[As published in March/April BayBuzz magazine.]
The coalition government’s catchall for making Aotearoa New Zealand a better, healthier country is ‘targeted funding for populations in need’.
In his State of the Nation speech on 18 February, PM Luxon listed these health achievements in the government’s first 81 days:
• We’ve progressed work on a third medical school with Waikato University, because we need more home-grown doctors.
• We’ve taken the first steps to extend free breast cancer screening up to age 74.
• Soon we’ll introduce legislation to disestablish the Māori Health Authority – because we want to see better results for Māori, not more bureaucracy.
• We deployed 200 additional security personnel which has reduced violent incidents in hospital emergency departments, keeping staff and patients safe.
With a major ‘reform’ agenda still to play out, at the time of writing Health Minister Shane Reti had so far announced a two-year $50 million package to help Māori providers lift immunisation rates for all children and also launched My Health Record – an App giving people improved access to their personal health records.
In his media interviews Reti has said the health workforce and building it was his biggest worry, with short, medium and long term aspects.
In Hawke’s Bay a recent search online revealed 88 clinical vacancies including a full-time cardiologist, a senior medical officer – intensive care, a consultant psychiatrist, and a surgical registrar.
Reti says the short-term focus will be immigration, noting the country’s dependence on international graduates forms 40 to 50% of our health workforce.
Retaining the workforce we have is the medium-term focus. And turning on the domestic tap for a homegrown, culturally competent workforce was the longer-term focus. Creating a third medical school falls into this category.
On other contentious issues, however, Reti remains tight-lipped.
When questioned about the coalition government’s smokefree law repeal, he has stated it was a decision for all partners in the coalition, but insists the government is committed to driving down smoking rates.
Asked repeatedly, Reti provided no comments to BayBuzz about the smokefree law repeal and how it would impact Māori, the very population that is over-represented in every unhealthy clinical performance metric.
With regard to a new or redeveloped Hawke’s Bay hospital, in September 2023, as the National Party’s health spokesman, he claimed the need for a new hospital was obvious, as was his want to fund one. At the time he just needed to see if a final business case had been completed by the previous government or if it was still at an indicative stage.
Abolition of the Māori Health Authority is proceeding, as the PM noted, with Reti saying decisions are better left in the hands of local iwi and hapū.
In view of planned government policies, BayBuzz asked other voices to comment about the policies and how they might impact our region.
Kevin Atkinson
A member of the Hawke’s Bay District Health Board from 1998 until 2022 and chairman from 2001 until 2019, Atkinson gives mixed reviews.
He is “very disappointed” about the lack of disclosure around the Smokefree law repeal during the election campaign. “It was very disappointing there was no real disclosure of thinking in the election campaign. I hope they go through the proper process – submissions and consultations and the need to take a different approach. Time is on the side of the select committee.”
He said experts in the field needed to be listened to. “We have made great progress with anti-smoking, and smoking cessation, it would be a shame if we went back on it. There are very few health experts, if any, willing to support the change.”
On the abolition of the Māori Health Authority, he is not overly concerned.
“There’s been a lack of significant achievement from the Māori Health Authority. We all want to see reduction in inequities around Māori health, especially life expectancy of Māori, but we have different ways to get there.”
In terms of the future of Hawke’s Bay Hospital, he said as a region, Hawke’s Bay couldn’t justify any more than a single hospital, but the current hospital needed to be fit for purpose with “significant investment in the ICU, ED, East Block”. He said there were viable options for the current site.
He sees the green-fields option as something which could be considered, but would come at a significant investment between $500-$600 million. “Growth on green field sites on the urban fringe of our cities is highly visible,” he said. “Much depends on the availability of land for new development and also on the consenting rate for new builds. That is heavily dependent on the policies and actions of both central and local government.”
He added that expansion of private services like the Kaweka facility showed the “significant advantage to public/private partnership”.
Atkinson is heartened about the coalition government’s policies around cancer treatment.
He said Hawke’s Bay would have had a state-of-the-art cancer treatment facility a fair few years ago had then-health minister David Clark not put “a complete kibosh” on a public-private partnership.
He mentioned the possibility of a LINAC machine at the hospital in the near future. LINAC or linear accelerator machines aim radiation at cancer tumours with pinpoint accuracy, sparing nearby healthy tissue. At present Hawke’s Bay cancer patients must travel to Palmerston North for LINAC treatment.
On other health policies, he said some of his biggest concerns were around the delays in drug approval.
On that the coalition government intends to require Medsafe to approve new pharmaceuticals within 30 days of them being approved by at least two overseas regulatory agencies recognised by New Zealand.
Atkinson approves of the move. “I am all for it … There is no point in trialling drugs for 2 years. If they are approved in US/UK/Australia, then it should be considered safe to dispense them in New Zealand.”
He also approves of the plan to update Pharmac’s decision-making model to ensure it appropriately takes patient voice into account and to reform the funding model to account for positive fiscal impacts on the Crown of funding more medicines.
“Our country will never be at the stage where we could fund every drug available. PHARMAC should be able to source drugs at cost, which would require an update to PHARMAC’s decision-making model.
He said these decisions should be made with “absolute priority because people could die”.
The National Party pledged to allocate $280 million in ring-fenced funding to PHARMAC over four years to pay for potentially lifesaving and life-extending treatments that are proven to work and are readily available across the Tasman.
Atkinson is also a big fan of health targets. “We used to be able to know where Hawke’s Bay sat when we still had health targets. We have lost a level of accountability when we lost those. Health targets need to be operating fully.”
Not surprisingly, his biggest disappointment in the health sector was the disbanding of District Health Boards. “It was a step too far. We have had a complete lack of community scrutiny since the DHBs disbanded.”
He expects by mid-year we will have a better idea of changes taking place in the health sector, and whether they are yielding the improvements we hoped for.
Bayden Barber
As a former chair of Health Hawke’s Bay, Ngāti Kahungunu chairman Bayden Barber offered these views.
He told BayBuzz Ngāti Kahungunu was “hugely disappointed” that the coalition government was dissolving the Māori Health Authority, Te Aka Whaiora.
“Māori health outcomes have not improved under the current model of health delivery, so this was a huge lost opportunity to try something innovative based on the Treaty of Waitangi principles,” he said.
He said relationships with the PM, Cabinet Ministers and local MPs would be important so the iwi would continue to have an open-door policy to engage across all of the issues.
“These are challenging times, but together I am confident we can ‘rapua te māramatanga i roto i te pō’ or ‘find the opportunity within the gloom’. The Prime Minister visited regional leaders in December and said that his government will improve Māori outcomes across all key wellbeing indicators. So, ‘kua takoto te mānuka’, the challenge has been laid, let’s see now if they can deliver.”
On the Smokefree Law Repeal Barber said the law would have made “major gains for our people, saving a whole generation from ever experiencing smoking”.
“Repealing the law will mean that smokes will be available in 6,000 stores rather than 600 specialty stores. This will likely see more of our younger people have access to cigarettes. Smoking has been a scourge to Māori over many generations.”
He said the numbers nationally spoke for themselves, and doubted Hawke’s Bay’s stats would be any different.
He said Māori were 3.4 times more likely than non-Māori to be daily smokers (adjusted for age and gender). They were 2.9 times more likely than non-Māori to be current smokers (adjusted for age and gender). Māori women were 3.1 times more likely to be current smokers compared to non-Māori women (adjusted for age).
Johanna Wilson
Wilson was former smokefree programme manager at the Hawke’s Bay District Health Board from 2014 to 2020. She agrees with Barber.
She believes the repeal of Smokefree laws will impact heavily on Māori, result in an increase in poverty, a hike in tobacco products price, increase in visual presence of smokers, increase in crime (particularly dairies), in rubbish, in tobacco related illnesses and death, and increase in uptake of smoking tobacco products by young people.
“I’m afraid for our people, our whānau, our children, and our babies. Smoking in cars and homes will be detrimental to the health and wellbeing of us all. I’m afraid the repeal of Smokefree laws will open the doors to smoking in cars and homes.”
She urges the coalition government to listen to the health and wellbeing experts.
Tukituki MP Catherine Wedd
MP Wedd tells BayBuzz there are “major issues” facing healthcare in Hawke’s Bay, essentially repeating her campaign talking points.
“Labour failed to address our health workforce shortage in Hawke’s Bay and failed to train, attract and retain more staff. The workforce needs to be a priority.
“People in Hawke’s Bay are fed up with failing infrastructure and a stretched health system. I’ll be a relentless advocate for better health services in Hawke’s Bay and the National Government has sensible policies to boost our health workforce so people here can be confident they’ll get the care they need, when they need it.”
She said Hawke’s Bay was sick of the “ballooning bureaucracy in Wellington when we need health services and frontline staff and equipment in the regions. Our new Health Minister Dr Shane Reti understands the challenges we face in provincial New Zealand. A ballooning bureaucracy in Wellington is not the way to help Hawke’s Bay.
“I have been advocating strongly for a new Hawke’s Bay hospital and will continue to do so.
“Our government is fully committed to reducing smoking rates in New Zealand and Hawke’s Bay.”
Time to deliver
As Bayden Barber said above, “So, ‘kua takoto te mānuka’, the challenge has been laid, let’s see now if they can deliver.”
In the meantime, some good things are happening on the ground for wellbeing, especially as related to recovery from cyclone trauma.
Te Whatu Ora and the Regional Public Service Commission allocated almost a million dollars to support the health and wellbeing of Hawke’s Bay communities recovering from Cyclone Gabrielle.
The partnership between the two organisations resulted in 75 groups being awarded Community Wellbeing and Hauora grants following a call for grant applications late last year.
Successful applicants received funds towards activities such as local community events, cultural and spiritual wellness retreats, wellness resources and facilitating weekly meals to impacted communities.
Te Whatu Ora Hawke’s Bay Psychologist Frances Oliver says for many living in the region, their hauora was deeply shaken. “It was a traumatic event that continues to impact people, and these opportunities to focus on wellbeing will make life a little brighter, and a little easier.”
Hawke’s Bay Regional Public Service Commissioner Karen Bartlett says the grants committee, made up of members from Te Whatu Ora, Te Aka Whai Ora, Department of Internal Affairs and Regional Recovery Agency, had a tough job of assessing who would receive money from the fund.
“There was an overwhelming number of applications, showing how great the need is. It was heart-warming to read the innovative ways groups and communities are wanting to come together, to stay connected and support each other as they recover,” she says.
“It was equally pleasing to learn that funding has been spread far and wide across the rohe with applications received from all impacted areas.”
One grant recipient was the Hawke’s Bay Fruitgrowers Association which received $10,000 to be used for an industry event centred around wellbeing.
Te Whatu Ora Te Matau a Māui also launched a $2m hauora and wellbeing package, including seven free counselling sessions and online doctor consults for Hawke’s Bay residents affected by Cyclone Gabrielle. Te Whatu Ora Cyclone Gabrielle Recovery Manager Pania Shingleton said the idea was supporting people with a comprehensive package, which alongside the counselling, includes online doctor consults, pharmacy treatments, and the traditional Māori healing practice of rongoā.
Further healthcare help was given to people displaced in category one, two or three and all Wairoa residents – two free GP and two nurse visits, and a free after-hours emergency consultation.
Funding was allocated to five Māori Health providers to facilitate people accessing Practice Plus, an online doctor service, giving people a place in the community to ask for help. These providers are helping people book appointments on the Practice Plus app, including people who are not enrolled with a doctor.
“We know accessing healthcare is a barrier to some people in our community. The sooner they see someone the more positive their health outcomes are, which is why we worked this into our funding,” Shingleton says.
The coalition government also funded additional security staff in Emergency Department’s nationally until February 29, a move very much appreciated by hospital workers at Hawke’s Bay Hospital. Security and Orderly Manager Richard Payne told BayBuzz Hawke’s Bay Hospital gained an additional four security kaimahi per day, with two extra rostered on per 12-hour shift. “The presence of the extra security staff had a positive impact for the Emergency Department kaimahi, who felt safer and believe it helped deter antisocial behaviour,” Payne says.
“Staff have experienced an increase in verbal and physical abuse over the past few years, which has resulted in security personnel wearing stab-proof vests, getting more training and awareness of how to deescalate situations, and enhanced communication with other Te Whatu Ora sites to share knowledge.”
