The government has green-lit a new medical school at the University of Waikato, ending months of delays due to coalition wrangling.
But the announcement on Monday also heralded several significant shifts from National's original campaign promise.
In a statement, Health Minister Simeon Brown said Cabinet had approved $82.85 million in government funding toward the project, with the university chipping in more than $150m.
The numbers differ from National's policy heading into the 2023 election. Then, it pledged $280m for a third medical school at Waikato University, with the university to raise a further $100m.
The school would also open in 2028, a year later than National had promised, but still with an initial roll of 120 students.
Brown said that would be a "significant boost" to the homegrown medical workforce and came on top of the 100 extra training places being added this term at Auckland and Otago universities.
"Today's decision will enable the University of Waikato to begin construction on new teaching facilities later this year and start planning for clinical placements, while giving more students the opportunity to study medicine in New Zealand," Brown said.
"It's an innovative model that supports our focus on strengthening primary care, making it easier for people to see their doctor - helping Kiwis stay well and out of hospital."
Universities Minister Shane Reti said the decision was a major milestone and real boost for tertiary education in Waikato.
"By expanding access to medical training, we're creating new opportunities for students from across the region and beyond, while also helping to future-proof the local workforce."
Prime Minister Christopher Luxon said it was a significant investment both for the healthcare system and for the wider Waikato region.
He refused to say who the philanthropists were who were supporting the school, but "suffice to say there's some serious commitment from some very generous people across the Waikato".
Brown said the graduate-entry programme would offer a strong focus on primary and rural health, which were areas where the need was greatest.
The addition of the medical school would also strengthen Waikato's position "as a centre of excellence in health education and research".
He said the funding would be going towards "establishment of the teaching spaces, the laboratories, and also establishing the space required in the regional communities for the clinical placements as well".
A controversial plan
The proposal was controversial from the outset. Both Auckland and Otago universities argued they could train more students at a lower cost.
Luxon said the government was confident the Waikato Medical School approach was the best value for money way of providing those additional training places.
"Yes, the business case came back saying this is the best option, but importantly we also think this is the right course forward, as we've been saying."
Brown clarified the case had looked at three different models including expanding the number of places at existing universities and concluded the Waikato School approach was the "best of the three".
ACT also raised concerns. During coalition talks, it secured a commitment that the project would not go ahead without a detailed cost-benefit analysis.
In August last year, ACT leader David Seymour said he was "dissatisfied" with the initial evaluation and cited Treasury advice that the proposal did not offer value for money.
In a statement on Monday, the ACT Party said it had saved the taxpayer hundreds of millions of dollars, with Seymour saying it was "down to Waikato University agreeing to contribute a higher proportion of the medical school's costs".
"ACT's rigourous questioning helped ensure a more efficient investment meaning Kiwis get better outcomes for less," he said.
"ACT insisted that a full cost-benefit analysis be done before signing off on such a large investment. We demanded better planning, transparency, and accountability. We raised concerns about the initial analysis failing to consider other options to address the issue. As a result, officials and Waikato University revised their assumptions, refined the proposal, and delivered a plan that achieves the goal of more doctors trained for rural communities at a significantly lower cost to taxpayers.
"ACT has always said we must save money where it counts so we can invest where it matters. This improved investment is a great example, with more money left in your back pocket and a solution found."
Luxon said the detailed business case had landed on total capital costs of $235m, which compared to a pricetag of $380m during the election.
"It's just genuinely with the passing of time... so when you fast forward from now, 10 years, 15 years from now we're going to look back on this as being a very good investment.
"Just much more precise economic analysis of what it's going to cost to do it ... we've had a lot more resource go into it to be reassured ourselves because we wanted to make sure that the government was not exposed beyond the $82 million."
He pushed back somewhat on ACT's claims the party was responsible for savings to the taxpayer.
"Oh, look, I mean this is a project that the National Party campaigned on in the election, and as you've seen Cabinet's come to a position... to endorse it today.
"What we've done is over the last 18 months is to make sure that actually we want to be reassured that the University of Waikato - given a lot of this comes from philanthropy and also we're welcoming the backstop by the university themselves - we've just spent a lot of time just making sure they're able to do that," he said.
Asked a second time if ACT had saved $200m from the project, Luxon said it was Cabinet that made the decision and it had gone through a detailed business case "as was the plan".
Asked a third time, he said it had been "a government process" to ensure the university actually had the philanthropic support the project relied on and that its financial balance sheet was strong enough to backstop it.
Luxon and Brown confirmed the detailed business case would be publicly released.
Curriculum to prioritise clinical placements in regional, rural areas - university
University of Waikato Vice-Chancellor Professor Neil Quigley said the university was delighted to have the government's support to develop New Zealand's first graduate-entry medical school.
He said the school would be called the New Zealand Graduate School of Medicine (NZGSM).
"We will be offering a programme that selects and trains doctors in a fundamentally different way and will complement New Zealand's two existing medical schools. It will be designed to produce more graduates who choose to become GPs and who want to work in regional and rural communities."
Pro Vice-Chancellor of Health Professor Jo Lane believed the NZGSM would "train the doctors New Zealand needs" to address workforce shortages in primary and community care.
"Our curriculum will prioritise clinical placements in regional and rural health settings, allowing graduates to experience working with diverse populations while building deep connections in the communities they serve."
The university said it would be engaging with rural and regional communities and primary healthcare providers across the country to finalise where clinical placements would take place.
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