Anneke Smith
Wellington, May 6, 2023
“I am determined that we will have the best plan that New Zealand has ever had,” Health Minister Dr Ayesha Verrall has said.
Covid-19, flu, RSV and other respiratory illnesses are on the rise as we inch towards winter, so Te Whatu Ora (Health Ministry) launched its winter preparedness plan this week with the aim of easing the pain for already overstretched hospitals.
The government argues that its reforms unifying the 20 DHBs have allowed it to prepare better. The plan promises to bring the health system closer to people – into the home, pharmacies and rest homes – but the opposition and health workers alike worry that there are too few frontline workers to staff it.
A bleak backdrop
A woman died of a brain bleed in Middlemore Hospital’s ICU last year, after leaving the emergency department the previous day due to long wait times.
Doctors at the time told RNZ that it was symptomatic of the entire health system; last winter was the worst on record for wait times in Accident and Emergency. That continued, with no city ED meeting treatment targets.
That is the bleak backdrop to the coming winter season and there are early indications the conditions this winter will be tougher. This year’s flu season arrived early, and Northland and North Auckland GP Tim Malloy said that it will be worse than Covid-19 because less exposure in recent years means lower immunity.
“We are expecting it to be significant, severe, and cause people probably greater harm than the current serotypes of Covid,” he said.
Dr Verrall, a former infectious diseases specialist, released the government’s 2023 Winter Plan this week expanding on 24 initiatives that proved useful in the pandemic and recent weather crises. The highlights include telehealth, pharmacy consults for minor ailments, direct referrals from GPs to radiology services, and giving paramedics access to GP advice for better care in ambulances.
Useful initiatives
Some initiatives, like the National Data System, are made possible by the health reforms which merged the country’s 20 District Health Boards into Te Whatu Ora less than a year ago – a point that Dr Verrall has emphasised.
However, most are already in place – and scaling up could be a risk, with the parts of the sector that would take on the burden already stretched to the limit.
Tevita Funaki, Chief Executive of The Fono, a group of Auckland GP clinics said that while the plan has good intentions, “in primary care – at the end where we need to actually divert a lot of this care to … it is already overwhelming.”
Australasian College for Emergency Medicine’s Aotearoa Chair Kate Allan, a senior ED doctor, said that the plan is proactive and pragmatic but requires a healthy workforce.
She is sceptical about whether it will help with the crucial problem of bed block – where hospital beds are being used for people who no longer need them technically.
Staff shortage hurts
The National Party has been saying for months that the government should widen the stream of health workers coming through the immigration system.
Its Health spokesperson Shane Reti said that the government has waited too long to recruit overseas talent – allowing other countries like Australia to snatch up much-needed health staff.
“This is too little too late. I think there are some of the 24 points that I would do also. A large number of the points are already in place … the big question is: where is the workforce and who is going to do it?”
He said that pharmacists were put on the immigration green list just last month, and nurses just before Christmas and although the plan includes international recruitment, there is no point trying to implement it without enough staff.
The debate over workforce shortages came to a head this week, after the National Party published a press release titled “19,000 nurses leave under Labour.”
It then announced a ‘bonding’ policy to pay more than $4000 a year over five years for nurses’ and midwives’ student loans if they committed to working in New Zealand for the duration.
Dr Verrall accused National of misusing the figures that she had provided, given the 19,000 includes those who simply moved roles within New Zealand.
Nurses Organisation Kaiwhakahaere Kerri Nuku says the real number of nurses heading overseas or quitting would be closer to 4000 – a concern, she said, but one not solved by bonding.
“This does not change the environment that they are going into. People are burdened, they are burnt out, they are tired, they are unable to give the quality of care that patients deserve – so it is more than just the pay,” she said.
Minister’s promise
With an election less than six months away, the government must be seen to be getting on with the job. Dr Verrall told RNZ that she is under no illusions about the struggle to find staff, but winter planning cannot wait.
“We cannot afford to wait for the workforce situation to be perfect, to be fully staffed, in order to start making these innovations happen that will make things better for patients. We have got to get on and do it.”
She said that the public can have confidence they will get the care they need this winter: while the plan will not be perfect, it should help the health system perform well on mortality metrics that have held up even during tough winters like the last one.
“That was hard work for our staff … people are getting delayed care and I don’t like that, but overall the performance is good,” she said
Exactly how the success of the ‘2023 Winter Plan’ will be measured is unclear.
Dr Verrall expects fewer hospital admissions compared to last year.
But as the days grow shorter, and the nights colder, voters will be watching.
Anneke Smith is a Political Reporter at Radio New Zealand based in Wellington. The above Report and pictures have been published under a special agreement with www.rnz.co.nz
