When HWNZ was established, New Zealand’s workforce was highly skilled and professional but characterised by staffing shortages. Locally trained doctors and nurses were leaving to work overseas, and there was a heavy reliance on highly mobile locums and overseas-trained health professionals to fill vacancies. The World Health Organization analysed the health workforces of OECD member countries in 2008 and concluded that New Zealand was overly reliant on migrant doctors and nurses.
Workforce distribution was another issue; some rural and provincial areas experienced consistent and significant gaps between supply and demand across all the major workforces. New Zealand’s small and widely dispersed population made regional delivery of certain specialised services a particular challenge. For example, some cancer treatments depend on services provided by small allied health, science and technical workforces. It takes time to train these specialist workforces, and New Zealand- trained graduates were sometimes lured off-shore by the higher salaries and career development opportunities available in other countries.
New Zealand had, and continues to have, an ageing workforce. Young people enter the health professions at a lower rate than they do in other professions. General practice in rural areas has an older workforce in general than in urban areas.5
Although Māori make up 15 percent of the general population, 2.9 percent of doctors and 6.6 percent of nurses are Māori. Pacific peoples represent 11.8 percent of the population, yet 1.8 percent of doctors and 2.5 percent of nurses are Pacific.6
Responding to current challenges requires leaders who understand the health system’s direction of travel, who work across the health and wider social sector, and who have the ability to innovate and steer a system in transition. But a shift in culture is also required, so the health system increasingly encourages individuals and communities to take greater personal care of their health and wellbeing. The health care system of the future will transcend traditional professional, provider and organisational boundaries.
As the population ages, community and home-based care will become increasingly important. HWNZ recognises that coordination of care for older people by inter-professional teams outside hospital settings will be necessary, and will become ‘business as usual’ for the relevant health practitioners.
The pace of change will need to increase to keep up with medical advances such as personalised medicine and genetic mapping. Work will also continue to reduce disparities in health outcomes for Māori and Pacific peoples (for example, through coordinated responses that target the early diagnosis of rheumatic fever).
HWNZ proposes the training and recruitment of more health professionals with generic skills. This will increase the workforce’s flexibility and support the increasing shift towards primary and community-based models of care and integration between institutional and community settings.
Another response to future challenges is to encourage health professionals to take on new tasks and responsibilities, freeing up limited and expensive clinician time. This can be achieved through the enhancement of existing roles and the development of new and innovative roles. Such an approach is expected to lead to improved satisfaction for trainees and earlier treatment for patients.
HWNZ has supported the demonstration and evaluations of a range of innovative roles in New Zealand settings. More information about these can be found in the Demonstrating innovative roles section (page 15).
Government’s health targets are a set of national performance measures that provide a clear and specific focus for improving health care at local and national levels. They provide a way of measuring whether the health and disability system is improving New Zealanders’ access to services, and also their overall health outcomes.
Six priority health targets have been in place over the past six years.
Shorter stays in emergency departments.
Improved access to elective surgery.
Shorter waits for cancer treatment.
Better help for smokers to quit.
More heart and diabetes checks.
Between 2007/08 and 2013/14, the number of elective surgeries increased by an average of more than 8000 a year, from 118,000 to 158,500. Collectively, DHBs achieved 105 percent against a target of 100 percent access to elective surgeries in the third quarter of 2013/14.
For the 2009/10 year, a target of radiotherapy treatment for all cancer patients within six weeks of their first specialist appointment was established. From December 2010, this was changed to ‘within four weeks’. In light of DHBs’ existing achievements, the target was changed to include chemotherapy as well as radiotherapy. All DHBs achieved the target in the third quarter of 2013/14.
The DHBs’ collective performance against the shorter stays in emergency departments target stayed at 94.3 percent in the third quarter of the 2013/14 year. All DHBs achieved 90 percent or greater in the same quarter (for the first time since the target was established in July 2009). Eleven DHBs met 95 percent of the target.
Almost 849,000 New Zealanders have had heart and diabetes checks over the past five years, and almost a quarter of a million have been offered advice and support to give up smoking. As a result of this and other initiatives (such as annual increases in tobacco excise and the withdrawal of retail displays), the prevalence of daily smoking in New Zealand has now reduced to 15 percent.
Six years ago, the Māori immunisation rate for eight-month-olds was 59 percent. Today, in over half of the DHBs, the rate is equal to or higher than the rate for Europeans. The current target is that by December 2014, 95 percent of all eight-month-old children will have had their primary course of immunisation.
Achieving health targets depends on a capable and well-distributed supply of health professionals. Since its establishment, HWNZ has worked on initiatives aimed at developing a workforce capable of supporting the delivery of health targets and other government and wider Ministry priorities for health.
Figure 1 describes key workforces we are working with to achieve government and Ministry of Health priorities. It also shows the aggregate areas, or interdisciplinary priorities, to which the individual workforces contribute. HWNZ will increasingly move towards an aggregate approach to workforce planning that works across the different workforces to achieve outcomes in a particular area, for example, in aged care.
Figure 1: Developing sustainable workforces and new models of care