We have a new Government in waiting as we mark time until the special votes are notified on November 3rd, and then the negotiations truly start among National, ACT and New Zealand First. It is really too early to tell what the new coalition will bring to health as the potential coalition partners have different and sometimes contrasting policies on how they pledged to ‘fix’ the broken system. These potential fixes included more training places, a potential third Medical School based in the Waikato focusing on rural GP, pay parity for nurses and others, increased capitation rates, consideration of the recommendations in the ‘Sapere Report’ on primary care funding, and much more. Any coalition involves compromise, and we have seen new Governments in the past discard pre-election pledges, using the excuse that they were left with fiscal conditions much worse than anticipated.
Common across the three potential coalition parties was a commitment to Public Service back-office cuts, reductions in Public Service spending and the dissolution of the Māori Health Authority, Te Aka Whai Ora. At the same time, Te Whatu Ora is in the middle of a major restructure, already causing significant disruption to progress in the implementation of Te Pae Tata, the interim Health Plan, through loss of decision-making. That will only be exacerbated in the next few months with this extra level of change as public servants wait for the new Government to indicate their priorities, and what will happen to their jobs!
We continue to stand ready and waiting to work with the new Government and their agencies to make positive changes for rural health; continuing to work for better health outcomes for rural communities and rural Māori who are currently getting the worse deal.
Act Party: Real change means achieving better health outcomes for Kiwis.
Greens: Accessible healthcare for everyone
Labour Party: Improving the Physical and Mental Health of Everyone (Page 33-37)
National Party: Better Health Outcomes
New Zealand First: Health Policy (Page 30-37)
Te Pāti Māori: In Control of Our Own Oranga
As we get closer to the election, we invited health representatives from all the major parties to take part in a panel discussion to understand what each party would aim to do to improve the health outcomes of rural communities should they be elected to form a government in the 2023 Elections. Unfortunately, Te Pāti Māori declined to provide a representative to this important discussion.
The panel discussion on rural health was held on the evening of September 7th, and a recording of this debate can be viewed here.
If you listen to the recording of the session you will be able to hear what the various politicians think about issues such as:
As a snapshot of what the Parties overall policy thrust is, we asked them a series of Agree or Disagree questions. Here is a look at some of their answers:
Labour – Have not responded
National – Have not responded
Greens – Yes
ACT – No. ACT believes that the $618.6 million that the Government has allocated towards the removal of the $5 prescription co-payment could be far better spent in other areas of healthcare. ACT would remove prescriptions fees for community card users only, and instead increase GP capitation by 13%. This would allow failing GP clinics to meet rising expenses and provide the equivalent of 2.5 million extra subsidised GP visits. ACT’s commitment to increasing GP capitation would remove one of the single biggest barriers to medicines access faced by New Zealanders, getting an appointment for a script in the first place.
TOP. – Yes. There is a large scale randomised controlled trial in Dunedin showing the harm and cost of continuing a $5 co-payment. Significant number of emergency department and hospital admissions arisen as a result of people unable to afford prescriptions. We recognise that the $5 co-payment disadvantages independent small pharmacies that are not able to absorb the co-payment like large scale corporate pharmacists.
Greens – Yes, rural communities should be ensured access to all basic services including health and mental health support. Staff with comparable skills and experience should receive equal pay to those in urban areas.
ACT – It was the initiative of ACT’s deputy leader Brooke van Velden that saw the inclusion of a rural health strategy in the Pae Ora (Healthy Futures) Act 2022. This shows that ACT is committed to supporting rural access to healthcare.
Although ACT has not yet developed policy concerning equivalent rural-urban healthcare funding and worker remuneration, we have committed to making it easier for doctors trained in comparable overseas jurisdictions to practise in New Zealand. We have also developed immigration pathways which will make it easier for rural hospitals to attract staff. These policies will ease pressures faced by healthcare professionals and practices operating in rural settings.
TOP. – Yes. The caveat to that is that we believe that our essential healthcare professionals should also be paid fair wages for the crucial work they do and have salaries pegged to CPI at a minimum. In places where it is difficult to staff, often rural areas, we would consider having increased salaries in those areas
Greens – We support a review into capitation funding for GPs and the Very Low Cost Access Scheme (VLCA) so that primary health services are adequately resourced, especially those in rural communities and those who work with Māori, Pasifika, migrant communities.
ACT – ACT acknowledges the unique challenges faced by practices and healthcare professionals who are based in rural settings. ACT’s policy is to remove financial risk for rural practices by increasing GP capitation by 13 percent. This will alleviate the $137 million per annum net deficit currently faced by GP clinics across New Zealand, including rural ones.
TOP. – Yes. This is part of our health policy. We are very interested in the model run at South Taranaki Rural Health and would support scaling up this model to other rural areas with unmet primary care need. This will inevitably reduce demand on secondary care, improve quality of life and productivity and reduce cost to the taxpayer long term.
Greens – Yes, rural communities should be ensured access to all basic services including health and mental health support like pharmacies
ACT – ACT is a party founded on free market principles. ACT has consistently advocated for deregulation as a means of increasing productivity and reducing costs for both small businesses and New Zealanders.
TOP. – We commit to keeping or even strengthening current pharmacy ownership regulation. There could be a place of allowing community trust or iwi ownership in community pharmacies especially in rural underserved communities. This would have to be in conjunction with universal fees-free prescriptions. As for how it looks in legislation I would be careful to ensure that there was a stopgap to reduce ability for corporate loss-leading style pharmacies to take advantage of this.
Greens – Yes, we understand that incentives like this can be crucial to competing with urban centres for staff
ACT – ACT will invest $163 million into GP capitation in 2023/24, $26 million more than the current annual net deficit of $137 million. This funding will be increased in outyears. This will allow rural practices to pay their staff more, incentivising staff to work and stay in rural communities.
TOP. – We would have to look at the business case for how efficient the use of taxpayer funding for this would be. Perhaps what it would look like is temporary housing so that healthcare professionals looking at moving rurally have somewhere to stay with their family while they settle in and look for more permanent housing. Rather than boarding school, I would like to see more funding and resourcing of rural schools within the communities from a wider education policy standpoint as that would be more beneficial to the communities. Transport is tricky, overall TOP supports long-term investment into regional rail services but this would only benefit some rural communities and not all.
All in all, the most important two things for retention are fair pay and working conditions. We need to fix fair pay so that we can employ enough staff to then improve working conditions.
“With the election drawing closer, and no clear primary care plan from any party released at the time of print, we asked the parties’ health spokespeople three questions on key issues facing the primary care sector – covering funding, equity and workforce. The answers, gathered by deputy editor Patrice Dougan and reporter Stephen Forbes, are collated below”
Funding: Many practices are struggling financially at the moment. How will you address the funding issues facing general practice?
Equity: Do you support targeted funding/ services for Māori and Pacific people, and those with high needs?
Workforce: How will your party address the workforce pressures facing general practice and primary care?
Click here to find the full article: Wishing it well: Health promises on the campaign trail
With less than one week to go before Election Day, I have spent the morning trawling through the political parties manifestos and policy statements to see what I can find around the issues we care about, and anything that relates to digital technology. Some have single documents (Labours is 77 pages long and NZ First is 44 pages) while others have it all split out on their websites making it hard to try and find what we need. I think I’ve managed to find everything relevant – but are likely to have missed something out that is buried somewhere.
Hopefully this is a little helpful as well as sets the scene for us for whoever turns out to be the next Government. I have copied the exact wording of the promises to ensure that I have not put any slant on them – except for the Act Party which I’ve summarised showing the things they propose to not fund going forward. I’ve also only covered off those that are likely to be in Parliament in current polling.
I hope this is somewhat helpful – of course all of this might change during any negotiations that take place after the election.
Finally on politics, as you know, we have released six position statements (which you can find here) which received some significant media coverage. If you’re interested in some of the commentary around it, last week’s Business of Tech podcast from Business Desk talked through what we and other tech lobbyists want.
Here they are in alphabetical order.
Key rural health services are under review but a long wait for fairer funding is unacceptable to many, writes Fiona Cassie
Rural health advocates have welcomed an upcoming review of PRIME and after-hours services but say rural general practices need a “Band-Aid” in the meantime.
Hauora Taiwhenua Rural Health Network general manager advocacy Marie Daly says some rural communities will be at extreme clinical risk without funding support soon for “unsustainable” after-hours and PRIME (Primary Response in Medical Emergencies) services.
Read the full article here: https://www.nzdoctor.co.nz/article/print-archive/rural-people-clinical-risk-band-aid-needed-rural-general-practices-while
The number of medical students spending a full year working in a rural or regional community is set to swell, thanks to new funding from Te Whatu Ora.
More than 35 trainee doctors will be able to spend a year working in rural communities in 2024, due to a funding boost from Te Whatu Ora aimed at tackling the shortage of rural doctors.
The funding will pay for ten extra students from Otago Medical School, on top of the 25 it currently puts through its Rural Medical Immersion Programme, and establishing a programme at Waipapa Taumata Rau, University of Auckland.
Read the full release here: https://htrhn.org.nz/news-media/government-funding-set-to-boost-rural-doctor-workforce/
Media Release Hauora Taiwhenua Rural Health Network welcomes Labour’s announcement to grow the health workforce but is concerned that there is no targeted rural strategy.
Minister Verrall’s announcement yesterday of a significant investment in the health workforce was welcome news for Hauora Taiwhenua and its rural stakeholders. There is finally acknowledgement in the announcement that the health workforce is, ‘the most important component of the health system,’ and that the workforce shortages need long-term solutions.
For full release or more information contact: communications@htrhn.org.nz
Louisa Steyl reports on Te Whatu Ora's offering of relocation grants of around $20,000 to help rural practices hire international general practitioners (GPs). https://www.stuff.co.nz/national/health/132940243/te-whatu-ora-paying-20k-to-net-rural-gps
Fiona Cassie reports on yesterday's pre-election political panel. Contact Fiona Cassie on: fcassie@nzdoctor.co.nz
Date: Thursday 7th September Time: 6pm-7:30pm
Pre-Election Political Panel Rural health professionals question 5 political parties
On Thursday 7th September, Hauora Taiwhenua Rural Health Network host their pre-election political panel. This year’s panel includes representatives from Labour, National, ACT, Greens, and The Opportunities Party. Unfortunately, Te Pāti Māori have declined an invitation to participate.
Dr Grant Davidson, Chief Executive, Hauora Taiwhenua says, “We are delighted that we have strong representation from across political parties for this webinar. It’s really heartening to see such a strong panel prioritising rural health”.
Commencing at 6pm on Thursday, the panellists will each have 5 minutes to outline what their party will do to improve the health outcomes in rural communities if elected. Registered attendees are invited to submit questions for the panel which will be moderated by Michael Morrah.
“This is an opportunity for rural health care professionals to understand where best to place their vote to better the outcomes for health in their communities. Living and working rurally they are committed to their community and as health care professionals are concerned about the sustainability of access to health care, to training for rural health professionals, and a workforce that is reaching burnout,” says Dr Davidson.
The recent release of the first-ever Rural Health Strategy is a welcome acknowledgment of the hard work of many, over years, to ensure that rural people are recognised for their unique needs in reaching equity of health and well-being.
The evening promises to be a lively event with panellists the Hon Dr Ayesha Verrall, Dr Shane Reti, Todd Stephenson, Ricardo Menéndez March, and Dr Nina Su presenting their party’s commitment to the health of rural New Zealanders.
If you have any questions you want to pose to this group, then please send them in now to: communications@htrhn.org.nz
Registration link: www.mobilehealth.co.nz/htrural
The Daily Blog share our media release on today's political panel. https://thedailyblog.co.nz
