In February 2025, Dr Diana Sarfati resigned, not unexpectedly, as Director-General of Health after only two years into her five-year term.

As a medical specialist, and in her role as developing the successful cancer control agency, she had extensive experience in New Zealand’s health system.

However, she did not conform to the privately expressed view of Prime Minister Christopher Luxon: That the problem with the health system is that it is led by health.

Responsibility for the appointment of public service chief executives rests with the Public Service Commissioner.

In carrying out this function, Brian Roche had two choices for the process of selecting Sarfati’s replacement — run a contestable hiring process (the usual method) or appoint someone without this process.

With the required approval of Attorney-General Judith Collins and Health Minister Simeon Brown, Roche opted for the exception rather than the rule.

This suggests a degree of pre-determination to appoint someone without the “hindrance” of health system experience, consistent with Luxon’s view.

An appointment from outside health
Consequently, on April 1, Audrey Sonerson was appointed the new Director-General of Health for a five-year term.

She had been the Ministry of Transport chief executive (including when Brown was transport minister). She also had senior positions in the Ministry of Foreign Affairs and Trade and in the Police and Treasury.

Though she had been part of the Treasury’s health team and has a master’s in health economics, her only health system experience was in the brief hiatus between Sarfati’s resignation when acting director-general and becoming the confirmed replacement.

‘For a minister with no experience of the complexity of health care delivery to choose a director-general who herself has no health experience is extremely concerning.’

— Dr David Galler, former intensive care specialist

This is unprecedented for the director-general position. Sonerson is the 18th person to hold this position. The first 10 had been medical doctors. In 1992, the first non-doctor holder was appointed (a Canadian with some health management experience).

The subsequent six appointees all had extensive health system experience. Three were medical doctors (two in population health), two had been district health board chief executives, and one had been the director-general in Scotland and a medical geographer.

Dr David Galler is well-placed to comment on the significance of this extraordinary change of direction. He is a retired intensive care specialist and former President of the Association of Salaried Medical Specialists.

He held the unique position of principal medical adviser to the health minister, the ‘eyes and ears’ of the health system for three health ministers in the mid to late 2000s. He also worked closely with two director-generals.

Drawing on this experience, Galler observes that: “Director-generals of health must be respected, influential, knowledgeable, connected and trusted, to ensure that good policy goes into practice and good practice informs policy . . .  For a minister with no experience of the complexity of health care delivery to choose a director-general who herself has no health experience is extremely concerning.”

Breadth of the health system
As the director-general heads up the Health Ministry, she is responsible for being the “steward” of our health system. In this context she is the lead adviser to the government on health. In the context of seeking to improve and protect the health and wellbeing of New Zealanders, the organisation Sonerson now leads is responsible for:

• the stewardship and leadership of the health system; and
• advising her minister and government on health and disability matters.

These responsibilities have to be considered in the context of how extensive the health system is beginning with its complexity, highly specialised range of health professional occupational groups, and its breadth.

This breadth ranges from community healthcare (predominantly general practices), local 24/7 acute hospitals, tertiary hospitals (lower volume, high complexity) and quaternary care services (national services for very uncommon or highly complex even lower volume procedures and treatments, including experimental medicine, uncommon surgical procedures, and advanced trauma care).

Another way of looking at this breadth is that it ranges in treatment from medical to surgical to mental health to diagnostic. And then there is population health such as epidemiology.

Population health and the Health Act
However, responsibility extends further to specific obligations under the Health Act 1956, many of which are operational. Although it is nearly 60 years old, this act has been updated by legislative amendments many times and as recently as 2022 with the passing of the Pae Ora Act that disestablished district health boards and established Health New Zealand.

The Health Act gives Sonerson’s health ministry the function of improving, promoting and protecting public health (as distinct from personal diagnostic and treatment health). Public health is legislatively defined as meaning either the health of all New Zealanders or a population group, community, or section of people within New Zealand.

A critical part of this role is the responsibility for ensuring that local government authorities improve, promote, and protect public health within their districts in appointing key positions (such as medical officers of health, environmental health officers and health protection officers); food and water safety; regular inspections for any nuisances, or any conditions likely to be injurious to health or offensive and, where necessary, secure their abatement or removal; make bylaws for the protection of public health; and provide reports on diseases and sanitary conditions within each district.

The population function under the Health Act of improving, promoting, and protecting public health means that how well the health ministry under Sonerson’s leadership performs directly affects the health and wellbeing of all New Zealanders.

This is an immense responsibility that cannot be minimised.

Understanding universal health systems
Universal health systems such as ours are characterised by being highly complex, adaptive and labour intensive and innovative (innovation primarily comes from its workforce). They provide a public good (rather than commodities) and their breadth is considerable.

But, despite appearances to the contrary, the different parts of this breadth don’t function separately from each other. They are not just interconnected; they are interdependent.

As a result, each part makes up a highly integrated system. Consequently, relationships are critical. The more relational the culture, the better the system will perform; the more contractual the culture, the poorer it will perform.

Galler’s experience-based above-mentioned observation needs to be seen in the context of the challenging nature of universal health systems.

In a wider discussion on health system leadership, Auckland surgeon Dr Erica Whineray Kelly got to the core of the issue very well: “You’d never have a conductor of an orchestra who’d never played an instrument.”

Audrey Sonerson comes into the director-general position with a deficit. It will help her performance if she first recognises that there are many unknowns for her and then proceeds to listen to those within the system who possess the experience of knowing well these unknowns.

It might go some way to alleviating the legitimate concerns of Galler and Whineray Kelly and many others.

Ian Powell is a progressive health, labour market and political “no-frills” forensic commentator in New Zealand. A former senior doctors union leader for more than 30 years, he blogs at Second Opinion and Political Bytes. This article was first published by Newsroom and is republished with permission.

Article by AsiaPacificReport.nz

A senior health practitioner in Fiji has warned that the exodus of nurses will put significant strain on the country’s health sector.

According to orthopaedic surgeon Dr Eddie McCaig, nurses are leaving in droves, with more than 800 — more than a quarter of the workforce — migrating overseas in 2019 alone.

Dr McCaig told delegates at the inaugural National Economic Summit in Suva that healthcare workers were opting to exit because of several factors, but their primary concerns were poor compensation and working conditions, a challenging political environment, and to seek better opportunities for their children.

“Last year, we lost 807 nurses which equates to 26.7 percent of 3056 nurses,” he revealed on Thursday.

He said the standard of patient care provided by health care professionals had also declined because of socio-economic issues.

“We do not have the resources to provide all the care that is promoted by providers and desired and demanded by the public,” he said, adding that FijianS also had “unrealistic expectations”.

The Fiji government has allocated almost FJ$800 million to the health and medical services ministry in the 2021-2022 and 2022-2023 budget cycles.

However, ageing infrastructure and the inability to retain medical workers has remains a problem.

Less than a week ago, Health Minister Ratu Antonio Lalabalavu declared that his ministry would work to improve staff living and working standards.

According to FBC News, Ratu Lalabalavu has toured more than 50 of the 220 medical services facilities in the country.

The Health Minister found that the majority of the medical facilities were in unsatisfactory condition due to damaged infrastructure, lack of maintenance, as well as poor water and sanitation, the state broadcaster reported.

“The government of the day is ready to work with nurses and find solutions to their grievances and this will be done in a consultative manner,” Ratu Lalabalavu said at the Fiji Nursing Association annual meeting on April 15.

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

Article by AsiaPacificReport.nz

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

Manukau Urban Māori Authority (MUMA) is welcoming the government’s health reforms as an important first step to improving Māori and Pasifika health in south Auckland.

But some in the health sector say the jury is still out on what will be achieved in Counties Manukau.

Under the reforms, the country’s 20 district health boards have now been replaced by Te Whatu Ora (Health New Zealand).

The new Crown entity will be responsible for running hospitals, primary and community health services.

The government says it will allow for more consistent delivery of health services nationwide and help stop the postcode lottery people face accessing healthcare based on where they live.

The reforms also include the establishment of Te Aka Whai Ora (the Māori Health Authority) to improve indigenous health which will work in partnership with Health NZ.

Muma chairman Bernie O’Donnell has seen the country’s district health boards work first-hand, as a member of the now-defunct Auckland DHB.

Greater responsibility for Māori
He said establishing a Māori Health Authority would give Māori greater responsibility for the delivery of their own health services.

“For too long the health system hasn’t addressed the wellbeing of Māori, or those at the bottom of the cliff,” O’Donnell said. “The reality is we couldn’t continue with what we had. Something had to be done and this is it.”

He said critics of the health reforms are defending a system which had to be replaced.

“The old way the DHBs were run didn’t work for our people. For too long it’s been non-Māori telling us what’s best for us.”

He said ongoing issues left by the Counties Manukau DHB, such as Middlemore Hospital’s under-pressure emergency department and its workforce shortages would all have to be addressed under the changes.

“But what we’re expecting is that Māori and Pasifika health in south Auckland will get better under the reforms,” O’Donnell said.

However, he admitted there’s a lot at stake.

‘Time will tell’
“If that doesn’t happen we won’t have achieved anything of significance,” he said. “But only time will tell.”

Yet not everyone is as certain as O’Donnell on what impact the changes will have.

Turuki Healthcare chief executive Te Puea Winiata said there were still a lot of unanswered questions about the reforms.

Winiata said the creation of the new authority dedicated to indigenous health is an important first step.

But she said it was vital that the new entity had the ability to make its own decisions and help support Māori self-determination.

“The resourcing of the Māori Health Authority is going to be critical to its success,” she said.

Many reform attempts
Winiata said she had worked in the health sector for the past 30 years and in that time had seen a number of attempts by the government of the day to restructure the health system.

She said it was hard to predict what impact the health reforms would have in south Auckland.

“But I think in 12 months’ time we will be able to look at what changes have been made and see what’s been achieved.”

Local Democracy Reporting is Public Interest Journalism funded through NZ on Air. Asia Pacific Report is an LDR partner.

Article by AsiaPacificReport.nz

An Aotearoa New Zealand health workforce recruiting agency is fielding calls from senior US doctors who say they can no longer live in their own country.

Accent Health Recruitment has been flooded with inquiries from US doctors wanting to come to New Zealand following the US Supreme Court’s decision overturning abortion rights last Friday.

The ruling has made access to abortions all but impossible in at least 18 states.

Accent Health Recruitment managing director Prudence Thomson said she normally got about 30 inquiries a day but that had doubled since the ruling.

“The emotion and frustration attached to their email, you could just feel it. They’re saying, ‘we can no longer live in this country, we need to come, will you have us in New Zealand?’

“It was quite an emotional tug, as far as of people really wanting to leave and throwing their hands in the air.”

Thomson said most inquiries were from GPs and obstetricians.

‘A spike in inquiries’
“There has been quite a spike in inquiries from them — they’re really passionate about looking after their patients and now they no longer are able to provide the healthcare they want,” she said.

“So they want to come to New Zealand to practise, which is good for New Zealand.”

Thomson said while it was sad these health workers felt forced morally to leave, it would help this country’s health worker “crisis”.

However, she said it would take at least six months before the American health professionals could work in New Zealand.

“Every medical professional needs to get their qualifications verified to come to New Zealand and that takes from three to six months.

“While we want to speed it up we don’t want to cut corners because in a crisis that’s when the weaknesses will be exposed and that’s when the people who want to commit identity fraud could get through.”

However, she said it should still give the chronically understaffed health sector some hope that help was coming.

Messaging about jobs
US nurse McKenzie Mills recently moved to New Zealand and said former colleagues had been messaging her about jobs ever since the US Supreme Court ruled against abortion.

She said she was heartbroken and angry after the ruling.

However, she said she was even more sure now that her decision to move to New Zealand in January was the right one.

“I take care of people and it just really broke my heart that there is so much health care that will be denied to millions of women.”

Mills said she felt like she had “escaped” her own country as a result of the ruling.

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

Article by AsiaPacificReport.nz