Part 1: The Environment for Workforce Development 2
1.1 Factors influencing demand for health and disability support services 2
1.2 Government agencies involved with health workforce development 6
1.3 Health workforce education and training 9
1.4 The New Zealand labour market 10
1.5 Characteristics of the health and disability workforce 11
1.6 Workforce shortages 13
Part 2: Approaches to Workforce Development 17
2.1 Can the health labour market be changed? 17
2.2 Health workforce culture and innovative models of care 19
2.3 International approaches to workforce development 24
2.4 The New Zealand approach to workforce development 28
2.5 Mental health and addiction workforce development 29
Part 3: Key Themes for the Shape of Future Workforce Development in New Zealand 32
3.1 Workforce development infrastructure 33
3.2 Organisational development 34
3.3 Recruitment and retention 37
3.4 Training and development 40
3.5 Information, research and evaluation 42
3.6 Leading change 43
Appendix 1: Summary of Priorities in DHB/District Health Boards of New Zealand (DHBNZ) Future Workforce 2005–2010 Document 45
Appendix 2: New Zealand Workforce Innovation Projects 48
Appendix 3: Some International Perspectives on Workforce Development 51
Appendix 4: Ministry of Health Workforce Development Actions 54
The environment for workforce development
Demographic change is a major driver of demand for health services. Between 2001 and 2021 it is predicted that the New Zealand population over 65 will increase from 461,000 to 729,000. Most significantly, in this period the population aged over 85 is predicted to grow from 48,639 to 105,400. The proportion of Māori and Pacific older people will also grow substantially.
Government strategies such as the Primary Health Care Strategy (Minister of Health 2001) require the workforce to work in new ways. They require a population-based approach to health care provision which emphasises prevention, education, health maintenance and wellbeing, and strengthening of connections with other health agencies, social and community services, and iwi. These strategies also emphasise improving the cultural appropriateness of services, the promotion of inclusive and consumer-centred approaches to service provision, and the development of new health care services and roles in the community.
Finally, health consumers in developed countries now have much greater access to information about health, and consequently greater expectations about what the health care system can potentially deliver for them. Those expectations are further amplified by the ‘medicalisation of wellbeing’ (Gorman and Scott 2003) and the publicity about technological developments that can improve treatment outcomes. All of these factors influence the kind of workforce that New Zealand will need in the future.
Health sector workforce regulation affects the shape of the workforce by setting and reinforcing the parameters for accountability. The Health Practitioners Competence Assurance Act 2002 (HPCAA) requires registration authorities to ensure that practitioners are competent and fit to practise their professions. It is also possible to develop and register new, different and/or overlapping professional scopes of practice under the HPCAA to support developments in services and in practitioner roles. Contractual requirements and collective employment agreements also define the roles and activities of occupational groups.
The Health Workforce Advisory Committee (HWAC) was set up under the New Zealand Public Health and Disability Act 2000 to advise the Minister on workforce issues. The HWAC also has a Māori Health and Disability Workforce Subcommittee and a Medical Reference Group.
District Health Boards New Zealand (DHBNZ), on behalf of DHBs, has developed a collaborative workforce development framework, based on a workforce action plan that focuses on information, relationships and strategic capability. The DHB/DHBNZ Future Workforce framework, developed in 2005, has identified future workforce needs and priorities for action. This framework is driven by collaborative mechanisms set up by DHBs, including the DHB/DHBNZ Workforce Development Group (WDG) and six workforce strategy groups, which provide capacity and leadership for the development of key workforces and report to the WDG.
The Ministry of Health’s role in this is to ensure that the policy and regulatory environments support the Government’s strategic objectives, and to provide leadership and support to the sector on workforce development. Work includes the development of workforce action plans targeting various sectors.
The education sector is responsible for funding health workforce education through the Tertiary Education Commission, and clinical training is generally funded through the Ministry’s Clinical Training Agency. DHBs also play a significant role in the clinical training of registered health practitioners. A stocktake of the provision of education in the 2002 year identified that the Commission’s funding was $191.2 million, Clinical Training Agency funding was $86.6 million, and DHB funding was $15 million (Ministry of Health and Tertiary Education Commission 2004).