University of Auckland: Health workforce crisis needs fresh approach

Of all the challenges facing Aotearoa New Zealand’s health system, the one the media most often refers to as a crisis is staffing.

Particularly since the Covid-19 pandemic, recruiting and retaining enough appropriately trained healthcare staff has been a global challenge. In its health reforms, the government has prioritised building and developing the health workforce – it’s one of five strategic ‘system shifts’ it has identified. It recently announced a suite of measures to expand training domestically and make it easier to get international health workers to New Zealand.

Experts at Waipapa Taumata Rau, University of Auckland, say the measures are a start. However, they agree more needs to be done to increase numbers of health workers, particularly of Māori and Pacific backgrounds, and to better support existing workers to upskill given the quick pace of change.

“Health reform is an opportunity to innovate and review the traditional structures we’ve had,” says Toni Laming, who as UniServices Executive Director of Business Units heads organisations providing learning and development for health professionals. “With the technological change we’ve seen in the health sector, some of the training pathways have not kept abreast of the skills workers need.”

Many of the problems boil down to resourcing, says Associate Professor Tim Tenbensel, a health systems expert. “Per capita government spending on health did not increase through the 2010s. In comparable countries, the norm was a three percent increase per annum. If you add that up over close to ten years, you’ve got a very big gap in funding.”

“The workforce has been neglected for a long time,” says Associate Professor Julia Slark, head of the School of Nursing. “We really need to be brave and put a lot more money in.”

Tim Tenbensei
Associate Professor Tim Tenbensei is a health systems expert.
University experts welcome the government’s plans to increase trainee numbers in some fields but say it’s only a step towards meeting the needs. However, ramping up training further won’t be easy.
“You can say you want more GPs and nurses but there needs to be the capacity to support placements at particular points in training,” says Tenbensel. “That’s a real bottleneck at the moment.”
“The government could provide more money to district hospitals so they can have dedicated education units with staff whose job it is to support students,” suggests Slark. “You would get much more meaningful clinical experiences and we might not need to do as many placement hours. It might also encourage graduates to work in the regions.”

Another issue is that training for healthcare workers doesn’t focus enough on prevention, say the experts. “We need to focus on the hauora of our communities rather than deploying health services as an ambulance at the bottom of the cliff,” says Laming.

Toni Laming
Toni Laming, UniServices: “Training lags behind the skills workers need.”
Slark and some of her colleagues have examined the reasons behind the low numbers of Māori and Pacific health workers and found that though systemic racism is a factor, “it largely comes down to hardship,” says Slark.

“Some of the Māori and Pacific nursing students have got three jobs and are trying to study, so it’s not too surprising they end up dropping out. We need to remove fees and support students financially while they’re training.”

One change Slark would like to see would be to pay student nurses for their final transition-to-practice placement. “Trainees do night shifts and weekends, so they can’t work other jobs at the same time,” says Slark. “We need to pay them to do that final placement, just like we pay training police officers, so all they have to concentrate on is becoming competent as a registered nurse.”

Another opportunity could be to encourage healthcare assistants and other kaiāwhina, especially those who completed vaccinating health worker training through the UniServices-run Immunisation Advisory Centre (IMAC) during the Covid-19 vaccination push, to undertake further training for roles beyond vaccination.

“A lot of healthcare assistants are Māori and Pacific but some don’t think they can go further in their careers,” says Slark. “We need to support them to do their enrolled nurse training and then to do their registered nurse training. With enough support, some of these people will be the nurse practitioners and other high-level health professionals of the future.”

Training organisations and health administrators also need to think about how they partner with communities to deliver workforce development and health services, says Laming.

“It’s about building trusting partnerships and stepping out of the way when appropriate,” says Laming. “We don’t have control over some of the delivery in Māori and Pacific environments – and that’s okay. We need to trust that local providers know what to do for their people and support them with access to the ongoing training they need for their communities.”

Among the measures the government recently announced is doubling the nurse practitioners trained annually from 50 to 100. Slark welcomes this, especially given that some of the funding will be available to Māori health providers to develop registered nurses into nurse practioners.
“Nurse practitioners are the ones living in the community and who want to support their communities, so that’s a good use of money,” says Slark.

Slark would also like to see more support for nurses to undertake specialty tertiary education in fields such as stroke, palliative and mental health and addiction care – and more flexibility regarding when they do it.