Health NZ funds up to 50 new hospital doctors in sleight of hand

Comment: Last month, Health NZ proposed to cut four of the country’s chief medical officers, RNZ reported. Last week, on the day public health officials announced a whooping cough epidemic, staff at the National Public Health Service and in the Hauora Māori group were told their roles were being restructured. Yesterday, staff in the data and digital teams were advised their jobs were going.
Newsroom reported last month that Health NZ Commissioner Lester Levy was planning to provision more than $130 million for redundancies in the 2023/24 books (the books that are now being audited) though the redundancies aren’t taking effect until now.
So in this context, it’s hard not to look a little askance at the trip up to Whangārei Hospital this morning, by Levy and Health Minister Dr Shane Reti, to announce about $42m funding for 50 new senior doctors, more specialists nurses, and minor improvements to hospitals – a mix of operating and capital expenditure.
It looks like moving deckchairs on the Titanic.
Whangārei, of course, is Reti’s hometown. That’s where he practised medicine. That’s where he bought a building and established a medical practice, a block down from the Burger King, that continues to this day.
Reti is no longer at that clinic, but when his successor Dr Paula Mathieson was called away in an emergency and needed a doctor to fill in urgently, Reti flew up from Wellington to help out. Then, he was an opposition MP; today, he’s Minister of Health.
This morning, Mathieson welcomes the rejig to allow the appointment of 50 new hospital doctors, but she questions where Health NZ will find them, and what difference they’ll make. In her view, the health crisis starts in primary care – and practices like hers struggle to get enough doctors to stay open. She herself had to call a telehealth doctor in Sri Lanka recently, when she was unwell.
Her practice is more than $100,000 in debt – a shortfall that’s increasingly difficult to manage. I wrote last week of the continued failure of successive governments to address capitation funding for medical practices, meaning they’re unable to hire doctors, or to pay practice nurses what they’re worth.
“Every fortnight I have to think about how I’m going to pay my staff,” says Mathieson, who has been a GP for nearly 30 years. “Now I have a business that’s worth nothing because nobody will buy it, because general practice is unsustainable.”
“I think we need to invest in primary care. Desperately. If you have a look at Whangārei, the wait time in some clinics is six to eight weeks, there’s a significant number of people who have no GP at all, and a lot of practices aren’t enrolling.”
Despite the announcement being sent out by the minister, this is not new money from the Government. This is $42m reassigned from elsewhere in Health NZ’s budget, Reti’s office acknowledges. 
“Since being appointed as commissioner, Professor Levy has worked hard to find efficiencies and get Health NZ back on track,” Reti says. “This has enabled us to put this funding where it matters most – into strengthening our clinical workforce and delivering timely access to quality healthcare for New Zealanders.”
The thing is, the $130m a month deficit – that’s the blowout that the minister projected would hit $1.4b over 12 months – that budget hole hasn’t yet been filled. There’s no new money from Government since the Budget, and Levy hasn’t yet made all the savings he’s promised.
Levy says this week’s announcement is funded by a mix of reducing poor quality expenditure as well as other elements such as reduced dependence on locums – a cost line that had increased very significantly over the past few years.
“These are new positions not in current budgets,” he tells Newsroom. “The principles behind today’s announcement are to strengthen the regions, reduce waiting times and enhance patient safety. There is also a component to support vulnerable services like gynaecological oncology, paediatric pathology, dermatology and the like.”
He acknowledges that Health NZ hasn’t yet cleared its monthly over-spend, though he says it has “stabilised”.
“We still need to undertake the cost-out to get back to budget. This is underway as planned.”
Asked by Newsroom whether there was a net increase or net reduction in clinical positions, allowing for the proposed cuts in chief medical officers, clinical consultants, public health and hauora Māori, he declined to say.
“The cost-out is a separate process and we do not comment on change processes underway or about to be underway.
“I said publicly a number of times, some months ago, that strengthening the clinical frontline was very much on the agenda and it is. I would like to emphasise again that these positions are to reduce waiting times and enhance patient safety and along with strengthening the regions each new position will have to meet that test.”
Dr Paula Mathieson welcomes support for the regions but remains dubious about the efficacy of the shift in spending.
“I just think primary care is really failing and really suffering,” she says. “There’s a lot of anxiety about, can I get treatment, not just at hospitals, but at primary care? And tinkering at the edges like this isn’t going to help the health of our community.”