Staffing woes menace Te Whatu Ora winter health plan

"I'm determined we'll have the best plan New Zealand's ever had" - Ayesha Verrall 

Covid-19, flu, RSV and other respiratory illnesses are on the rise as we inch towards winter, so Te Whatu Ora launched its winter preparedness plan this week with the aim of easing the pain for already overstretched hospitals. 

The government argues its reforms unifying the 20 DHBs have allowed it to better prepare. The plan promises to bring the health system closer to people - into the home, pharmacies and rest homes - but the opposition and health workers alike worry there's too few frontline workers to staff it. 

A woman died of a brain bleed in Middlemore Hospital's ICU last year, after leaving the emergency department the previous day due to long wait times. 

Doctors at the time told RNZ was it symptomatic of the entire health system; last winter was the worst on record for wait times in accident and emergency. That continued, with no city ED meeting treatment targets.

That is the bleak backdrop to the coming winter season and there are early indications the conditions this winter will be tougher. This year's flu season arrived early, and Northland and north Auckland GP Tim Malloy says it will be worse than Covid-19 because less exposure in recent years means lower immunity. 

"We are expecting it to be significant, severe, and cause people probably greater harm than the current serotypes of Covid," he says. 

Read more: 

• Doctors, nurses still expect 'slog' for winter despite government plan
• Health NZ Te Whatu Ora unveils winter preparedness plan
• Flu vaccination: Nearly 600,000 had jab in first four weeks
• Nurses sceptical National's bonding scheme will fix shortage
• Rest home bed shortage puts pressure on health system, providers say
• Staff shortages hit Auckland urgent care: 'Cavalry has not yet arrived'
• Taskforce to address health staff gaps failing to deliver, doctors say

Health Minister Ayesha Verrall, a former infectious diseases specialist, released the government's 2023 Winter Plan this week expanding on 24 initiatives that proved useful in the pandemic and recent weather crises. Highlights include telehealth, pharmacy consults for minor ailments, direct referrals from GPs to radiology services, and giving paramedics access to GP advice for better care in ambulances. 

Some initiatives, like a national data system, are made possible by the health reforms which merged the country's 20 district health boards into Te Whatu Ora less than a year ago - a point Dr Verrall's keen to emphasise. 

However, most are already in place - and scaling up could be a risk, with the parts of the sector that would take on the burden already stretched to the limit. 

The Fono is a group of Auckland GP clinics, and chief executive Tevita Funaki says while the plan has good intentions, "in primary care - at the end where we need to actually divert a lot of this care to ... already it's overwhelming". 

Australasian College for Emergency Medicine's Aotearoa chair Kate Allan, a senior ED doctor, says the plan is proactive and pragmatic but requires a healthy workforce. She's sceptical too about whether it will help with the crucial problem of bed block - where hospital beds are being used for people who technically no longer need it. 

The National Party has been campaigning for the Government to widen the stream of health workers coming through the immigration system for months. Its Health spokesperson Shane Reti says the government has waited too long to recruit overseas talent - allowing other countries like Australia to snatch up much-needed health staff.

"This is too little too late," Dr Reti says. "I think there are some of the 24 points that I would do also. A large number of the points are already in place ... the big question is: where's the workforce, who's going to do it?" 

He says pharmacists were put on the immigration green list just last month, and nurses just before Christmas - and although the plan includes international recruitment, there's no point trying to implement it without enough staff. 

The debate over workforce shortages came to a head this week, after National published a press release titled "19,000 nurses leave under Labour". It then announced a 'bonding' policy to pay more than $4000 a year over five years for nurses' and midwives' student loans if they committed to working in New Zealand for the duration.

Dr Verrall accused National of misusing the figures she'd provided, given the 19,000 includes those who simply moved role within New Zealand. 

Nurses Organisation kaiwhakahaere Kerri Nuku says the real number of nurses heading overseas or quitting would be closer to 4000 - a concern, she says, but one not solved by bonding.

"This doesn't change the environment that they're going into.  People are burdened, they're burnt out, they're tired, they're unable to give the quality of care that patients deserve - so it's more than just the pay."

With an election less than six months away, the government must be seen to be getting on with the job. Verrall told RNZ she's under no illusions about the struggle to find staff, but winter planning cannot wait. 

"We can't afford to wait for the workforce situation to be perfect, to be fully staffed, in order to start making these innovations happen that will make things better for patients. We've got to get on and do it." 

She says the public can have confidence they will get the care they need this winter: while the plan won't be perfect it should help the health system perform well on mortality metrics that have held up even during tough winters like the last one. 

"That was hard work for our staff ... people are getting delayed care and I don't like that, but overall the performance is good." 

Exactly how the success of the '2023 Winter Plan' will be measured is unclear. Dr Verrall says she does think there will be fewer hospital admissions compared to last year. 

But as the days grow shorter, and the nights colder, voters will be watching.

In this week's Focus on Politics, Political Reporter Anneke Smith considers the government's health plan and the workforce challenge it faces.

Listen free to Focus on Politics on Apple Podcasts, on  Spotify, on iHeart Radio or wherever you get your podcasts.