Kiota.
I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by the New Zealand Herald. New Zealand's Hunter a poach. Oversees doctors gets another tool in the toolbox today. From now, medical graduates from the UK, Ireland and Australia will be able to have their applications for
registration assessed within twenty working days. It'll speed up a process that would usually take six months, and the government hopes it'll fill critical gaps in our health workforce, but unions on the ground doubt the impact of this fast track pathway, saying it's welcome but not sure that it's going to make a difference. Today on the Front Page, Association of Salaried Medical Specialists executive Director Sarah Dalton.
Is with us to discuss.
Sarah, first off, the fast tracking regime begins today for overseas doctors.
Can you tell me a little bit more about this scheme?
Yea.
So, basically, any doctor who wants to practice in New Zealand has to be registered with the Medical Council. They review their training and qualifications, their current recent experience and determine whether they can practice under general registration. Or vocational
registration in this country. So general registration means you're qualified to practice as a doctor, but you don't have a particular specialty, whereas vocational registration would recognize you as a specialist, for example, in general practice, ana seizure, in psychiatry, in internal medicine, surgery, whatever it might be.
So often it's not.
Unusual for that process of getting a registration sorted out to take months rather than weeks. So the fast tracking for certain doctors with particular specialties from a limited number of countries, which will bring it down to force weeks, you know, we'll make it a lot quicker.
It is a welcome development in.
That respect, right, So we're wanting specialists trained in anesthesia, dermatology, emergency medicine, general practice, internal medicine, pathology, and psychiatry. Basically we're looking for everything and everyone. At the moment, how do you think this initiative is going to go?
Well, look, it's.
Obviously going to be quicker and better for people who already want to come here in practice. So in that sense it's great, and it might make the time frame from job offer to having a senior doctor in place.
It might shave a couple of months off it, which.
Is fantastic, but it is for a limited number of countries, and they are systems that have very similar training and qualifications to our own right, so it is going to be helpful to that extent, and maybe it will mean that some doctors who are thinking of coming to live and work here or Australia might still decide to come to New Zealand rather than Australia because perhaps the registration
process will be a little bit quicker for them. But in turn of making a substantial dent in our staff and gaps for senior hospital doctors and dentists, that is not what's going to solve the problem.
The joined upness of the Medical Council's globally has started to happen, so it helps a lot for us to know exactly what other jurisdictions are doing, so that we know what we're getting when they come in. There are a lot of people who do want to come, and we have forty one percent of our medical professions are overseas graduates, so we do attract a lot.
So while the entire country obviously has gaps, rural areas are really hurting. Hey, a recent survey by the Rural Health Network found there are staffing shortages, under investment and an increasing burden on facilities continuing to impede the recruitment and retention of healthcare workers. Should there be any kind of incentive in place? Given four overseas doctors say to go into rural areas.
I think there should be rural allowances in place. And in fact, we are in bargaining at the moment. And while we don't go into the details of what the specifics of bargaining are, members are really keen on. A claim around rural allowances is one of the things we discuss.
You know, even if a hospital doesn't qualify as rural, so for example, tight Afterygisbon, that may not actually meet the definition of a rural hospital, but it's so remote from the rest of New Zealand that if you choose to live and work there, thinking about not just you, but if you go there with your family, if you want to take them, for example, to a concert or to a sporting event, that it might be a reasonable
thing to want to go to. The Costs of getting to and from one of those events if you've got your family there in Gisbone are massive compared to someone who chooses to live and work in one of the major centers. So I think if you really want to support people to put down routes to stay in those communities, you're going to have to recognize it in differential pain conditions.
It comes to the gaps inner health workforce, and we know it's dire. We're always hearing it's dire, and we've heard it's dire for years and years. Is there any way to try and quantify this or explain it to people so they actually understand the direness of the situation.
Such a good question and also such a frustrating one.
So when Tefatora was first established, one of the things they said they were going to put in place was it called a workforce task Force, And I was like, hooray, They're actually going to put some time and energy into what I would call a workforce census, so that we've got a reliable data set that tells us exactly who's working and what specialties and where where the junior doctors are.
Because there's a difference if you're thinking about the medical workforce pipeline in terms of junior doctors or ramos, it's resident medical offices. Some of them are in training roles, which means they've already selected a specialty pathway and they're training in that specialty. And you also have non training registrars who have yet to choose a special pathway, but
who are working in the hospital. They have a general registration and they provide valuable care in hospitals and will be on their journey to deciding what specialty pathway they want to follow. And then you've got your house officers who are in their first couple of years out of
med school and who also perform useful functions. So I thought the Workforce task Force under order would focus really carefully on that kind of boring but important work of really sorting out what the census is for our healthcare workforce, but they didn't. Similarly, the Workforce Plan that was released last year for the first time did try and quantify the extent of the shortages. They came up with a number of seventeen hundred doctors across our whole system. Is
the total number of missing doctors from our system. We think they've probably under reported that by about half, but at least they have started to try and crunch the numbers. What they haven't done, though, is tie the numbers that they've identified. And I'm primarily interested in doctors because you know that's how Union represents. But they came up with
numbers for nursing and allied health as well. But those numbers identified in last year's workforce Plan have not been tied to budgets or budget allocations for staffing this year, which is one of the reasons to futt Order's got itself into such a pickle over nursing numbers. They have increased nursing staffing, not to the extent identified by the Workforce Plan, but ahead of budget allocations, and budget allocations weren't matched to the numbers identified in the workforce Plan.
This year's workforce plan is missing an action. We understand it's with the minister or with Cabinet, but it is months overdue.
In terms of DEFATU Order.
I read actually in an Auckland Union analysis piece and this really struck out to me, this line that short term belt time will most likely deepen the crisis. And this is while the government dismissed the board and appointed a commissioner to reduce over spending. Would you agree that belt tightening will deepen the crisis.
It's a really succinct description of what's likely to happen, So, particularly when it comes to staffing, what that leads to.
Let me give you an imaginary department.
Let's say it's a pediatric department and that they currently have approved FTE or a staffing level approved of six people. And let's say they've got two current vacancies that they're struggling to fill. And then we turn up and we work with those doctors and we established that actually, while they've got six approved ft, they really need eight, so they've got an acknowledged gap of two. And if they were actually to staff according to current need, they've got
a gap of four doctors. And then we will go to the management and say, come on, we need to be recruiting those two that you know are vacancies, but you actually also need another two, and they will tend to say, well, we've got no money for that. So we will think about continuing to recruit to those two, but in the meantime we will appoint some locums to fill in some of.
The urgent gaps.
So what we've seen is, I don't know if you'd call it an investment in locums or a reliance on locums, which is short term expensive staffing to fill gaps in the short term, but are reluctance to agree to increase staffing or better recruitment strategies for the longer term.
So I completely agree that.
Short term ism and the belt tightening often leads to decisions that actually cost more overall. And we're starting to see that in the locom figures that are coming through.
Is locums like in a regular company and an offers say hiring a casual or attemp's.
Exactly what it is.
And we've started to see some data, particularly for psychia, that the locum spend in psychiatry is massive. Now there are massive staff gaps in psychiatry, but what we're seeing is their own members deciding to quit their permanent jobs and then seek work as a locum because they can control their work life balance better and it's quite well remunerated.
So we've created kind.
Of perverse incentives to casualize our senior medical workforce in some specialties, which is going to be a really hard thing to break.
I saw that Labour's health spokesperson Asia Vereal said the national government is hiding the gaps in the health workforce from New Zealand and that National has not been upfront about the nature and extent of the needs, nor will they address the staff shortages.
Around the country. Hiring for frontline staff, especially nurses, has ground to a halt. It's well known that rural services are under resourced, but under the current government the situation is getting worse. Labor is focused and growing the health workforce to make sure hospitals were properly staffed and improving
pay for nurses to keep them in New Zealand. Minister Ritti needs to take urgent action to stop the cats and make sure rural hospitals have enough staff to deliver the kere people need.
I also found another statement from National Health spokesperson in twenty twenty two and now that's the Health Minister of course, Shane Retti saying the Health Minister is out of touch with his portfolio and still refuses to accept that there is a crisis under his watch. The health sector deserves better. Mister Little should redirect funding from the health restructure and
invest it in the front line. My question, after reading a couple of releases from years past is why is health one of these political footballs that politicians love to throw around. It's the same sound bites that we hear. Like I said, those virile and ready quotes are quite similar. Do you just sigh when you see them come out and say stuff like that, Yeah.
Health is a political fall.
Is such a frustration because increasingly when I talk to media, I talk about the social contract in New Zealand that says there's a I don't know, an understanding in New Zealand that if you need health care, you will get it right, that we have a public health system that is there to provide care to all New Zealanders. But I think we need to have a better national conversation about what people have a right to expect.
When it comes to healthcare and how that should be funded.
So rather than wait for the politicians, we have started
to embark on some of that research work ourselves. So we are going to look into how might we fund our health system differently and whether if we could get broad, cross party, multi sector wide community agreement about what should be included that is provided within our health system, would it be possible to establish effectively an independent body that would look at those criteria about what should be provided and then determine what levels of funding are needed to
ensure that that happens. And if that became not party political but simply a requirement that any government of the day needs to meet that that need, that might change things. It's a long term proposition, but it seems to me that always the numbers are so large. It's really frightening for any government that's hoping to hold on to a further term, and they don't like having to try and
sell that cost to voters to tax payers. I also think that we've lost our way when we talk about health and we frame it as a cost rather than an investment, because actually prevention and early intervention for people with health issues there's a cheaper and better way to manage things.
Waiting till people are really really.
Sick and need to be admitted to hospital is the most expensive and least effective way to manage healthcare.
Yeah, there really needs to be like a thirty year plan or something, and like you said, cross party discussions around this, because we are constantly saying that it's on the brink of failure.
Times out getting longer.
In EDS, for example, there are widespread staffing shortages, burnout and lack of funding, like it's a tail as old as time, isn't it really is.
But it's also you know, we've segmented out our health system into quite a few pieces. And if you look at community based healthcare as opposed to hospital based healthcare, most of us ideally will access most of our health provision in community settings, right whether it's dentists, GPS, physiotherapists, if we need help with our eyesight or our hearing, all of those things ideally we will access in the community. And if you think about it, some of those things
are subsidized. Some of those things are not. We have somewhat or entirely privatized large swathes of community based healthcare.
You could include aged.
Residential care into that mix as well, hospices, ambulances, even many of those are partly state funded but not wholly state funded. We have somewhat or completely privatized community based healthcare. And it is only when you get to the point of hospital presentation at the ED or a referral to the hospital with an admission where that care becomes free.
And then sitting alongside that is the acc system, whereby if you have an accident and it is deemed to meet the criteria that care will be funded either through public or private healthcare provision. You know, back in the day, there was meant to be a second phase of the acc that included healthcare more broadly and not just the results of accidents or trauma. So you know, there's unfinished
business there. And I do think that because we put a lot of barriers, as in price to early healthcare and preventive healthcare, we are seeing the results of that in ever increasing hospital admissions and a reliance on hospital level care that is increasing at a greater rate than the rate of population growth.
Are there any countries you reckon have got it right?
It's a really interesting question.
I don't necessarily have the answers myself, but someone pointed out to me that hospitals in Japan have to be run by doctors and aren't allowed to make a profit, and apparently they're doing quite a good job. I mean, there are a lot of OECD comparators about the efficiency and effectiveness of a lot of similar hospital systems to ours. We tend to go in the middle of the pack, but we certainly spend less on average as a proportion of GDP on our health bill than a number of
similar countries. So if we invested another one or two percent into our health system, we would likely deliver a really strong return on that further investment.
Obviously, that's a different approach.
To the one that the current government is taking, and you know they've appointed the Health Commissioner to absolutely stop any further spending on health and to rain things in. But we get weekly cries of pain from our members about the immediate impacts of that approach.
Thanks for joining us, Sarah.
That's it for this episode of the Front Page. You can read more about today's stories and extensive news coverage at enzidherld dot co dot nz. The Front Page is produced by Ethan Sills and sound engineer Patti Fox. I'm Chelsea Daniels. Subscribe to The Front Page on iHeartRadio or wherever you get your podcasts, and tune in on Monday for another look behind the headlines.