Election 2023: The health system is limping along - what are political parties going to do about it?

The Herald’s political and specialist reporters examine the big issues facing New Zealand and how the main political parties plan to deal with them. Today, Isaac Davison looks at health.

Healthcare is usually among the top concerns for New Zealanders leading into an election, but has been overtaken by the cost of living, crime and housing.

Chronic doctor and nursing shortages mean the fragile state of the system is now more visible. Some patients are waiting weeks to see their GP, hospital wards and emergency departments are heaving, and there are long wait lists for surgery.

While the sector limps along, the biggest health reforms in a generation are taking place. The 20 district health boards have been scrapped and replaced with a single, national entity, Health NZ/Te Whatu Ora, and a dedicated Māori agency, Te Aka Whai Ora.

The rollout of the reforms will take years, but there have been glimpses of some of the potential benefits – in particular the initial moves to address the “postcode lottery” for some surgeries.

Te Whatu Ora is still unable to produce up-to-date national health data, but the most recent available figures show nearly all key indicators – immunisation, wait lists, cancer treatment – heading in the wrong direction or flat-lining. The Government claims at least one of those indicators – people waiting over a year for surgery – is now improving.

The central issue for the health system remains the lack of staff. The problem has been building over successive governments but was turbo-charged by the Covid pandemic as New Zealand’s steady pipeline of foreign doctors and nurses was shut off.

In all, there are now 8000 vacancies in the health sector, and this figure will rise by 1600 a year without drastic action.

All parties say they will fill workforce gaps, but their plans differ in method, scale and timing.

National would train an extra 225 doctors a year by 2030, partly by establishing a new medical school at the University of Waikato – a plan previously rejected by the Labour Government. The new med school – a graduate-entry, four-year course – would supply 120 more doctors a year, and the other 100 would come from existing schools in Auckland and Dunedin. National would also offer incentives to nurses who stay in New Zealand after they graduate.

Labour would train more doctors, more quickly – 335 extra a year by 2027 – by boosting the capacity of the two existing medical schools. It also wants to ensure 300 graduates (out of around 875) head into general practice to address chronic shortages in that sector. Both major parties would offer incentives to doctors who work in the regions.

Labour’s manifesto has a special emphasis on universal, preventative healthcare, with promises of free dental and cervical screening and raising the breast cancer screening age from 69 to 74 (matching National’s policy).

On the preventative front, National wants to lift immunisation rates by offering bonus payments to GP clinics which increase vaccinations within their clinics. It also wants to reinstate a national health target for immunisation, along with four other targets (health targets were scrapped by Labour).

The Greens go much further, promising fully-funded care for all illnesses and injuries, including GP and dental checkups, aged care, ambulance and emergency services, mental health services and palliative care, all paid for with a wealth tax. The party would overhaul ACC and create a new comprehensive care system which pays 80 per cent of the minimum wage for anyone who cannot work because of injury or disability.

The Māori Party also wants free primary and dental care but would limit it to low-income families. The party would massively increase funding for the Māori Health Authority and create dedicated mental health and ACC services for Māori.

However, the Māori Health Authority will not survive a change in government, with National, Act and NZ First all promising to scrap it. National would also reduce the powers of influential iwi-Māori partnership boards, which have a say on local healthcare plans.

While the Government has made huge investments in lifting pay for hospital nurses and is negotiating pay rises with senior doctors, GPs and community nurses say they have missed out. General practice warns of a looming crisis because of an underfunded, ageing, burnt-out workforce. One report showed the sector needed $600m more a year to address unmet needs.

The Labour Government says it is looking at the funding model for GPs, but has not made any promises in its manifesto. Act and NZ First have both promised an increase in funding for general practice. The Greens and the Māori Party want to review the way GPs are funded, saying it does not properly address social and ethnic inequities.

Several parties want change at the bulk-buying drug agency Pharmac, which procures subsidised medicines for patients.

National would boost Pharmac’s funding to allow it to fund 13 cancer treatments that are available in Australia. It would pay for this by reinstating the $5 fee for prescriptions.

Labour has also promised an increase: $1b over four years, including $200m for new treatments. It is critical of National’s approach, saying the independent agency should not be told by politicians what drugs to buy.

The Māori Party and NZ First also say they would lift Pharmac’s funding, while Act wants the agency’s operating model to be reviewed.

As Covid’s shadow retreats, no party has promised any pandemic-related measures. NZ First is the only one to mention Covid in its manifesto, saying it will rehire unvaccinated health workers and pay them compensation.

HEALTH: THE POLICIES

Labour

National

Greens

Act

Te Pāti Māori

NZ First