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Our big levers

To achieve a sustainable, equitable, supported and thriving health workforce we can’t just do more of the same. We will need to change how we grow our workforce, and how we deliver care, across the health system. This will require partnership and drive from other parts of our system and across government.

The Plan highlights seven ‘big levers’ which we’ll need to influence long-term to achieve workforce sustainability:

  • How we regulate: the contribution of responsible authorities and professional bodies to the growth of our workforce.
  • How we train: making best use of our education and training capacity to build the workforce we need.
  • How we recruit: drawing talent from overseas to augment our domestically-trained workforce.
  • How we retain: keeping our people well in work through a lifelong career in health.
  • How we work: changing how we work together with our people to deliver more, better care, and improve the experience of our workforce.
  • How we invest: using our buying power more intelligently to get the workforce we need, and align incentives to workforce sustainability.
  • How we enable: ensuring our use of data, digital technology and physical infrastructure drive productivity and good work.

For each lever, we lay out where we want to get to, what we’re going to do, and what we need from others over the short-, medium- and long-term. This vision extends from today through to 2033 because some of these levers are slow to move, and we will need sustained ambition to achieve the change we want.

As part of each lever, we also ask for action from organisations other than Health NZ. That’s because we can’t do this alone – and we are committing to working with our partners across the health sector and government to make these shifts possible in years to come.

How we regulate

We have a strong regulatory sector, with a long-standing reputation for keeping New Zealanders and their health professionals safe. But in some areas our regulatory environment has become overly burdensome. For our regulatory settings to work we have to tackle:

  • Relatively high barriers to entry making it difficult for competent overseas-trained professionals to practice here, in some professions.
  • Some training pathways being longer than they need to be by international standards, with sometimes convoluted pathways to being able to practise. Though it varies by case, this is driven by both regulatory and education settings (discussed further below).
  • Slow processing times for some regulators, which leads to us losing skilled workers to other jurisdictions. We need to continually improve our regulatory performance to compete globally.

Specific challenges vary from profession to profession, so a tailored approach to improving regulation will be needed.

What we want to achieve

When? Outcome we need
By 2025
  • We speed up and modernise our slowest and most cumbersome regulatory processes, targeting areas where we have the greatest workforce need.
By 2027
  • Our regulatory systems make transitions between professions – particularly those with some overlapping skills, like enrolled and as is appropriate, with appropriate recognition of prior learning (RPL).
  • All our regulators process overseas applications for New Zealand registration at least as fast as the average across our competitors, with modern systems and processes. Digital processing is the norm.
  • We’ve modernised our recognition of other countries’ qualifications and professions to consistent standards across professions.
By 2033
  • Our regulatory system is lean, safe and efficient. It’s easy to move between professions with similar skillsets, and regulatory settings aren’t a barrier to people pursuing diverse careers in health, or to teams practising in an interdisciplinary manner.
  • It’s fast and easy to bring your overseas registration here to practice in New Zealand from a range of countries, and we regularly outcompete our international competitors on speed of registration – without compromising safety.

What we'll do to get there

Health NZ isn’t responsible for regulatory settings – so there is little we can do independently to improve how we regulate the health workforce.

However, we will act as a champion for regulatory simplification and improvement across all the stakeholders with a role in regulation – including responsible authorities, professional bodies (such as medical colleges) and the immigration system to facilitate a shared approach to regulatory improvement.

 

What we need from others

When? What we need?
By 2025
  • Ministry of Health
    Set clear expectations for how quickly international applications for New Zealand registration from health practitioners are processed – benchmarked to international comparator processing times.
  • Responsible authorities and regulators
    Reduce processing times for international applications for New Zealand registration to better compete with our competitors overseas – focusing on professions with long processing times today and priority workforces. Consult with us proactively about changes which impact the health workforce, or the health system’s performance and operation.
  • Medical colleges
    Collaborate to recognise appropriate levels of vocational specialisation in different settings (particularly in rural areas). Support efficient, timely vocational registration of overseas doctors – and appropriate training and vocational registration settings for New Zealand’s context.
By 2027
  • Ministry of Health
    Deliver the review of the Health Practitioners Competence Assurance Act 2003.
  • Responsible authorities and regulators
    Significantly reduce processing times for international professionals seeking NZ registration.
  • Facilitate appropriate use of RPL through regulations to make moving between professions faster and simpler.
  • Undertake a full review of comparator jurisdictions, including consideration of other jurisdictions’ mutual recognition arrangements, with a view to lowering barriers to NZ practice (including reducing supervision requirements where appropriate).
By 2033
  • Ministry of Health
    Support ongoing monitoring of regulators against credible, competitive standards of regulatory performance.
  • Responsible authorities and regulators
    Sustain continual regulatory improvement, maintaining public safety and confidence in our health workforce – while ensuring that regulatory settings let us grow workforce we need for the future. Ensure regulations do not unduly inhibit innovation in growing new workforces, or using workforces better (such as through changes to scopes of practice).

How we train

To have a sustainable workforce we need to train a greater proportion of New Zealanders to work in health. Doing this requires changes across the board to how we train:

  • Our tertiary education system is demand-driven – so we need student interest to grow the health workforce we need for the future. If we want to grow our numbers, we need to sell students on health careers – with a focus on Māori and Pacific students to get a representative workforce.
  • We need to build on existing partnerships with the Tertiary Education Commission (TEC) and tertiary providers to better align training capacity to health system demand, and to improve student experiences across placement and the classroom.
  • Models of training in health are often traditional, with few options to train part-time, or while working and earning. This makes it hard to reach students with whānau commitments or those later in life, who mightn’t be able to get by on student support while they train.

What we want to achieve

When? Outcome we need
By 2025
  • To the extent possible, we’ve matched growth in training volumes for 2025 to current and future health system need.
  • We’ve expanded the scope of earn-as-you-learn and accelerated pathways, starting by spreading and scaling existing programmes across Health NZ and the primary and community sector.
By 2027
  • Annual training volumes for key professions are mapped to system demand today and in a decade’s time – focused on professions where we have the biggest shortages. Students report better placement experiences, with more choice and flexibility.
  • We have significantly higher levels of RPL for those retraining across health professions; and part-time / earn-as-you-learn pathways have launched for several professions.
By 2033
  • Annual training volumes are mapped to health system demand 10 to 20 years out; we use strong engagement with schools to support learners towards fruitful health pathways mapped to demand. We work with the tertiary education sector to align capacity with this need. Placements are flexible and bookable, with students exercising meaningful choice.
  • Earn-as-you-learn, on-the-job training is a normal way for many people to start careers in health – around 20% of people entering health do so under some kind of earn-as-you-learn arrangement. No-one working in health has to leave their job to retrain within health. Most of our in-career training and retraining is earn-as-you-learn.

What we’ll do to get there

When? What we'll do
By 2025
  • Work with tertiary education providers and the TEC so that our needs influence the where we grow tertiary education capacity over time – and to influence student preferences where we can.
  • Make progress on improved systems for student placements, to lift pressure on tertiary education providers and our services.
  • Continue to fund earn-as-you-learn pilots in some areas, focused on vulnerable professions. Invest in longitudinal rural training capacity.
By 2027
  • Support tertiary education providers and qualification owners with a fulsome review of health programmes and qualifications, with a focus on recognition of prior learning, strong pathways between professions, on-the-job training, and part-time training opportunities.
  • Expand student placement systems to allow for student choice in placement, and to expand our total training capacity.
  • Work with Iwi-Māori Partnership Boards to establish strong, Māori-led pathways to attract rangatahi Māori to health careers. We’ll likewise work with other communities, including Pacific communities, to strengthen health pathways out of schooling.
By 2033
  • Continue to partner with the tertiary education sector, bringing a view of workforce demand to how programmes change, expand and contract – working jointly to reshape training to meet new workforce and health service needs.

What we need from others

When? What we need
By 2025 Immigration NZ
As workforce demands and needs change, work with us – as we have over the past year – to align immigration settings to relative health system demand.
By 2027 Primary and community sector
Shape together a common expectation for how we fund and support international and local recruitment for the primary and community sector, leveraging our national scale and meeting community needs. Our approach will need to encourage innovation to models of care and investment in technology.
By 2033 Immigration NZ and the primary and community sector
Continually improve how we collaborate to get the right blend of international and domestic talent for all our health services, regardless of setting – using the full range of levers available to government and the sector.

How we retain

Keeping our talented people working in our health system is essential to our success. To do that we have to tackle some challenges:

  • Despite progress, culture remains variable across the health system. Some teams have incredible cultures which keep people around; others still work in ways that don’t.
  • Long-standing differences in how people are remunerated and the other benefits they get have become more obvious, which often feels unfair – including pay differences between hospitals and community settings.
  • Care quality and workforce retention are best where our people are healthy and have manageable workloads.
  • Some health workers have limited opportunities to specialise or develop, which can make a career in health less fulfilling.

What we want to achieve

When? Outcome we need
By 2025
  • An improved experience of work and improved work culture in areas which have poor culture or signals of staff dissatisfaction today. Our workforce have a clear understanding of the culture we want to move to – and what that change looks like in their context.
  • Reduced rates of attrition and turnover across our workforce, particularly in areas of current high turnover.
By 2027
  • All our teams are working towards our desired culture, focusing on targets that make sense for their work and context. Our primary and community providers share our commitment to our future culture, with plans in place to achieve change in their contexts.
  • Significantly reduced rates of attrition and turnover across our workforce, settling towards our desired enduring future state. We intervene swiftly to change the trend where high turnover is identified.
  • Clearer opportunities to develop, grow and specialise across all roles, including transition pathways between key roles or professions.
By 2033
  • The culture of our health system is inclusive, welcoming, patient-centred and productivity-driving, with a focus on excellence for New Zealanders.
  • Regardless of setting – including in the community – New Zealand health workers work in environments with great culture; feel valued; and have sustainable workloads that allow them to stay in health long-term.
  • The reward, recognition and benefits we offer for working in health are sufficiently competitive to keep people – and are consistent and fair across the country, with differences being explainable and reasonable.

What we’ll do to get there

When? What we'll do
By 2025
  • Launch a culture change programme guided by the values and behaviours in the New Zealand Health Charter | Te Mauri o Rongo, using evidence-based approaches to culture, leadership and productivity.
  • Use our Pulse Survey to identify areas where teams are not thriving and provide targeted support to address local issues and improve team performance. Launch the Kaimahi Hauora Service and the Resident Doctors’ Support Service (RDSS) to make sure our people are well at work; and the Leadership Institute to build better health system leadership for the future.
  • Focus on key development pathways aligned to our pressing workforce needs, like increased opportunities for people to expand their scopes.
By 2027
  • Sustain progress on culture change, both across Health NZ and at the level of individual teams, providing support where issues are identified.
  • Work with the primary and community sector to consider what culture change looks like in their settings, and build supports for them that make sense for diverse community contexts.
  • Improve pathways for our people to develop in all roles, including a clear architecture to move between roles and extend scopes.
By 2033
  • Develop an enduring solution to pay disparities between our hospitals and the funded sector, to ensure appropriate competitive remuneration across the whole Health NZ-funded health service – while living within our means as a health system.
  • Continually improve our national support services and grow our national and local cultures, in line with Te Mauri o Rongo.

What we need from others

When? What we need
By 2025

Funded sector providers
Partner with us to build a shared commitment to Te Mauri o Rongo for the primary and community sector, and in private services – and agree how to unpack a common culture in ways that respect the unique cultures and contexts of our providers.

Te Kawa Mataaho
Collaborate to ensure Health NZ’s practice as a best-in-sector employer aligns with the wider expectations for the public service.
By 2027 Funded sector providers
Put plans in place for how they intend to make Te Mauri o Rongo real in their contexts, tied to our contracts for service provision.
By 2033 Funded sector providers
Depending on how we address pay disparities, we may need providers to take different approaches to how we pay staff in the primary and community sector to ensure relativities are maintained over time, within funding available to the health system.

How we work

Models of employment and working are a major opportunity for our system. We think we can do better in several areas:

  • Our models of care don’t reliably make best use of our people’s talents. Often, we ask our workforce to do tasks which are better placed given to others on the team. And where whānau care for people, we don't do enough to support them - and connect them to other workforces who can help ensure appropriate care.
  • We don’t do enough to value our people’s time. Beyond just underutilising skills, our systems and processes often create administrative burden and waste, lowering productivity and frustrating our workforce.
  • It can be difficult to enable flexible work arrangements in rostered work environments. This means we lose people who make a strong contribution to our services if they can’t make rosters work, like where they have conflicting whānau commitments.
  • We need to work with unions to get our collective agreements are simpler, clearer, and better support our workforce and leaders to achieve positive change – allowing for more consistent arrangements over time.

What we want to achieve

When? Outcome we need
By 2025
  • We have adopted new models of care and service delivery models in areas where we already have clinically-led work underway – like for radiology.
  • Our people can get flexible work patterns when they need them; we may need to use special arrangements or ‘overrides’ to make it work.
By 2027
  • Our people’s time is valued, making them more productive, delivering greater care for whānau more sustainably. This doesn’t mean asking our people to work harder – but rather taking lower value work off people’s plates, and alleviating burdens from administration, poor technology or bureaucracy.
  • Model of care and service delivery model change is underway across a range of services, with accompanying workforce modelling to prepare us for the future – rather than the present.
  • Flexible work patterns are increasingly normal and easy to get, supported by improved rostering systems.
By 2033
  • Our people have a much easier experience of work, with relatively seamless technology and administration. We have a better blend of workforces so people can work at the top of their game – with the capacity to think and work at a measured pace that leads to great care.

What we’ll do to get there

When? What we'll do
By 2025
  • Continue our work on changes to models of care and service delivery models in areas like radiology and primary care.
  • Use our new Kaimahi Hauora service (our national hub for employee wellbeing) to create avenues for people to get flexibility in their work, even where today’s rostering systems make it difficult.
  • Adopt common national policies to make flexible employment easy.
By 2027
  • Start work on improving a wider range of models of care and service delivery models, building on our early successes.
  • Deliver improved rostering systems across the country, which help us offer roster flexibility – and work with our leaders and unions to shift our culture to one that better embraces these ways of working.
  • Adopt nationally consistent ways of working and models of care where we have clear best practice – and start to build national systems for services that can be delivered better together as a national network.
By 2033
  • Shift rostering tools and renegotiate collective agreements – working closely with unions – to facilitate flexibility for our people as a matter of course, while maintaining safe, productive services.
  • Sustain enduring improvement to models of care and service delivery models, reorienting our approach to service delivery and funding to reflect community need and workforce capacity.

 

What we need from others

When? What we need
By 2025 Primary and community providers
Collaborate with Health NZ to redesign models of care in the primary and community sector so they work both for providers and for whānau, and to ensure both service and workforce sustainability.
By 2027

Primary and community providers
Build a joint understanding of the workforces we need to grow in the public health, primary and community sector – and where we need to, work out how to live with the workforce capacity that we can grow, rather than the capacity we might like to have.

Jointly develop workforces that allow us to shift service capacity towards prevention, early intervention and more holistic care for whānau with complex needs.

Expand our capacity to train more health workers in the community, to support new community-based models of care.
By 2033 Primary and community providers
Continue to innovate together on models of care and service delivery models to make best use of the workforces we have and adapt to community needs as they evolve – and plan together for the workforces we need at least a decade out.

How we invest

Health NZ is a significant funder – both of health services in the primary and community sector, and of workforce training and development. We can use these levers to influence and grow the workforce we need better than we do today:

  • Our agreements with the primary and community sector do not always reflect our shared aspirations for workforce – including clear expectations about where the costs of training lie, and how training capacity, quality and outcomes are rewarded and incentivised.
  • Across the health system, we have inconsistent investments in our workforce – ranging from how we fund student placements, to how we fund training roles in the community. This leads to inefficiencies and missed opportunitiesfor better returns for our investment.
  • We make limited use of private sector capacity to train, and primarily rely on the public sector for training. This isn’t the best use of our capacity across the health system, given our future need.
  • We also know that pay parity is a significant challenge for community providers. While this is not the focus of this Plan, we know it has a significant impact on workforce sustainability in the community.

What we want to achieve

When? Outcome we need
By 2025
  • We better understand our own investments in health workforce across the health system. Where it’s simple to do so, we’ve made our approaches across similar settings more consistent.
  • We have strong evaluation of Health Workforce Plan initiatives – building on the evaluation of 2023/24 initiatives – to demonstrate return on investment, and to help us make informed decisions moving forward.
By 2027
  • Our major contracts and agreements reflect a shared understanding of our mutual contributions to workforce – giving us better data and shared planning for primary, community and rural workforces.
  • We have a good evidence base for what kind of workforce interventions work in New Zealand, which don’t, and what factors make the difference – which we use to invest intelligently. We have clear targets for when we expect to see medium- and long-term workforce outcomes achieved.
By 2033
  • We have an enduring, equitably-funded relationship with providers to support primary, community and rural workforce development. Training is incentivised so as to reward innovation, volume and quality.
  • We have a consistent and informed evidence base for investment in our health workforce, underpinned by sophisticated labour market models.

What we’ll do to get there

When? What we'll do
By 2025
  • As major national contracts come due for renegotiation – both for services, and for workforce – work with providers to shift to consistent, clear expectations for our respective contributions to workforce growth, development and innovation.
  • Analyse our current spend on health workforce across Health NZ to understand how equitably funding is allocated, and to better understand the value we get for our investments.
By 2027
  • Work with the primary and community sector, and rural hospitals, to adopt a consistent, balanced approach to supporting workforce development through our major contracts.
  • Shift to nationally consistent funding of workforce costs where we can – for example, how we account for training demands on staff – accounting for differences in scale, rurality and need across settings (including the primary and community sector and rural hospitals).
  • Develop an early New Zealand evidence base for health workforce planning and intervention – which will aggregate and analyse our best available evidence on different intervention types.
By 2033
  • Continually monitor our spend on health workforce, reinvesting to reflect best practice, target changing priorities, and encourage performance.
  • Continue to build and refine our evidence base on the impact of different investments and approaches on the health workforce.

What we need from others

When? What we need
By 2025

Ministry of Health
Collaborate on our analysis of labour markets and our evidence base for interventions, so that we work from the same assumptions and have common expectations of what good looks like.

Other agencies which employ or contract health workers
Build a coordinated approach to workforce planning and investment, so we spend in a complementary rather than competitive fashion – with clarity on how agencies share the burden and cost of training health workers.
By 2027 Other agencies which employ or contract health workers
Build a common workforce planning approach which reflects the collective needs of the New Zealand government sector – and our partners in the primary and community sector.
By 2033 Other agencies which employ or contract health workers
Continue working together to ensure we plan together for the future health workforce we need across government and our respective funded sectors.

How we enable

Our workforce can’t thrive in isolation. The environments they work in – including physical spaces, the tools and resources they have, and the data and technology they have available – affect how well our people can work. There are things we can do to better in these areas:

  • Our technology is fragmented, with low levels of automation. Disparities and different tools across the country make it hard to move information around; and we often require significant effort from our workforce where technology could help. This is a poor use of their time.
  • Some of our physical care settings do not make it easy for our people to work efficiently and contribute to a poor experience of work. In the primary and community sector, we rarely have a focus on physical infrastructure – which can erode care quality.
  • Our data is patchy, and often relatively low quality. For workforce data this impedes our planning; for patient and service data, it makes it hard to identify areas to improve patient flow and service performance.

What we want to achieve

When  Outcome we need
By 2025
  • We have a clear roadmap to improve our critical people systems – like rostering, payroll and workforce data – with a focus on areas which are most disruptive to our people’s work today.
  • In key areas – such as moving clinical notes between systems, and using generative AI to help fill forms – we have early pilots going to try and give our people back time and energy for value-adding work.
By 2027
  • Across the whole health system, we have core tools in place to reduce administrative burdens – such as to support note-taking, discharge and rostering. All our paper-based payroll systems are digital.
  • We have a plan in place to improve our physical infrastructure over time, which reflects the places and settings where care should be best delivered in future.
By 2033
  • We have modernised our payroll, rostering and other people systems into a coherent, national network.
  • Our people work on modern platforms to do their work, with minimal effort dedicated to administration – and tools like software and generative AI are used safely to free up our people’s time.

What we’ll do to get there

When? What we'll do
By 2025
  • Start to progress payroll and roster change in areas where we have the most dated systems.
  • Pilot digital tools in some settings where they can start making a difference rapidly (for example, by improving systems which enable teleradiology), and learn from others who are already piloting these technologies (such as in the use of generative AI note-taking by GPs).
By 2027
  • Improve our most dated technology – and areas where we are not using technology at all – to reduce workload. Many of these fixes will be relatively straightforward, like moving clinical notes to simpler, faster systems which can pre-populate information from other systems.
  • Retire our most dated payroll and rostering systems, and implement a consistent, more flexible rostering approach nationwide.
  • Shift to investing in physical infrastructure through a systematic planning process, which evaluates relative need across the country, rather than by ad hoc, local business cases.
  • Design a coherent, comprehensive approach to workforce data collection with the primary and community sector and use it to gather distinct data across all major workforces for the Workforce Plan 2027-30.
By 2033
  • Invest in enduring change to people systems, which will bring payroll, rostering and other people systems (like learning) onto a national spine. While we do not yet know what this solution will look like, it will not look like 25+ different, unconnected systems.
  • Shift our frontline clinical systems so everyone in Health NZ can use the best systems currently available to us, addressing variability between districts. Where we test or pilot new technologies (like AI-driven tools) and they work well and safely, we move to adopt them more widely.

What we need from others

When? What we'll need
By 2025 Primary and community providers
Collaboration on ad hoc methods of workforce data collection, while we get stronger systems in place to gather better data as a matter of course.

By 2027

 

By 2033

Primary and community providers
Partnership and planning for key physical and digital infrastructure (such as community care sites, and the use of AI tools) in the community sector so we can expand the range and quality of services available in the community, and to strengthen our primary and community workforce.

Collaboration on an enduring means to gather primary and community workforce data, for the shared benefit of Health NZ and the funded sector.