960 --> 00:02:19,480 Speaker 3: they get older have multiple conditions that would need treatment. 38 00:02:19,680 --> 00:02:23,639 Speaker 3: At the same time, that complexity brings with it increase 39 00:02:23,800 --> 00:02:28,800 Speaker 3: need for healthcare, professional time, more medicines, more expenditure on 40 00:02:28,919 --> 00:02:32,760 Speaker 3: expensive medicines, and so on. And that is a real driver. 41 00:02:33,040 --> 00:02:36,000 Speaker 3: It's a driver of complexity. It's a driver of difficulty, 42 00:02:36,040 --> 00:02:39,720 Speaker 3: it's a driver of expenditure, and that's no one's fault. 43 00:02:40,040 --> 00:02:43,919 Speaker 3: It's not a bad thing. It is a fact. Nevertheless, 44 00:02:44,120 --> 00:02:46,600 Speaker 3: what it does mean is that there is pressure on 45 00:02:46,680 --> 00:02:51,920 Speaker 3: a government, on all governments, to deliver in those circumstances 46 00:02:51,960 --> 00:02:55,920 Speaker 3: where there's a great deal of pressure driving upward expenditure. However, 47 00:02:56,040 --> 00:03:00,880 Speaker 3: hard governments try that pressure on and it can only 48 00:03:00,919 --> 00:03:05,280 Speaker 3: be partly addressed through increasing product to video or increasing efficiency. 49 00:03:05,440 --> 00:03:08,600 Speaker 3: It does, in the end need more expenditure per capita 50 00:03:08,760 --> 00:03:12,480 Speaker 3: per person. I would say that in our system we 51 00:03:12,560 --> 00:03:15,639 Speaker 3: have over the long term, we've underinvested in primary care, 52 00:03:15,960 --> 00:03:19,480 Speaker 3: by which I mean nurses, doctors, and all those people 53 00:03:19,520 --> 00:03:22,120 Speaker 3: in the community who look after us when we get 54 00:03:22,120 --> 00:03:25,760 Speaker 3: on will and that's where the bulk of healthcare is provided, 55 00:03:25,960 --> 00:03:29,040 Speaker 3: and we've underinvested in that, and that is at the 56 00:03:29,080 --> 00:03:32,320 Speaker 3: point of extreme stress right now. And what that means, 57 00:03:32,360 --> 00:03:34,920 Speaker 3: amongst other things, is that we get sicker, we're not 58 00:03:34,960 --> 00:03:37,080 Speaker 3: treated early enough, and then we end up in the 59 00:03:37,120 --> 00:03:42,520 Speaker 3: hospital system, costing the system more and also driving up pressures, stresses, 60 00:03:42,560 --> 00:03:45,720 Speaker 3: and waiting times in hospitals. So that's in there as 61 00:03:45,760 --> 00:03:50,200 Speaker 3: an underlying reason. Look, I think there's two more immediate 62 00:03:50,760 --> 00:03:53,360 Speaker 3: aspects of the health system which need to be commented on. 63 00:03:53,440 --> 00:03:57,520 Speaker 3: The first is COVID and post COVID politics. There has 64 00:03:57,600 --> 00:04:02,400 Speaker 3: been a rapid shift to political populism and that brings 65 00:04:02,440 --> 00:04:06,400 Speaker 3: with it less trust in so called elites, less trust 66 00:04:06,480 --> 00:04:10,360 Speaker 3: in science, less trust and experts. And because the health 67 00:04:10,360 --> 00:04:15,280 Speaker 3: system so reliant on experts and science, and while groups 68 00:04:15,320 --> 00:04:19,200 Speaker 3: of people who are regarded as being elite has a 69 00:04:19,240 --> 00:04:22,640 Speaker 3: destabilizing effect in the health system. And not just in 70 00:04:22,640 --> 00:04:24,640 Speaker 3: New Zealand but all around the world. That this is 71 00:04:24,680 --> 00:04:28,359 Speaker 3: a new phenomenon. And of course COVID. Coming back to COVID, 72 00:04:29,200 --> 00:04:32,200 Speaker 3: it brings with it all the stress is on the 73 00:04:32,200 --> 00:04:35,840 Speaker 3: country's finances that we know are very very difficult. Again, 74 00:04:35,920 --> 00:04:38,200 Speaker 3: this isn't about this government or the previous government or 75 00:04:38,200 --> 00:04:41,240 Speaker 3: any government. It's just countries around the world are experiencing 76 00:04:41,360 --> 00:04:45,320 Speaker 3: huge stress post COVID. In addition to that, the previous government, 77 00:04:45,360 --> 00:04:48,119 Speaker 3: the Labor government with Andrew Little as the Minister of Health, 78 00:04:48,160 --> 00:04:51,360 Speaker 3: initiated a set of major reforms of the health system. 79 00:04:51,560 --> 00:04:56,320 Speaker 3: This kicked off under Minister David Clark who initiated a 80 00:04:56,360 --> 00:04:59,240 Speaker 3: review of the health system. I was on that review panel. 81 00:04:59,279 --> 00:05:02,120 Speaker 3: We made a number of recommendations to the then government. 82 00:05:02,400 --> 00:05:05,080 Speaker 3: Some of those recommendations were taken up, others were not. 83 00:05:05,760 --> 00:05:10,240 Speaker 3: In the event, Minister Little made his own decision to 84 00:05:10,320 --> 00:05:14,960 Speaker 3: centralize the health system under one organization, to Fatal Order 85 00:05:15,000 --> 00:05:18,000 Speaker 3: Health New Zealand, and that of course represents what is 86 00:05:18,080 --> 00:05:22,560 Speaker 3: undoubtedly the largest merger ever in New Zealand's history, bringing 87 00:05:22,600 --> 00:05:27,120 Speaker 3: together the twenty district health boards into one organization. And 88 00:05:27,200 --> 00:05:31,440 Speaker 3: another of other changes were initiated at that point, and 89 00:05:31,480 --> 00:05:34,080 Speaker 3: then there was a change in government, so the new 90 00:05:34,160 --> 00:05:39,000 Speaker 3: government inherited this rather complex and difficult set of circumstances. 91 00:05:39,520 --> 00:05:42,600 Speaker 3: This would have been very difficult for any government. There's 92 00:05:42,640 --> 00:05:46,000 Speaker 3: no doubt this was a very challenging set of circumstances. 93 00:05:46,040 --> 00:05:49,640 Speaker 3: And what they've done since then is introduced their own changes. 94 00:05:50,080 --> 00:05:53,880 Speaker 3: For example, they scrapped order the Maori Health Authority, which 95 00:05:53,920 --> 00:05:57,080 Speaker 3: brought expertise into the center of the system. Last year 96 00:05:57,200 --> 00:06:00,320 Speaker 3: the Board of Health New Zealand to Fatal Order was 97 00:06:00,600 --> 00:06:05,040 Speaker 3: sacked and replaced with a commissioner, along with several co commissioners, 98 00:06:05,200 --> 00:06:08,520 Speaker 3: and since then there have been a number of resignations, 99 00:06:08,800 --> 00:06:12,560 Speaker 3: thinking particularly back to last week where we had three 100 00:06:13,200 --> 00:06:17,040 Speaker 3: important resignations in the health system, but the government was 101 00:06:17,080 --> 00:06:22,160 Speaker 3: not responsible for the challenging circumstances it inherited. But it 102 00:06:22,200 --> 00:06:23,919 Speaker 3: is of course now in charge and has been for 103 00:06:24,000 --> 00:06:26,320 Speaker 3: well over a year, and is making its own decisions 104 00:06:26,400 --> 00:06:30,680 Speaker 3: about how to lead the system. 105 00:06:30,760 --> 00:06:32,719 Speaker 4: I mean, it might be scary to have to respond 106 00:06:32,760 --> 00:06:36,479 Speaker 4: to the Prime Minister, the Minister of Finance and the 107 00:06:36,520 --> 00:06:39,960 Speaker 4: Minister of Health, but nothing is more scary than my 108 00:06:40,080 --> 00:06:45,839 Speaker 4: own wife holding me to account for the health system. 109 00:06:46,120 --> 00:06:50,039 Speaker 4: And I love her and respect her, and I'm going 110 00:06:50,120 --> 00:06:52,720 Speaker 4: to make sure I'll keep it that way because she's 111 00:06:52,880 --> 00:06:55,520 Speaker 4: holding me to account, which is a different time but 112 00:06:55,760 --> 00:07:02,240 Speaker 4: type of accountability. 113 00:07:01,440 --> 00:07:04,640 Speaker 2: You mentioned Health end Z Commissioner Lester Levy. He was 114 00:07:04,680 --> 00:07:07,760 Speaker 2: broad on board last July. He was tasked with solving 115 00:07:07,800 --> 00:07:11,560 Speaker 2: an estimated one point four billion dollar overspend and then 116 00:07:11,640 --> 00:07:14,760 Speaker 2: he and then chief executive Marjie Arper have been in 117 00:07:14,840 --> 00:07:17,320 Speaker 2: charge of a reset, so to speak, so to ensure 118 00:07:17,640 --> 00:07:20,000 Speaker 2: it's spending within its budget after it was found in 119 00:07:20,120 --> 00:07:22,840 Speaker 2: July to be spending one hundred and thirty million dollars 120 00:07:22,880 --> 00:07:24,960 Speaker 2: more than its budget each month. 121 00:07:25,200 --> 00:07:27,280 Speaker 1: How do you think all of this is. 122 00:07:27,320 --> 00:07:31,240 Speaker 2: Going the cutting, the cost cutting, I suppose, I. 123 00:07:31,320 --> 00:07:36,520 Speaker 3: For one, feel unclear about the actual state of healthcare expenditure. 124 00:07:36,840 --> 00:07:40,640 Speaker 3: Generally there is a single source of authority d data 125 00:07:40,680 --> 00:07:44,040 Speaker 3: about how much we're spending on health per capita and 126 00:07:44,080 --> 00:07:46,840 Speaker 3: how that fits into the long term trends. I would 127 00:07:46,920 --> 00:07:49,560 Speaker 3: say at the moment, I, for one, don't have that clarity. 128 00:07:49,840 --> 00:07:52,520 Speaker 3: You know, the government says repeatedly that it's spending more 129 00:07:52,760 --> 00:07:55,480 Speaker 3: on health now than has ever been spent before. There 130 00:07:55,640 --> 00:07:59,720 Speaker 3: is the expenditure above budget that you've just talked about 131 00:07:59,800 --> 00:08:02,400 Speaker 3: with in Fascil order. But as I said, I'm unclear 132 00:08:02,600 --> 00:08:05,240 Speaker 3: on this point. There was one analysis I read last 133 00:08:05,360 --> 00:08:08,800 Speaker 3: year from a well respected health economist which looked at 134 00:08:08,800 --> 00:08:12,480 Speaker 3: the twenty year healthcare expenditure and it went up per 135 00:08:12,520 --> 00:08:16,760 Speaker 3: capita around four to five percent during the first more 136 00:08:16,840 --> 00:08:19,040 Speaker 3: or less during the first decade of the century. That 137 00:08:19,160 --> 00:08:22,920 Speaker 3: was with the Labor government. That per capita annual increase 138 00:08:23,040 --> 00:08:27,200 Speaker 3: in expenditure went down to I'm remembering three or four 139 00:08:27,240 --> 00:08:31,120 Speaker 3: percent under the nine years of the subsequent national government, 140 00:08:31,520 --> 00:08:34,120 Speaker 3: and then it went back up again slightly to or 141 00:08:34,160 --> 00:08:38,600 Speaker 3: four plus percent annual per capita increase in expenditure during 142 00:08:38,840 --> 00:08:43,920 Speaker 3: the last Labor government. And according to that analysis, the 143 00:08:43,960 --> 00:08:47,320 Speaker 3: twenty twenty four year was the first time in that 144 00:08:47,600 --> 00:08:50,959 Speaker 3: twenty four year period that the health systems faced an 145 00:08:51,120 --> 00:08:55,560 Speaker 3: actual decrease in per capita healthcare expenditure. Now, that was 146 00:08:55,679 --> 00:08:59,079 Speaker 3: just one analysis. It received some publicity at the time, 147 00:08:59,400 --> 00:09:02,520 Speaker 3: but incredibly important that we actually know whether or not 148 00:09:02,600 --> 00:09:05,120 Speaker 3: that's true, because if it is true, it explains so 149 00:09:05,280 --> 00:09:08,840 Speaker 3: much of the intense stress and pressure within the health system. 150 00:09:09,000 --> 00:09:12,880 Speaker 3: Because basically the health system which is facing real per 151 00:09:12,960 --> 00:09:17,800 Speaker 3: capita decrease in expenditure is sort of an unprecedented thing. 152 00:09:18,280 --> 00:09:20,560 Speaker 3: Not many countries would ever attempt to do that. Now, 153 00:09:20,720 --> 00:09:24,200 Speaker 3: government's making claims that that's not the case. Some economists 154 00:09:24,320 --> 00:09:26,240 Speaker 3: or this one in particular, is making a claim that 155 00:09:26,400 --> 00:09:30,040 Speaker 3: is the case. I think we need authoritative analysis around that. 156 00:09:30,360 --> 00:09:33,880 Speaker 3: Coming back to your question about how is it going 157 00:09:34,000 --> 00:09:37,920 Speaker 3: into fatal Aura, Well, look, I would say three things. Firstly, 158 00:09:38,000 --> 00:09:41,719 Speaker 3: that fat AURA is a highly stressed, highly disrupted organization 159 00:09:41,760 --> 00:09:44,240 Speaker 3: at this point in time, there is a great deal 160 00:09:44,240 --> 00:09:48,439 Speaker 3: of change and uncertainty and that affects probably the vast 161 00:09:48,520 --> 00:09:51,480 Speaker 3: majority of people who work within the organization. And remember 162 00:09:51,559 --> 00:09:54,839 Speaker 3: this is a huge organization. This is a single employer 163 00:09:55,000 --> 00:09:57,560 Speaker 3: of When I last heard the numbers, it was between 164 00:09:57,559 --> 00:10:00,840 Speaker 3: eighty and ninety thousand people doing all lots of jobs 165 00:10:01,200 --> 00:10:05,240 Speaker 3: all the way from the frontline clinical roles through to 166 00:10:05,520 --> 00:10:09,480 Speaker 3: IT systems and procurement and supply and all the things 167 00:10:09,520 --> 00:10:12,640 Speaker 3: that are a huge organization like that is responsible for 168 00:10:12,720 --> 00:10:16,160 Speaker 3: doing so a great deal of disruption in that organization. 169 00:10:16,760 --> 00:10:19,960 Speaker 3: How it's going financially, I don't know. Again. I think 170 00:10:20,040 --> 00:10:24,480 Speaker 3: that we need authoritative financial data being produced at regular 171 00:10:24,520 --> 00:10:27,199 Speaker 3: intervals so that we can we the public can make 172 00:10:27,280 --> 00:10:30,720 Speaker 3: judgments on that point. And certainly I've no doubt at 173 00:10:30,760 --> 00:10:34,160 Speaker 3: all that Commissioner Lester Levy is working extremely hard on this, 174 00:10:34,320 --> 00:10:37,880 Speaker 3: as are the other co commissioners. That that's I think 175 00:10:38,040 --> 00:10:40,000 Speaker 3: as much as I can say on how it's going, 176 00:10:40,080 --> 00:10:42,719 Speaker 3: because this is the story is unfolding in front of us. 177 00:10:42,880 --> 00:10:45,400 Speaker 3: Maybe one can take a little bit of a steer 178 00:10:45,440 --> 00:10:49,160 Speaker 3: from the fact that there are senior resignations in the system, 179 00:10:49,280 --> 00:10:52,880 Speaker 3: some of which might have been anticipated, others not. The 180 00:10:52,960 --> 00:10:56,560 Speaker 3: resignation of the Chief Executive of Health New Zealand faceral 181 00:10:56,720 --> 00:11:00,440 Speaker 3: At Margie Upper, which was two Fridays ago, may have 182 00:11:00,520 --> 00:11:03,640 Speaker 3: been anticipated. I certainly wasn't expecting it to happen on 183 00:11:03,720 --> 00:11:06,120 Speaker 3: that day and that week her term came up for 184 00:11:06,160 --> 00:11:09,240 Speaker 3: a renewal later on this year, and I was expecting 185 00:11:09,240 --> 00:11:11,320 Speaker 3: her to step down perhaps at that point, because that 186 00:11:11,440 --> 00:11:12,319 Speaker 3: had been signaled. 187 00:11:23,600 --> 00:11:25,839 Speaker 1: And what about Diana Saferti's resignation. 188 00:11:25,960 --> 00:11:27,680 Speaker 2: I don't know about you, but where I work, i'd 189 00:11:27,679 --> 00:11:30,200 Speaker 2: need to give at least four weeks notice, and she 190 00:11:30,240 --> 00:11:31,440 Speaker 2: finishes up this Friday. 191 00:11:31,800 --> 00:11:34,440 Speaker 3: I think that is unusual, Chelsea. I think that is 192 00:11:34,480 --> 00:11:38,360 Speaker 3: a very unusual thing. It was an unexpected announcement. She 193 00:11:38,960 --> 00:11:43,079 Speaker 3: is leaving very abruptly within a week, so no notice 194 00:11:43,160 --> 00:11:45,680 Speaker 3: bit with those sorts of senior roles. Now we're talking 195 00:11:45,720 --> 00:11:48,840 Speaker 3: about Professor Diana Safati, who was the Director General of Healthcare. 196 00:11:49,280 --> 00:11:54,000 Speaker 3: Resignation was announced on Friday, taking effect this sometime this week. 197 00:11:54,120 --> 00:11:56,960 Speaker 3: That's very unusual with those senior roles. We expect that 198 00:11:57,120 --> 00:12:00,920 Speaker 3: a resignation to be announced well well in advance of 199 00:12:00,960 --> 00:12:03,520 Speaker 3: it taking effect, and their time for the system to 200 00:12:03,600 --> 00:12:06,880 Speaker 3: respond and an interim person or an acting person to 201 00:12:06,880 --> 00:12:10,880 Speaker 3: be put in place, and ideally a recruitment process to 202 00:12:10,920 --> 00:12:13,360 Speaker 3: be god underway. None of that has happened this time, 203 00:12:13,400 --> 00:12:15,920 Speaker 3: of course, so we don't know what lies behind that, 204 00:12:16,280 --> 00:12:19,320 Speaker 3: except this is an unusual circumstance. What we do know, 205 00:12:19,360 --> 00:12:20,960 Speaker 3: of course, is that we have a new Minister of 206 00:12:21,000 --> 00:12:24,800 Speaker 3: Health who's come in. The Honorable Sandertti has moved on 207 00:12:24,840 --> 00:12:28,120 Speaker 3: to other portfolios and we now have the Honorable Simeon 208 00:12:28,200 --> 00:12:31,000 Speaker 3: Brown in the role of Health Minister. He's brand new 209 00:12:31,040 --> 00:12:33,160 Speaker 3: to health. Not only is he brand new to the 210 00:12:33,320 --> 00:12:37,440 Speaker 3: portfolio as Minister of Health, he's also brand new to health. 211 00:12:37,600 --> 00:12:40,000 Speaker 3: Nothing wrong with that, per se, It's just that we 212 00:12:40,080 --> 00:12:42,000 Speaker 3: all need to recognize it will take him some time 213 00:12:42,040 --> 00:12:44,640 Speaker 3: to get his FETA under the desk properly and understand 214 00:12:44,720 --> 00:12:49,360 Speaker 3: this extremely complex system that he's now responsible for. And 215 00:12:49,559 --> 00:12:51,920 Speaker 3: I don't hold him. I don't think he's the author 216 00:12:51,960 --> 00:12:56,439 Speaker 3: of these resignations necessarily at all. But following his taking 217 00:12:56,559 --> 00:12:59,520 Speaker 3: on the portfolio of Health, there have been, as I said, 218 00:13:00,080 --> 00:13:03,680 Speaker 3: a number of very senior people resigning, and maybe with 219 00:13:03,760 --> 00:13:06,079 Speaker 3: the fullness of time, we'll understand more about the nine 220 00:13:06,080 --> 00:13:06,760 Speaker 3: amics there. 221 00:13:06,960 --> 00:13:09,320 Speaker 2: Well, if we go back to the system itself, I 222 00:13:09,360 --> 00:13:13,280 Speaker 2: know that staff shortages have plagued the sector for years now, 223 00:13:13,320 --> 00:13:16,320 Speaker 2: and this is right across the workforce, from GPS closing 224 00:13:16,320 --> 00:13:18,560 Speaker 2: their books with nearly forty percent of them actually not 225 00:13:18,679 --> 00:13:21,760 Speaker 2: taking new patients last year to of course nurses being 226 00:13:21,800 --> 00:13:24,760 Speaker 2: tempted across the ditch by better pay, packets, added extras, 227 00:13:24,760 --> 00:13:28,000 Speaker 2: et cetera. Health New Zealand has released its workforce Plan 228 00:13:28,280 --> 00:13:31,280 Speaker 2: in December and that outlined how gaps will be filled 229 00:13:31,320 --> 00:13:33,880 Speaker 2: over the next three years, and the government's already made 230 00:13:33,920 --> 00:13:38,040 Speaker 2: moves to fund more homegrown doctors and midwives for example. 231 00:13:38,120 --> 00:13:39,240 Speaker 1: Do you think it's doing enough? 232 00:13:39,600 --> 00:13:44,840 Speaker 3: Health workforce probably is the number one or number two, 233 00:13:45,040 --> 00:13:46,800 Speaker 3: or at least one of the top issues in the 234 00:13:46,840 --> 00:13:49,920 Speaker 3: health system. And this is again not unique in New Zealand. 235 00:13:50,120 --> 00:13:53,360 Speaker 3: Health systems all around the world experiencing the same sorts 236 00:13:53,360 --> 00:13:56,959 Speaker 3: of health workforce pressures that we're experiencing. Is the government 237 00:13:57,040 --> 00:13:59,960 Speaker 3: doing enough well? I mean, the answer has to be known. 238 00:14:00,080 --> 00:14:02,320 Speaker 3: I say that was some sympathy for the government, but 239 00:14:02,840 --> 00:14:06,280 Speaker 3: the problems are mounting in the health workforce space. I 240 00:14:06,280 --> 00:14:08,120 Speaker 3: think the government wants to get on top of this. 241 00:14:08,360 --> 00:14:10,920 Speaker 3: A great deal of good work is being done. Certainly, 242 00:14:10,920 --> 00:14:13,880 Speaker 3: we don't have solutions to all the problems at the 243 00:14:13,880 --> 00:14:17,480 Speaker 3: moment at all, by any stretch of the imagination. And 244 00:14:17,520 --> 00:14:19,960 Speaker 3: I'll come back to point I made earlier about the 245 00:14:19,960 --> 00:14:24,280 Speaker 3: point you mentioned about general practices and general practitioners and 246 00:14:24,320 --> 00:14:27,880 Speaker 3: practice nurses in the community. That is an area of neglect, 247 00:14:28,080 --> 00:14:31,160 Speaker 3: which is one of the most urgent pressure points in 248 00:14:31,160 --> 00:14:34,160 Speaker 3: the health system, I would say, and it's not receiving 249 00:14:34,200 --> 00:14:37,720 Speaker 3: a huge amount of public air time. Is receiving some 250 00:14:37,840 --> 00:14:40,680 Speaker 3: but not a huge amount. The whole system is reliant 251 00:14:40,760 --> 00:14:44,800 Speaker 3: on that layer in the health system with GPS practice 252 00:14:44,880 --> 00:14:48,000 Speaker 3: nurses and or all the others who work in the 253 00:14:48,000 --> 00:14:52,520 Speaker 3: community keeping people well and out of hospital. The financing 254 00:14:52,640 --> 00:14:56,920 Speaker 3: situation for GPS is complex and has been neglected for 255 00:14:56,960 --> 00:15:00,800 Speaker 3: a long time. Work is underway by to Facial Order 256 00:15:00,840 --> 00:15:03,360 Speaker 3: Health New Zealand and by the Ministry of Health to 257 00:15:03,440 --> 00:15:06,600 Speaker 3: fix that, but it's a long time coming, and it's 258 00:15:06,880 --> 00:15:11,000 Speaker 3: it's an area of really considerable pressure and stress within 259 00:15:11,040 --> 00:15:14,960 Speaker 3: the system. I fear that these really important strategic or 260 00:15:15,000 --> 00:15:18,240 Speaker 3: long term issues like health workforce are probably being somewhat 261 00:15:18,280 --> 00:15:20,800 Speaker 3: neglected right now as the system goes through its own 262 00:15:21,000 --> 00:15:22,440 Speaker 3: processes of change. 263 00:15:23,920 --> 00:15:27,160 Speaker 5: Official information reveals that in the first six months of 264 00:15:27,280 --> 00:15:31,640 Speaker 5: last year, more than three hundred thousand patients around New 265 00:15:31,720 --> 00:15:36,040 Speaker 5: Zealand who turned up in an imminently or potentially life 266 00:15:36,040 --> 00:15:40,880 Speaker 5: threatening condition were not seen in a clinically appropriate time. 267 00:15:41,560 --> 00:15:45,120 Speaker 6: Is that a concern it's really concerning data and as 268 00:15:45,280 --> 00:15:49,280 Speaker 6: we have to do better. It is showing a system 269 00:15:49,360 --> 00:15:53,160 Speaker 6: under intense pressure, and it's showing a whole system under pressure. 270 00:15:53,320 --> 00:15:56,560 Speaker 5: Is it showing a system failing by. 271 00:15:56,440 --> 00:15:58,760 Speaker 6: The numbers you're telling me, it is showing a system 272 00:15:58,800 --> 00:15:59,760 Speaker 6: that is failing. 273 00:16:04,160 --> 00:16:04,320 Speaker 4: Well. 274 00:16:04,360 --> 00:16:07,160 Speaker 2: Something that does get a lot of airtime is ed 275 00:16:07,480 --> 00:16:10,440 Speaker 2: waight times. Right, we haven't even gotten to that yet. 276 00:16:10,480 --> 00:16:13,680 Speaker 2: We're constantly hearing horror stories about people waiting upwards of 277 00:16:13,720 --> 00:16:16,600 Speaker 2: eight ten hours for care. More than three hundred thousand 278 00:16:16,800 --> 00:16:20,240 Speaker 2: patients with time critical conditions were not seen within the 279 00:16:20,240 --> 00:16:23,720 Speaker 2: recommended time frames during the first six months of last year. 280 00:16:24,000 --> 00:16:26,200 Speaker 2: And this is where there's a bottleneck, isn't it. It's 281 00:16:26,240 --> 00:16:28,240 Speaker 2: like all the other areas of the health system when 282 00:16:28,240 --> 00:16:29,000 Speaker 2: they underperform. 283 00:16:29,120 --> 00:16:30,800 Speaker 1: This is what we see. This is what we get. 284 00:16:30,880 --> 00:16:33,640 Speaker 2: The fact that all of the country's eds are failing 285 00:16:33,680 --> 00:16:38,000 Speaker 2: to assess patients with eminently or potentially life threatening conditions 286 00:16:38,040 --> 00:16:40,840 Speaker 2: on time. That's a massive problem, isn't it. 287 00:16:41,120 --> 00:16:44,160 Speaker 3: It is a problem, and it speaks to failure elsewhere 288 00:16:44,200 --> 00:16:47,400 Speaker 3: in the system. GP's books are full in many parts 289 00:16:47,400 --> 00:16:52,240 Speaker 3: of the country. Waiting time for CGP are unacceptably long 290 00:16:52,560 --> 00:16:56,480 Speaker 3: in many many places, the failure of primary healthcare to 291 00:16:56,560 --> 00:16:59,000 Speaker 3: meet the basic needs of people is one of the, 292 00:16:59,200 --> 00:17:03,480 Speaker 3: if not the most important factors leading to pressure on eds. 293 00:17:03,760 --> 00:17:06,160 Speaker 3: Because what do you or I do when we can't 294 00:17:06,160 --> 00:17:08,320 Speaker 3: get to see our doctrine, we're worried about our health. 295 00:17:08,400 --> 00:17:10,840 Speaker 3: We go to the ED. That is all we can do. 296 00:17:11,040 --> 00:17:13,800 Speaker 3: That's the only option available to us, So we go, 297 00:17:14,640 --> 00:17:16,359 Speaker 3: you know, And that's what people do. They're going to 298 00:17:16,800 --> 00:17:19,720 Speaker 3: ED departments and wait to be seen there rather than 299 00:17:19,760 --> 00:17:23,120 Speaker 3: having issues dealt with in primary care. And it's not 300 00:17:23,359 --> 00:17:26,400 Speaker 3: just the issue of closed books and pressure on primary 301 00:17:26,400 --> 00:17:29,720 Speaker 3: care services, so also the issue of cost for many people. 302 00:17:29,880 --> 00:17:32,879 Speaker 3: A lot of people can't afford even sometimes quite basic 303 00:17:32,920 --> 00:17:36,840 Speaker 3: elements of care. So there's constellation of factors there which 304 00:17:36,960 --> 00:17:41,000 Speaker 3: leads to pressure on ED departments. But yes, it's a 305 00:17:41,040 --> 00:17:41,680 Speaker 3: big issue. 306 00:17:41,840 --> 00:17:45,000 Speaker 2: Finally, Peter, I feel like speaking about the health sector 307 00:17:45,040 --> 00:17:48,960 Speaker 2: and the health sector in crisis is just a broken record, right. 308 00:17:49,200 --> 00:17:52,520 Speaker 2: Is the health sector a prime example for the need 309 00:17:52,720 --> 00:17:57,000 Speaker 2: for long term bipartisan agreements, because surely we can't go 310 00:17:57,119 --> 00:17:57,639 Speaker 2: on like this. 311 00:17:58,600 --> 00:18:01,280 Speaker 3: I think that is just so on the money, long 312 00:18:01,440 --> 00:18:04,840 Speaker 3: term bipartisan agreement around the direction of the health system. 313 00:18:04,960 --> 00:18:07,760 Speaker 3: I think one of the things that we're experiencing right now, 314 00:18:08,119 --> 00:18:10,520 Speaker 3: at least I am, and I think many people working 315 00:18:10,560 --> 00:18:13,760 Speaker 3: in the health system is a sense of not really 316 00:18:13,840 --> 00:18:16,520 Speaker 3: knowing what the direction is right now. Because it's a 317 00:18:16,560 --> 00:18:21,200 Speaker 3: system which is so reliant on good will, trust, people 318 00:18:21,440 --> 00:18:25,439 Speaker 3: working over beyond the call of duty, et cetera, et cetera. 319 00:18:25,880 --> 00:18:28,760 Speaker 3: There needs to be confidence that the systems lead in 320 00:18:28,800 --> 00:18:31,919 Speaker 3: a way that is consistent with the values that people 321 00:18:32,040 --> 00:18:36,640 Speaker 3: work in the system have, and that we have stability 322 00:18:36,760 --> 00:18:40,440 Speaker 3: in leadership and leaders who are capable of forming long 323 00:18:40,560 --> 00:18:44,760 Speaker 3: term relationships all around them to give confidence that we're, 324 00:18:45,119 --> 00:18:48,000 Speaker 3: even through tough times, that we're all pulling in the 325 00:18:48,040 --> 00:18:52,520 Speaker 3: same direction. And I think that having some sense of 326 00:18:52,680 --> 00:18:55,080 Speaker 3: direction for the public health system right now would be 327 00:18:55,280 --> 00:18:58,880 Speaker 3: immensely helpful because to my mind, there are mixed signals 328 00:18:58,920 --> 00:19:00,840 Speaker 3: at the moment around them. Role of I mean, the 329 00:19:00,920 --> 00:19:03,760 Speaker 3: natural default I think for many in the current government 330 00:19:03,800 --> 00:19:08,040 Speaker 3: would be private provision, a privatization of services, not just 331 00:19:08,160 --> 00:19:11,600 Speaker 3: healthcare but in many domains. And I think people working 332 00:19:11,640 --> 00:19:14,520 Speaker 3: in the public system, which so many people in New 333 00:19:14,640 --> 00:19:17,960 Speaker 3: Zealand are totally reliant on, they need confidence that there 334 00:19:18,040 --> 00:19:22,320 Speaker 3: is a long term commitment and a bipartisan approach I 335 00:19:22,359 --> 00:19:24,160 Speaker 3: think would be extremely helpful. 336 00:19:24,200 --> 00:19:26,359 Speaker 1: Thanks for joining us, Peter pleasure to talk. 337 00:19:28,920 --> 00:19:32,040 Speaker 2: That's it for this episode of the Front Page. You 338 00:19:32,080 --> 00:19:35,879 Speaker 2: can read more about today's stories and extensive news coverage 339 00:19:35,920 --> 00:19:39,920 Speaker 2: at enzdhrald dot co dot nz. The Front Page is 340 00:19:39,960 --> 00:19:43,720 Speaker 2: produced by Ethan Sills and Richard Martin, who is also 341 00:19:43,880 --> 00:19:44,960 Speaker 2: our sound engineer. 342 00:19:45,440 --> 00:19:46,960 Speaker 1: I'm Chelsea Daniels. 343 00:19:47,520 --> 00:19:50,679 Speaker 2: Subscribe to the Front Page on iHeartRadio or wherever you 344 00:19:50,720 --> 00:19:54,520 Speaker 2: get your podcasts, and tune in tomorrow for another look 345 00:19:54,560 --> 00:19:55,840 Speaker 2: behind the headlines.