4 Jul 2023

Te Whatu Ora launches strategy for health recruitment and retention

12:55 pm on 4 July 2023
Ayesha Verrall

Photo: RNZ / Samuel Rillstone

New Zealand is estimated to need to increase recruitment by 8000 nurses and 3400 doctors on top of meeting current staffing levels to deal with demand out to 2033.

The government has released a strategy for making up the gaps in the health workforce, building on new data that estimates health need for the next decade.

The data suggests New Zealand will need to recruit or train another 1600 health professionals a year just to maintain current staffing levels relative to population growth - despite the number of new nurses registered in the past year increasing to 8000, up from 5000 the previous year.

Te Whatu Ora Health NZ estimated Aotearoa was currently short by 4800 nurses, 1700 doctors, 1050 midwives, 220 dental or oral health practitioners, 200 anaesthetic technicians, 170 pharmacists, 120 sonographers, 30 radiation therapists and 30 clinical or cardiac physiologists.

However, the agency estimated another 8000 nurses, 3400 doctors and 250 midwives would be needed to make up shortfalls in health demand out to 2033. That also excludes demand for other health professions, which the organisation was unable to estimate based on current data.

The modelling is also based on an assumption of no change to the efficiency of current systems - which the government also plans to improve.

Health Minister Ayesha Verrall announced the plan to boost recruitment and retention at Parliament on Tuesday morning.

It targets six areas:

  • Māori health workforce recruitment and retention
  • Pacific health workforce recruitment and retention
  • Driving local-led innovation in training
  • Boosting recruitment in priority workforces
  • Retention, including through support
  • Developing clinical workers to become leaders

Specific initiatives include:

  • Growing rural and interdisciplinary training programmes to enable larger student intakes
  • Growing 'earn-as-you-learn' programmes across health professions
  • Creating 135 new training places a year for allied and scientific professionals, including paramedics, oral health therapists, radiation therapists and pharmacy prescribers and anaesthetic technicians
  • Seed funding for new programmes to grow these allied professions
  • Sustained investment in Return to Nursing and support for internationally-qualified nurses (IQNs) to get ready to practice in New Zealand
  • Launch of a Return to Health project focused on flexible opportunities for those with health qualifications to return to work
  • Expanding access to cultural and hardship support for Māori and Pacific students in training to minimise student attrition and grow workforces faster
  • Establishing funding for Māori providers to take more students on placement and to offer increased training and development roles

Verrall said the plan - developed by Te Whatu Ora and Te Aka Whai Ora - would make early differences to health workforces, and was aimed at making a difference to workforces within a year's time.

"Just like in medicine, you can't start the treatment until you've got the diagnosis right - so we need to know what our gaps are. Some of them are confronting but until we do that we can't make the progress we need to fill them," Verrall said.

"While the modelling in this plan might be confronting to some, I think it is important that Te Whatu Ora is clear on workforce shortages to enable action."

She said the problem had been decades in the making.

"The gaps have emerged over decades and we have grown the health workforce 16 percent in nurses, 16 percent growth in doctors, during the term of this government. However, it's not enough to keep up with the population, the ageing population, and the new demands we need, so we have to do more."

There was a focus on boosting Māori and Pacific workforces, and rolling out successful methods developed in the former DHBs to support health workers with things like pastoral and trauma care, and cultural competency. The agency noted current staffing levels - 9 percent Māori and 5 percent Pacific - were falling well below the 19 percent and 10 percent proportions of the general population.

"A key thing is to make sure that we're building a pipeline all the way from high school, encouraging Māori and Pasifika students to study science subjects at high school so they have the background in order to do that in tertiary study," Verrall said.

Other initiatives would include things like scholarships; guaranteeing places in the national health workforce for those planning to go overseas and return; and making it easier for them to do so - or offering more international fellowships with the hopes they would remain in New Zealand.

A "boots on the ground" approach with staff based in overseas offices - including London - could also be taken to help boost international recruitment, although the plan in the long term aimed to lift domestic training rates so the system was relying less on foreign workers.

The voluntary bonding scheme would also be reviewed and reworked.

"In some cases, international experience is what we want from our health professionals. I did my fellowship in Singapore and sought to bring my experience back home but we need to join that up better. Currently, New Zealanders returning to New Zealand can't access relocation costs - we need to fix that," Verrall said.

"It means everything from when you're on night duty, we'll now make sure that there is nutritious food available for you. It means that when something distressing happens at work, we need to be there with the appropriate debrief."

She said no one had spoken to her back when she was a junior doctor and experienced her first patient death from an arrest.

"There was no one whose job it was to speak to me about that experience. Now, for some people that makes the difference between staying in the health sector or driving burnout and leaving. We want our workers to be better supported."

'Going to have to see how she goes' - Senior doctors' union

Association of Salaried Medical Specialists executive director Sarah Dalton has booked a meeting with Te Whatu Ora to talk through the plan and the details of the medical components.

She said she welcomed the accountability the numbers brought to the problem of health staffing - but was not surprised by the estimates.

"While we welcome the workforce plan and we welcome Te Whatu Ora's commitment to share some data, we believe it's still an understatement of facts for the medical workforce.

Sarah Dalton, Association of Salaried Medical Specialists executive director

Sarah Dalton Photo: LDR / Stuff / Kevin Stent

"The fact that they're committing to some follow-up discussions and know that there's work to be done is encouraging, we're just going to have to see how she goes."

The union had in the past come up with similar numbers that were denied by the former DHBs, and it was encouraging to see the change in attitude, she said.

"The fact they have put pen to paper, set down some numbers and established some accountabilities we can work with them against year by year is a positive step forwards.

"I think there is an attitude at the top levels of Te Whatu Ora to try and tackle this but we are still underfunding our health system."

However, there still appeared to be no real interest in closing the wage gap with Australia - and that, along with good working terms and conditions, were the best way to boost recruitment and avoid attrition, she said.

'Too little, too late' - National

National's health spokesperson Shane Reti said after six years of failure, the best Labour could offer was half-baked announcements.

"The government chose to focus on the bureaucracy, rather than the frontline. And with the workforce now in crisis, Labour is desperate to make it look like they're doing something but it's all too little, too late."

Shane Reti

Photo: RNZ / Samuel Rillstone

It was a long-term plan with some short-term measures, he said.

"You know, maybe they should have thought about that before they were so late coming to the day-one pathway for nurses, so I think they've been the masters of their own mistakes here."

There were some holes in the plan, including a lack of any costings, Reti said. He also had concerns over midwife recruitment, and wanted a bigger focus on retention.

"There's no really strong pathway for midwives but I'm not surprised by that because a year ago the minister told me there was no shortage of midwives in regions and that the regions were coping.

"What's also missing is around the 3000 extra nurses who've registered. What is really important and what they [Labour] continue to fail to put out at the same time is how many have left.

"National knows that workforce is one of the main issues facing the sector and we have a plan to deliver more nurses and midwives by paying student loan repayments if they enter a bonding agreement of five years, and make New Zealand a more attractive destination for international nurses.

"We'd look at the doctors that are in New Zealand registered from overseas, completed NZREX (the exam for foreign doctors without a comparable qualification), and they're driving Uber Eats in Auckland. It would seem to be a pool that's here and already available to us - and nurses as well, we need to credential them and bring them on board."

National would announce further health policies ahead of the election, Reti said.

Government points to reforms as enabling nationwide plan

While research on health workforce gaps has been done in the past, this is the first time such estimates had been applied across the new national health agency.

Verrall pointed to the health reforms as a key part in making the plan possible.

"There are a number of actions we can take now that we couldn't take when we had 20 DHBs competing against each other for staff. In that old system it was nobody's responsibility to address the training pipeline, now we recognise that is the health system's responsibility and we're working hard on it - that led to the announcement of the 830 nursing placements yesterday."

Te Whatu Ora plans to continue to improve its data gathering for estimating workforce shortages and need, and produce reports and estimates on a regular basis into the future.

Reti said it was useful to have a better understanding of the health workforce, but the colleges' annual workforce surveys had painted that picture for some time.

"So I don't accept that it required the health reforms to set out this sort of plan today. The operational part to fixing things, that may benefit from having more ability to set policies down at a hospital level."

"I think it's late in the piece to be recruiting and Health NZ has an appalling record with recruitment - if we look at all the recruitment programmes they've done to date they've done a terrible, terrible job."

Te Whatu Ora's chief people office Andrew Slater said the research and plan had been pulled together as part of the organisation's annual budget process.

"By bringing the 29 organisations together we've been able to take sort of a whole-of-system approach and as the largest employer of health workforce as well we're able to look at the really good practice we've got going across in certain areas and in certain hospitals.

"We've been able to evaluate some of the pilots, work out those ones that we need to scale, and then bring those through."

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