The Role of Health Workforce New Zealand is one of two reports that Health Workforce New Zealand (HWNZ) is publishing in 2014. The other report, The Health of the Health Workforce 2013–2014, describes the state of the health and disability workforce (the workforce) in New Zealand at the present time. It is the first of what will be a yearly report.
The data and workforce intelligence cited in these reports are drawn from multiple sources; for example, regulatory bodies such as the Medical Council of New Zealand (MCNZ) and Nursing Council of New Zealand (NCNZ), the wider Ministry of Health, district health boards (DHBs) and other employers, OECD reports, the New Zealand Census and Workforce Service Forecasts commissioned by HWNZ.
Because of this, there is some variation in the date ranges of the workforce data used.
New Zealand has, by international standards, a high-performing and efficient health system. But, in common with other OECD countries, we face a number of challenges. The proportion of New Zealanders aged 65 and over is predicted to increase from 14 percent of the general population in 2012 (600,000 people) to 23 percent in 2036 (1.2 million people).1 The growing cost of health care for this ageing population is expected to fall on a relatively smaller number of taxpayers.
Chronic conditions and non-communicable diseases such as diabetes, heart disease and mental health conditions are likely to be more prevalent in future, and may have a disproportionate effect on Māori and Pacific people, whose life expectancy is lower than that of the general population. On the positive side, new technologies are expected to result in earlier diagnoses and return more people to good health, but their benefits cannot be fully exploited without a skilled and well-trained workforce.
New technology also contributes to the uncertainty and ambiguity associated with the future of public health services. Solutions are not always clear, and may not lie entirely with the health sector. For this reason, increased cooperation across the health and wider social sector will, of necessity, become more and more the norm.
Health spending accounted for 10.3 percent of gross domestic product in New Zealand in 2011, which is higher than the OECD average of 9.3 percent.2 In the same year in New Zealand, 82.7 percent of health spending was funded by public sources; this was well above the average of 72.2 percent for other OECD countries. About two-thirds of Vote Health operational funding is spent on workforce, which amounted to approximately $9 billion in the 2013/14 financial year.
Responses to health care challenges
There have been a series of consistent responses around the world to the challenge of delivering high standards of health care within manageable budgets. In New Zealand, a Ministerial Review Group (MRG) set up in 2009 to make recommendations to the Minister of Health on the future direction of the health and disability system said New Zealand could only meet forecast growth within a sustainable cost track by investing in more efficient solutions.3 The MRG’s recommendations were based around one central theme – ensuring that New Zealand continued to have a world-class health and disability system.
The MRG concluded that New Zealand needed to move away from hospital-based models of care and rigid job definitions and work practices.44 New models of care were needed that placed the patient at the centre of service delivery, and placed health care services as close to home as possible. The MRG suggested that New Zealanders should be encouraged to play a greater part in their own health and wellbeing, noting that prevention and self-care would become increasingly important in future.
These strategic responses had implications for the workforce. The MRG pointed out that workforce planning at the time was fragmented and hampered by the variable quality of data collection systems. National oversight and leadership was needed to develop a strategic response to New Zealand’s workforce challenges.
Government, the Ministry of Health, the DHBs and HWNZ have implemented a number of policy responses to address wider service delivery challenges and those specific to the health and disability workforce. The Ministry’s two primary outcomes reflect government priorities for health: that New Zealanders live longer, healthier and more independent lives, and the health system operates effectively within a constrained funding environment.
The health and disability sector is working towards a system in which:
individuals, families/whānau and communities take greater ownership of their health and wellbeing
health responses are geared towards keeping people well through early intervention and prevention – at both individual and population levels
more health and disability care is delivered in primary and community settings
work across the public social sector is incorporated into achieving better health, social and economic outcomes.
Health Workforce New Zealand was set up in 2009 to provide strategic leadership for a sector-wide response to New Zealand’s workforce challenges. HWNZ consists of a multi-disciplinary board and a business unit that employs 17 full-time staff. The business unit is part of the National Health Board within the Ministry of Health, and is funded from Vote Health.
Professor Des Gorman has been the Executive Chair of the HWNZ Board since 2009. The Director of the business unit is Dr Graeme Benny, who took up the post in February 2014.
In 2009, HWNZ also became the primary provider of funding for post-entry clinical training in New Zealand, with an allocation of approximately $174 million from Vote Health for postgraduate clinical training, workforce development and innovation in the 2013/14 financial year. More information about the education and training programmes HWNZ supports can be found in the Funding section (page 28).