29 Sep 2022

Health ministers queried why nurses not on fast track residence list, papers show

12:43 pm on 29 September 2022
Andrew Little and Ayesha Verrall.

Health Minister Andrew Little and Associate Health Minister Ayesha Verrall. Photo: RNZ

Government papers show health ministers questioned why nurses and dentists were not being put on the fast-track to residence when the Green List immigration policy was being drawn up.

And officials suggested to Immigration Minister Michael Wood that he might want to talk to the head of Te Whatu Ora Health NZ after she told media nurses should go straight to residence to address workforce shortages.

Since the border reopening and immigration changes were was announced in May there has been criticism from doctors and nurses organisations that they would do little to help a system under strain.

Nurses coming to New Zealand are on the 'work to residence' pathway, putting them two years behind doctors, engineers and IT professionals, who from this month can go straight to residence.

A Cabinet paper from March showed Health Minister Andrew Little and Associate Health Minister Ayesha Verrall had questioned the immigration priorities.

The same document said the Ministry of Health's view was the same as immigration policymakers - that nurses were best kept on the two-year programme, due to concerns over retaining them.

The Green List was discussed at Cabinet's Social Wellbeing Committee on 13 April and an extract from an email the following day sheds some light on the concerns that were raised.

The email was shared with Little and Verrall and Prime Minister Jacinda Ardern, pointing out the 6 percent workforce exit rate of nurses from abroad compared to 4 percent of New Zealand-trained nurses.

They were told there was real risk of "creating a relatively easy pathway for large numbers of migrants to rapidly seek residence if this offer is granted too widely or in roles where retention is a known issue".

"The Minister of Health and Associate Minister of Health queried whether nurses and midwives could be provided a fast track to residence rather than work-to-residence path within the Green List. We raised this topic with the Ministry of Health and were aligned in the view that due to retention concerns post-residence, these roles were better placed on a work to residence path, which will still provide certainty and support to attract migrant workers into these roles. We have not changed the placement of these roles," the Cabinet paper said.

Asked for comment, Little said today decisions about immigration green lists were made collectively by Cabinet.

While other feedback was redacted, briefing papers to Cabinet, released under the Official Information Act to RNZ, show there were calls from the Ministry of Health (MOH) and its ministers for dentists to also be included in the 'straight to residence' path.

In the briefing papers, Immigration NZ said its analysis did not support what health the Ministry of Health was asking for, and the Ministry of Business, Innovation and Employment's (MBIE) standpoint was there was insufficient evidence of a shortage in the wider dental sector rather than solely district health boards. MBIE also said some dentists would be eligible for the Green List fast-track based on their salaries. MOH advice on nurses and dentists has not yet been made available.

Ricardo Menendez March. Photo:

Green Party immigration spokesperson Ricardo Menendez March said there had not been a robust enough process to determine whether dentists and nurses should have been put on the fast track process.

"For dentists, if there's an acknowledgement that there is a shortage in the public healthcare system, then we should have addressed that by ensuring that we create an immigration system that supports migrant dentists to work in the public health care system. And when we know that accessing dental care is really expensive in the private sector, we should be building a workforce in the public health care system."

Elsewhere in the documents, medical radiation therapists and mental health roles were flagged as a potential focus in the immigration changes unveiled in May.

MOH also called for immigration's upper age limit on medical specialists to be adjusted upwards, saying even very small numbers of specialist practitioners aged over 55 (an estimated 2.5 percent of the health workforce) being made eligible for residence could make a difference.

The Green List placing of nurses was met with anger and dismay among nursing groups and the aged care sector. Andrew Little publicly defended the decision.

In early July, when Te Whatu Ora Health NZ came into being, its chief executive Margie Apa said publicly nurses should be on the straight to residence pathway, to mitigate workforce shortages.

A briefing to Wood some 10 days later referenced those remarks and officials asked what steps he would like to take.

It suggested speaking directly with her and the health minister to clarify whether her comments reflected the organisation's view.

Wood said he had not spoken to her, adding that there was reasonably extensive engagement with Health New Zealand, but that pre-dated him becoming immigration minister.

Health New Zealand did not respond to the specific question of whether Apa was asked about her comments, but instead outlined that its senior leadership regularly meet with ministers and other agencies to discuss a range of issues.

"Meetings or discussions during the formulation of immigration policy for healthcare workers is part of this overall relationship and process," a spokesperson said in a statement. "As part of this engagement with ministers, comments made by Te Whatu Ora leaders cannot be categorised as being 'against government policy.' That's because whenever we are asked for input on policy, we provide it."

National Party immigration spokesperson Erica Stanford said the briefings suggested Immigration NZ was out on a limb with its perspective on nurses.

"There's two options here. The first option is that this was a genuine request to say to the minister, maybe we should go and have a chat with Health New Zealand and see what their position is and maybe we should change our policy if they are correct. And the other view is that this was a 'hey, please explain Health New Zealand why you're not on the same page as us, why are you making comments that aren't in line with our policy'."

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