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Speaker 1: Kiota.

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Speaker 2: I'm Chelsea Daniels and this is the Front Page, a

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Speaker 2: daily podcast presented by the New Zealand Herald. New Zealand's

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Speaker 2: Hunter a poach. Oversees doctors gets another tool in the

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Speaker 2: toolbox today. From now, medical graduates from the UK, Ireland

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Speaker 2: and Australia will be able to have their applications for

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Speaker 2: registration assessed within twenty working days. It'll speed up a

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Speaker 2: process that would usually take six months, and the government

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Speaker 2: hopes it'll fill critical gaps in our health workforce, but

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Speaker 2: unions on the ground doubt the impact of this fast

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Speaker 2: track pathway, saying it's welcome but not sure that it's

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Speaker 2: going to make a difference. Today on the Front Page,

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Speaker 2: Association of Salaried Medical Specialists executive Director Sarah Dalton.

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Speaker 1: Is with us to discuss.

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Speaker 2: Sarah, first off, the fast tracking regime begins today for

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Speaker 2: overseas doctors.

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Speaker 1: Can you tell me a little bit more about this scheme?

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Speaker 3: Yea.

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Speaker 4: So, basically, any doctor who wants to practice in New

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Speaker 4: Zealand has to be registered with the Medical Council. They

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Speaker 4: review their training and qualifications, their current recent experience and

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Speaker 4: determine whether they can practice under general registration. Or vocational

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Speaker 4: registration in this country. So general registration means you're qualified

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Speaker 4: to practice as a doctor, but you don't have a

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Speaker 4: particular specialty, whereas vocational registration would recognize you as a specialist,

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Speaker 4: for example, in general practice, ana seizure, in psychiatry, in

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Speaker 4: internal medicine, surgery, whatever it might be.

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Speaker 3: So often it's not.

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Speaker 4: Unusual for that process of getting a registration sorted out

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Speaker 4: to take months rather than weeks. So the fast tracking

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Speaker 4: for certain doctors with particular specialties from a limited number

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Speaker 4: of countries, which will bring it down to force weeks,

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Speaker 4: you know, we'll make it a lot quicker.

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Speaker 3: It is a welcome development in.

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Speaker 2: That respect, right, So we're wanting specialists trained in anesthesia, dermatology,

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Speaker 2: emergency medicine, general practice, internal medicine, pathology, and psychiatry. Basically

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Speaker 2: we're looking for everything and everyone. At the moment, how

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Speaker 2: do you think this initiative is going to go?

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Speaker 3: Well, look, it's.

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Speaker 4: Obviously going to be quicker and better for people who

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Speaker 4: already want to come here in practice. So in that

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Speaker 4: sense it's great, and it might make the time frame

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Speaker 4: from job offer to having a senior doctor in place.

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Speaker 3: It might shave a couple of months off it, which.

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Speaker 4: Is fantastic, but it is for a limited number of countries,

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Speaker 4: and they are systems that have very similar training and

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Speaker 4: qualifications to our own right, so it is going to

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Speaker 4: be helpful to that extent, and maybe it will mean

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Speaker 4: that some doctors who are thinking of coming to live

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Speaker 4: and work here or Australia might still decide to come

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Speaker 4: to New Zealand rather than Australia because perhaps the registration

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Speaker 4: process will be a little bit quicker for them. But

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Speaker 4: in turn of making a substantial dent in our staff

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Speaker 4: and gaps for senior hospital doctors and dentists, that is

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Speaker 4: not what's going to solve the problem.

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Speaker 5: The joined upness of the Medical Council's globally has started

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Speaker 5: to happen, so it helps a lot for us to

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Speaker 5: know exactly what other jurisdictions are doing, so that we

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Speaker 5: know what we're getting when they come in. There are

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Speaker 5: a lot of people who do want to come, and

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Speaker 5: we have forty one percent of our medical professions are

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Speaker 5: overseas graduates, so we do attract a lot.

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Speaker 2: So while the entire country obviously has gaps, rural areas

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Speaker 2: are really hurting. Hey, a recent survey by the Rural

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Speaker 2: Health Network found there are staffing shortages, under investment and

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Speaker 2: an increasing burden on facilities continuing to impede the recruitment

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Speaker 2: and retention of healthcare workers. Should there be any kind

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Speaker 2: of incentive in place? Given four overseas doctors say to

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Speaker 2: go into rural areas.

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Speaker 4: I think there should be rural allowances in place. And

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Speaker 4: in fact, we are in bargaining at the moment. And

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Speaker 4: while we don't go into the details of what the

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Speaker 4: specifics of bargaining are, members are really keen on. A

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Speaker 4: claim around rural allowances is one of the things we discuss.

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Speaker 4: You know, even if a hospital doesn't qualify as rural,

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Speaker 4: so for example, tight Afterygisbon, that may not actually meet

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Speaker 4: the definition of a rural hospital, but it's so remote

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Speaker 4: from the rest of New Zealand that if you choose

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Speaker 4: to live and work there, thinking about not just you,

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Speaker 4: but if you go there with your family, if you

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Speaker 4: want to take them, for example, to a concert or

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Speaker 4: to a sporting event, that it might be a reasonable

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Speaker 4: thing to want to go to. The Costs of getting

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Speaker 4: to and from one of those events if you've got

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Speaker 4: your family there in Gisbone are massive compared to someone

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Speaker 4: who chooses to live and work in one of the

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Speaker 4: major centers. So I think if you really want to

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Speaker 4: support people to put down routes to stay in those communities,

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Speaker 4: you're going to have to recognize it in differential pain conditions.

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Speaker 2: It comes to the gaps inner health workforce, and we

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Speaker 2: know it's dire. We're always hearing it's dire, and we've

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Speaker 2: heard it's dire for years and years. Is there any

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Speaker 2: way to try and quantify this or explain it to

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Speaker 2: people so they actually understand the direness of the situation.

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Speaker 3: Such a good question and also such a frustrating one.

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Speaker 4: So when Tefatora was first established, one of the things

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Speaker 4: they said they were going to put in place was

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Speaker 4: it called a workforce task Force, And I was like, hooray,

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Speaker 4: They're actually going to put some time and energy into

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Speaker 4: what I would call a workforce census, so that we've

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Speaker 4: got a reliable data set that tells us exactly who's

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Speaker 4: working and what specialties and where where the junior doctors are.

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Speaker 4: Because there's a difference if you're thinking about the medical

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Speaker 4: workforce pipeline in terms of junior doctors or ramos, it's

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Speaker 4: resident medical offices. Some of them are in training roles,

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Speaker 4: which means they've already selected a specialty pathway and they're

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Speaker 4: training in that specialty. And you also have non training

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Speaker 4: registrars who have yet to choose a special pathway, but

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Speaker 4: who are working in the hospital. They have a general

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Speaker 4: registration and they provide valuable care in hospitals and will

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Speaker 4: be on their journey to deciding what specialty pathway they

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Speaker 4: want to follow. And then you've got your house officers

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Speaker 4: who are in their first couple of years out of

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Speaker 4: med school and who also perform useful functions. So I

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Speaker 4: thought the Workforce task Force under order would focus really

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Speaker 4: carefully on that kind of boring but important work of

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Speaker 4: really sorting out what the census is for our healthcare workforce,

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Speaker 4: but they didn't. Similarly, the Workforce Plan that was released

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Speaker 4: last year for the first time did try and quantify

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Speaker 4: the extent of the shortages. They came up with a

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Speaker 4: number of seventeen hundred doctors across our whole system. Is

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Speaker 4: the total number of missing doctors from our system. We

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Speaker 4: think they've probably under reported that by about half, but

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Speaker 4: at least they have started to try and crunch the numbers.

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Speaker 4: What they haven't done, though, is tie the numbers that

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Speaker 4: they've identified. And I'm primarily interested in doctors because you

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Speaker 4: know that's how Union represents. But they came up with

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Speaker 4: numbers for nursing and allied health as well. But those

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Speaker 4: numbers identified in last year's workforce Plan have not been

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Speaker 4: tied to budgets or budget allocations for staffing this year,

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Speaker 4: which is one of the reasons to futt Order's got

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Speaker 4: itself into such a pickle over nursing numbers. They have

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Speaker 4: increased nursing staffing, not to the extent identified by the

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Speaker 4: Workforce Plan, but ahead of budget allocations, and budget allocations

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Speaker 4: weren't matched to the numbers identified in the workforce Plan.

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Speaker 4: This year's workforce plan is missing an action. We understand

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Speaker 4: it's with the minister or with Cabinet, but it is

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Speaker 4: months overdue.

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Speaker 1: In terms of DEFATU Order.

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Speaker 2: I read actually in an Auckland Union analysis piece and

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Speaker 2: this really struck out to me, this line that short

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Speaker 2: term belt time will most likely deepen the crisis. And

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Speaker 2: this is while the government dismissed the board and appointed

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Speaker 2: a commissioner to reduce over spending. Would you agree that

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Speaker 2: belt tightening will deepen the crisis.

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Speaker 4: It's a really succinct description of what's likely to happen, So,

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Speaker 4: particularly when it comes to staffing, what that leads to.

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Speaker 3: Let me give you an imaginary department.

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Speaker 4: Let's say it's a pediatric department and that they currently

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Speaker 4: have approved FTE or a staffing level approved of six people.

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Speaker 4: And let's say they've got two current vacancies that they're

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Speaker 4: struggling to fill. And then we turn up and we

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Speaker 4: work with those doctors and we established that actually, while

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Speaker 4: they've got six approved ft, they really need eight, so

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Speaker 4: they've got an acknowledged gap of two. And if they

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Speaker 4: were actually to staff according to current need, they've got

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Speaker 4: a gap of four doctors. And then we will go

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Speaker 4: to the management and say, come on, we need to

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Speaker 4: be recruiting those two that you know are vacancies, but

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Speaker 4: you actually also need another two, and they will tend

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Speaker 4: to say, well, we've got no money for that. So we

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Speaker 4: will think about continuing to recruit to those two, but

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Speaker 4: in the meantime we will appoint some locums to fill

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Speaker 4: in some of.

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Speaker 3: The urgent gaps.

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Speaker 4: So what we've seen is, I don't know if you'd

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Speaker 4: call it an investment in locums or a reliance on locums,

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Speaker 4: which is short term expensive staffing to fill gaps in

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Speaker 4: the short term, but are reluctance to agree to increase

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Speaker 4: staffing or better recruitment strategies for the longer term.

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Speaker 3: So I completely agree that.

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Speaker 4: Short term ism and the belt tightening often leads to

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Speaker 4: decisions that actually cost more overall. And we're starting to

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Speaker 4: see that in the locom figures that are coming through.

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Speaker 2: Is locums like in a regular company and an offers

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Speaker 2: say hiring a casual or attemp's.

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Speaker 3: Exactly what it is.

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Speaker 4: And we've started to see some data, particularly for psychia,

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Speaker 4: that the locum spend in psychiatry is massive. Now there

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Speaker 4: are massive staff gaps in psychiatry, but what we're seeing

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Speaker 4: is their own members deciding to quit their permanent jobs

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Speaker 4: and then seek work as a locum because they can

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Speaker 4: control their work life balance better and it's quite well remunerated.

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Speaker 3: So we've created kind.

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Speaker 4: Of perverse incentives to casualize our senior medical workforce in

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Speaker 4: some specialties, which is going to be a really hard

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Speaker 4: thing to break.

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Speaker 2: I saw that Labour's health spokesperson Asia Vereal said the

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Speaker 2: national government is hiding the gaps in the health workforce

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Speaker 2: from New Zealand and that National has not been upfront

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Speaker 2: about the nature and extent of the needs, nor will

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Speaker 2: they address the staff shortages.

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Speaker 6: Around the country. Hiring for frontline staff, especially nurses, has

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Speaker 6: ground to a halt. It's well known that rural services

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Speaker 6: are under resourced, but under the current government the situation

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Speaker 6: is getting worse. Labor is focused and growing the health

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Speaker 6: workforce to make sure hospitals were properly staffed and improving

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Speaker 6: pay for nurses to keep them in New Zealand. Minister

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Speaker 6: Ritti needs to take urgent action to stop the cats

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Speaker 6: and make sure rural hospitals have enough staff to deliver

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Speaker 6: the kere people need.

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Speaker 2: I also found another statement from National Health spokesperson in

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Speaker 2: twenty twenty two and now that's the Health Minister of course,

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Speaker 2: Shane Retti saying the Health Minister is out of touch

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Speaker 2: with his portfolio and still refuses to accept that there

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Speaker 2: is a crisis under his watch. The health sector deserves better.

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Speaker 2: Mister Little should redirect funding from the health restructure and

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Speaker 2: invest it in the front line. My question, after reading

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Speaker 2: a couple of releases from years past is why is

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Speaker 2: health one of these political footballs that politicians love to

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Speaker 2: throw around. It's the same sound bites that we hear.

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Speaker 2: Like I said, those virile and ready quotes are quite similar.

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Speaker 2: Do you just sigh when you see them come out

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Speaker 2: and say stuff like that, Yeah.

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Speaker 3: Health is a political fall.

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Speaker 4: Is such a frustration because increasingly when I talk to media,

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Speaker 4: I talk about the social contract in New Zealand that

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Speaker 4: says there's a I don't know, an understanding in New

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Speaker 4: Zealand that if you need health care, you will get

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Speaker 4: it right, that we have a public health system that

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Speaker 4: is there to provide care to all New Zealanders. But

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Speaker 4: I think we need to have a better national conversation

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Speaker 4: about what people have a right to expect.

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Speaker 3: When it comes to healthcare and how that should be funded.

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Speaker 4: So rather than wait for the politicians, we have started

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Speaker 4: to embark on some of that research work ourselves. So

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Speaker 4: we are going to look into how might we fund

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Speaker 4: our health system differently and whether if we could get broad,

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Speaker 4: cross party, multi sector wide community agreement about what should

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Speaker 4: be included that is provided within our health system, would

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Speaker 4: it be possible to establish effectively an independent body that

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Speaker 4: would look at those criteria about what should be provided

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Speaker 4: and then determine what levels of funding are needed to

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Speaker 4: ensure that that happens. And if that became not party

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Speaker 4: political but simply a requirement that any government of the

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Speaker 4: day needs to meet that that need, that might change things.

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Speaker 4: It's a long term proposition, but it seems to me

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Speaker 4: that always the numbers are so large. It's really frightening

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Speaker 4: for any government that's hoping to hold on to a

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Speaker 4: further term, and they don't like having to try and

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Speaker 4: sell that cost to voters to tax payers. I also

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Speaker 4: think that we've lost our way when we talk about

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Speaker 4: health and we frame it as a cost rather than

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Speaker 4: an investment, because actually prevention and early intervention for people

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Speaker 4: with health issues there's a cheaper and better way to

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Speaker 4: manage things.

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Speaker 3: Waiting till people are really really.

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Speaker 4: Sick and need to be admitted to hospital is the

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Speaker 4: most expensive and least effective way to manage healthcare.

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Speaker 2: Yeah, there really needs to be like a thirty year

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Speaker 2: plan or something, and like you said, cross party discussions

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Speaker 2: around this, because we are constantly saying that it's on

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Speaker 2: the brink of failure.

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Speaker 1: Times out getting longer.

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Speaker 2: In EDS, for example, there are widespread staffing shortages, burnout

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Speaker 2: and lack of funding, like it's a tail as old

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Speaker 2: as time, isn't it really is.

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Speaker 4: But it's also you know, we've segmented out our health

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Speaker 4: system into quite a few pieces. And if you look

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Speaker 4: at community based healthcare as opposed to hospital based healthcare,

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Speaker 4: most of us ideally will access most of our health

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Speaker 4: provision in community settings, right whether it's dentists, GPS, physiotherapists,

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Speaker 4: if we need help with our eyesight or our hearing,

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Speaker 4: all of those things ideally we will access in the community.

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Speaker 4: And if you think about it, some of those things

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Speaker 4: are subsidized. Some of those things are not. We have

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Speaker 4: somewhat or entirely privatized large swathes of community based healthcare.

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Speaker 3: You could include aged.

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Speaker 4: Residential care into that mix as well, hospices, ambulances, even

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Speaker 4: many of those are partly state funded but not wholly

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Speaker 4: state funded. We have somewhat or completely privatized community based healthcare.

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Speaker 4: And it is only when you get to the point

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Speaker 4: of hospital presentation at the ED or a referral to

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Speaker 4: the hospital with an admission where that care becomes free.

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Speaker 4: And then sitting alongside that is the acc system, whereby

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Speaker 4: if you have an accident and it is deemed to

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Speaker 4: meet the criteria that care will be funded either through

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Speaker 4: public or private healthcare provision. You know, back in the day,

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Speaker 4: there was meant to be a second phase of the

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Speaker 4: acc that included healthcare more broadly and not just the

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Speaker 4: results of accidents or trauma. So you know, there's unfinished

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Speaker 4: business there. And I do think that because we put

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Speaker 4: a lot of barriers, as in price to early healthcare

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Speaker 4: and preventive healthcare, we are seeing the results of that

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Speaker 4: in ever increasing hospital admissions and a reliance on hospital

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Speaker 4: level care that is increasing at a greater rate than

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Speaker 4: the rate of population growth.

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Speaker 1: Are there any countries you reckon have got it right?

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Speaker 3: It's a really interesting question.

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Speaker 4: I don't necessarily have the answers myself, but someone pointed

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Speaker 4: out to me that hospitals in Japan have to be

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Speaker 4: run by doctors and aren't allowed to make a profit,

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Speaker 4: and apparently they're doing quite a good job. I mean,

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Speaker 4: there are a lot of OECD comparators about the efficiency

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Speaker 4: and effectiveness of a lot of similar hospital systems to ours.

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Speaker 4: We tend to go in the middle of the pack,

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Speaker 4: but we certainly spend less on average as a proportion

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Speaker 4: of GDP on our health bill than a number of

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Speaker 4: similar countries. So if we invested another one or two

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Speaker 4: percent into our health system, we would likely deliver a

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Speaker 4: really strong return on that further investment.

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Speaker 3: Obviously, that's a different approach.

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Speaker 4: To the one that the current government is taking, and

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Speaker 4: you know they've appointed the Health Commissioner to absolutely stop

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Speaker 4: any further spending on health and to rain things in.

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Speaker 4: But we get weekly cries of pain from our members

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Speaker 4: about the immediate impacts of that approach.

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Speaker 1: Thanks for joining us, Sarah.

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Speaker 2: That's it for this episode of the Front Page. You

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Speaker 2: can read more about today's stories and extensive news coverage

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Speaker 2: at enzidherld dot co dot nz. The Front Page is

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Speaker 2: produced by Ethan Sills and sound engineer Patti Fox. I'm

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Speaker 2: Chelsea Daniels. Subscribe to The Front Page on iHeartRadio or

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Speaker 2: wherever you get your podcasts, and tune in on Monday

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Speaker 2: for another look behind the headlines.