The ideological fanaticism at play in overhaul of health workforce

Tuesday, 21 October 2025

Jenny Carryer CNZM is a professor in the School of Nursing at Massey University.

OPINION: The Government’s apparent intention to pursue its “modernising health professional” legislation raises major concern. The proposed legislation is an ideologically driven attempt to solve problems that simply do not exist in the manner outlined. This is particularly hard to swallow at a time when there are numerous significant problems requiring attention.

It is suggested that the proposed changes will make it quicker to bring in additional health professionals from other countries to solve our workforce needs. This is inaccurate and misleading. For the nursing profession the workforce is already almost 50% qualified in other countries and a large number use New Zealand registration as a pathway to other countries.

Of approximately 10,000 nurses in 2023-24 and 14,000 in 2024-25 seeking evidence to emigrate, 90% were internationally qualified. At the same time a major proportion of our own New Zealand graduates are not being employed, or not sustainably employed.

The consequences of this are far reaching and costly. Growing and employing our own graduates in any discipline is critically important. They are culturally grounded in Aotearoa and a stable component of our future workforce.

For medicine very few applications to practice in New Zealand are unsuccessful and 60% of foreign doctors only remain here for two years, using their NZ registration as a stepping stone to practice elsewhere.

The medical workforce already comprises over 40% of internationals. It is extremely difficult to see any connection between the workforce problems we do have and the intent or value of the proposed legislative changes.

More perniciously the proposed bill will open the way for greater government involvement in regulatory processes. A simple example of how this might play out would be clearing the way for Health New Zealand to have control over the number of clinical training hours allocated within the nursing bachelor’s degree. In a sector with major cost pressures the risks to patient safety are very much compromised.

The consultation document offered to introduce this planned legislative change was notable in several ways. Firstly it was embellished with a picture of someone recording a blood pressure with the blood pressure cuff upside down. Clearly no clinical oversight was involved.

Secondly it contained a large number of apparently self-evident but deeply disingenuous statements designed seemingly to attract uncritical agreement from the public.

Finally, and perhaps worst of all, these statements included suggestions that requiring health professionals to be aware of and attentive to cultural requirements when providing care was somehow a waste of time. The naivety and sheer arrogance of such assertions is deeply concerning to those who work in clinical practice.

Many members of an already overwhelmed health sector spent hours in discussion and writing submissions to point out the dangers of the proposed changes. It was pointed out in submissions, with strong supporting evidence, that the changes would in fact not increase patient safety as suggested. Rather, they would create significant additional risk, both direct and indirect.

Despite the professional opposition through the submission process and despite no evidence of a problem this bill could solve, the Health Minister has announced the intention to proceed. Should this actually happen we have a rocky and fraught road ahead.

Regulation through profession specific councils (medical, nursing etc) ensures that international qualifications are valid and appropriate.

It ensures that the relevant educational programmes in NZ are fit for purpose.

Finally, the councils oversee attention to unsafe clinical practice, patient harm and the disciplining of health professionals as required. The central goal of health professional councils is and always has been patient safety.

It is very hard to see how the proposed generic occupational oversight group in place of the designated professional councils will safely conduct these critical roles across health professional groups.

So why, we ask ourselves, is this happening. We know that right-wing governments have a long standing ideological tendency towards deregulation We know this coalition does not place much value on evidence or logic.

Even so, in a time of attention to fiscal discipline it is hard to read anything other than ideological fanaticism behind this proposal.

Similarly in a time of such stress in the health sector it is hugely annoying to face such a distraction.

Yes, we are short of critical workforce. But an inability to bring even more internationally qualified staff to our country is not the problem.

Yes, there are opportunities to use the existing workforce more flexibly. For nursing at least there is nothing that impedes such an agenda. Over the last 20 years nursing has made huge inroads in creating a highly responsive regulatory situation which has supported major increases in the nursing contribution.

Dealing with significant numbers of foreign-trained staff can raise challenges. They are a vital and valued part of our workforce and can enrich our services with diversity and skill. But balance is important. The fact that we are relying on poaching staff from countries who cannot spare them also raises important ethical issues.

The absolute failure of this bill to address any real problem in any useful way is deeply disturbing. Even more concerning is the potential of this bill to disrupt and distract a sector that is already working under immense and increasing pressure.