Late last month, New Zealand Health Minister Andrew Little stated what most who work in health already know.

Healthcare is all about people – the people being cared for and the people doing the caring.

Population growth, ageing and a pandemic mean there is no shortage of those needing care, but in New Zealand and globally, there is a chronic shortage of healthcare workers.

Little stopped short of calling it a crisis, but researchers and international agencies alike agree with a survey of New Zealand doctors that the health workforce is in crisis.

In 2016, the World Health Organisation (WHO) projected a global shortage of 18 million healthcare workers by 2030. That was before the covid-19 pandemic. Between 80,000 and 180,000 healthcare workers have died globally during the pandemic’s first 16 months, according to the WHO’s conservative estimate.

“Public statements from political leaders that there is ‘no crisis’ in the health system have seemed increasingly out of step with doctors’ experience over the past year” https://t.co/dXMhA38XIO

— Emma Espiner (@emmawehipeihana) July 11, 2022

Add to this the impact the pandemic has had on the mental health of frontline health staff, including reports of post-traumatic stress disorder (PTSD), and a healthcare workforce seven times more likely to have severe covid and now carrying the burden of long covid.

It’s clear healthcare is no longer the attractive sector it once was.

A highly mobile workforce and a global shortage
Like the cost-of-living crisis, the health workforce shortage is not unique to Aotearoa New Zealand.

This year’s budget included NZ$76 million for medical training and primary care specialists, but doctors who started training this year will not be specialists until 2034.

Meanwhile, Labour’s solution is to undertake an international recruitment drive. It is hailing New Zealand as one of the easiest places in the world for healthcare workers to come to. But are our newly opened borders attractive enough?

Overseas recruitment drive for nurses gains ‘good response’ https://t.co/RZrM4fW67L

— RNZ News (@rnz_news) July 13, 2022

In my health economics lectures I often use an anecdote about the Indian doctor who gets a job in the UK (colonial ties and a multicultural society), the British doctor who moves to Canada (less administration and more family friendly hours), the Canadian doctor who moves to the United States (specialists have much higher earning potential), and the US doctor who undertakes missionary work in India.

This highlights two issues: the health workforce is highly mobile and employment isn’t always about money. Aotearoa New Zealand is competing in a global health workforce market, and minister Little recently acknowledged the health sector as “fiercely competitive”.

But this isn’t a new phenomenon for New Zealand.

The health workforce in New Zealand has one of the largest shares of migrant workers, with 42 percent of doctors and almost 30 percent of nurses foreign-born (second only to Israel and Ireland, respectively). This is much higher than the aggregate estimates showing one in six doctors practicing in OECD countries studied overseas.

The OECD estimates the number of foreign-born doctors and nurses in OECD countries has increased by 20 percent, twice the growth rate of the overall increase across the workforce. This is what is most concerning.

The health workforce is not equally distributed. Migration of workers from low- and middle-income countries to high-income countries like Aotearoa New Zealand is a real threat to achieving universal health coverage and sustainable development goals.

New Zealand needs to be mindful that promoting our open borders is not at the expense of under-performing health systems with much greater need.

Losing healthcare workers to Australia
Outflow is also a problem in New Zealand, with New Zealand-trained doctors and nurses crossing the Tasman every year. Add to this the international recruits leaving New Zealand for Australia and there most definitely is a health workforce crisis.

As our nearest neighbour, Australia is aggressively recruiting staff. And like pavlova and Phar Lap they are happy to claim what is ours as theirs. An easier route to citizenship and voting rights will make Australia even more desirable.

How can New Zealand compete in this market? Minister Little refers to encouraging New Zealanders to return home, including lifting their pay. Research shows it’s not all about income. Location and professional development opportunities are important factors when choosing career moves.

The healthcare reforms helped tempt me back to New Zealand after 22 years away. Perhaps working in a system which has equity as its focus may encourage those who are clinically trained to return as well.

There is considerable research to inform policies around retention and recruitment. The New Zealand Ministry of Health may wish to look to the UK, which was historically dependent on EU health and care workers and now has a health workforce depleted by both Brexit and the pandemic.

In the recent LSE-Lancet Commission on the future of the NHS, British scholars argued a sustainable workforce needed integrated approaches to be developed alongside reforms to education and training that reflect changes in roles and the skill mix, and more multidisciplinary working.

The LSE-Lancet Commission authors flagged the need for better workforce planning. New Zealand’s approach to workforce forecasting has also been criticised previously.

Planning aside, a possible solution worthy of discussion is the required skill mix of the workforce, particularly with technological advancements and changing health needs. For example, the introduction of non-medical prescribers has improved job satisfaction, released clinical time and increased patient access.

New Zealand’s once-in-a-generation health reforms offer a logical time to undertake workforce reforms. We need to learn from our own historical mistakes and avoid disconnecting the workforce from the policy reforms.

If minister Little and the ministry are to solve this, he will first need to admit there is a health workforce crisis.

Aotearoa New Zealand is unfortunately not alone in its quest to adequately staff healthcare, but the transformation of the health sector to create a more equitable, accessible, cohesive and people-centred system means New Zealand is uniquely placed to put those people who deliver care at the centre.

Dr Paula Lorgelly is professor of health economics, University of Auckland. This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Article by AsiaPacificReport.nz

Health workers in Aotearoa New Zealand are thanking Director-General of Health Dr Ashley Bloomfield for his work stopping the ailing health system from collapsing in the covid-19 pandemic — and for saving lives.

They say they can relate to him needing a rest.

Dr Bloomfield leaves his job in July, stepping down 12 months early after the huge stress of the past two years.

There are few public servants who have had the same degree of fame.

For two years he has been a regular in the living rooms of the country, particularly in the first lockdown when almost everyone was home turning in every day to hear news of the covid-19 threat.

Emergency doctor and chair of the Council of Medical Colleges Dr John Bonning said Dr Bloomfield had to step up to communicate with the public in a role that would normally have been done by politicians.

He exuded trust and had stellar public health credentials, as a medical doctor who had worked for the World Health Organisation and headed a district health board (DHB), Dr Bonning said.

Engaged and communicated
He engaged and communicated very regularly with health worker groups.

“He felt the pain, he felt the pressure along with the rest of us,” he said.

Frontline GP and chair of the Pacific GP Network Api Talemaitoga said the country was lucky to have a director-general with top public health skills when they were needed most.

That meant Dr Bloomfield understood the practicalities of what had to be done — like limiting numbers, mass masking, vaccination programmes and the importance of communication, he said.

Covid-19 Minister Chris Hipkins said Dr Bloomfield’s advice had been at the heart of the government’s decision making and he “had saved thousands if not tens of thousands of lives”.

But not everything was perfect under his tenure. There was a blunder that meant high-risk border workers were not being routinely tested as promised, criticisms about spread in MIQ facilities, delays at times over testing, and a slow vaccine rollout for Māori.

Delays over Māori health autonomy
Te Whānau O Waiapareira chief executive John Tamihere said the director-general had done a decent job but he was uncomfortable with the “idolatry” that had sprung up around him.

He had called Dr Bloomfield out over the past two years on issues like the delays giving Māori health groups autonomy to look after their communities, and of the ministry’s initial failure to hand over health data.

It would be mean-spirited to criticise Dr Bloomfield on his way out, he said.

He was a highly-paid public servant who had done a decent job, particularly for mainstream New Zealand, but his copybook was not completely clean, Tamihere said.

“But … Dr Bloomfield will go down as leading a great result when compared with other nations,” he said.

Pacific health groups had shared the concerns about not initially being able to lead the response for their communities, who bore the brunt of early waves of the virus.

Privy to the big picture
GP Dr Api Talemaitoga said while that was frustrating, he and his colleagues on the frontline were not always privy to the big picture Dr Bloomfield was dealing with “in terms of the whole country, the ministry, and his political masters”.

Senior emergency doctor Dr Kate Allan represents the College of Emergency Medicine and said Dr Bloomfield inherited a “broken health system” but led a response that stopped it from collapsing under the weight of covid-19.

“I take my hat off to him. I think it’s been an amazing job and an incredibly difficult job and I can’t imagine how tired he must be,” she said.

Dr Bloomfield is, in turn, quick to credit people like Dr Allan who worked on the frontline to battle the virus.

‘Relentless’
The director-general of health was one of three top health chiefs to announce their resignations yesterday.

Director of Public Health Caroline McElnay and Deputy Director of Public Health Niki Stefanogiannis are also leaving the ministry.

Health Minister Andrew Little told RNZ Morning Report they had been at the forefront of the covid-19 response and had worked tirelessly. “As Ashley said to me in the weekend, he is just exhausted.”

Thousands of front line health workers had done a phenomenal job and would be feeling the same after two years of the pandemic, he said.

There was still work to be done in terms of the rebuild and the nationwide health restructure “because we’ve got to create that extra capacity.”

“I am committed to filling the gaps that are there.”

‘Saved thousands of lives’
Epidemiologist Professor Rod Jackson said the key leadership group including Dr Bloomfield, the prime minister, senior ministers and others “saved thousands of lives, it saved our health services”.

“The work that they did over the past couple of years, it’s just relentless.” Jackson said. “I’m amazed that they lasted so long.”

All three were there at the most important stage but it was “a bit worrying” they were leaving. “The next phase is going to be messy, it’s going to be more political.”

However, New Zealand had “fantastic” vaccines and the knowledge on how to slow down and contain a pandemic.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz