Kaiāwhina and care roles

There are a whole range of vital roles in our health workforce filled by people who are not registered health professionals, but who provide frontline care or support to patients and whānau. This category includes healthcare assistants, kaiāwhina, kaimanaaki and support workers; as well as workforces like interpreters and orderlies.

A significant proportion kaiāwhina and care roles don’t require a qualification, though many people on our teams in these roles do have them, allowing them to take on a wider range of tasks. Healthcare assistant roles, among others, typically involve progression towards qualifications as part of work.

Sizing our kaiāwhina and care workforce across the health system is difficult, because they are not required to be registered. Health NZ employs 8,230FTE care and support workers, including kaiāwhina; we loosely estimate that around another 70,000 may work in the community, extrapolating from historic Census data.

While we only have loose data on where kaiāwhina work in the community, we know:

The number of people we employ in care roles has been growing at a steadily higher rate than other professions over recent years – an increase of 684 FTEs from 2023 to 2024, or 9.1%. There are a few reasons for this:

• In recent years, we’ve moved towards a more holistic view of care: recognising that only addressing immediate medical needs often doesn’t achieve the best outcome for patients’ long-term health. Kaiāwhina and other care roles are well-placed to support more holistic care, because they have time to spend time with patients and their whānau and to ensure they’re looked after as whole people.
• Making better use of healthcare assistants, kaiāwhina and other care roles is well aligned to our philosophy of supporting everyone to work at top-of-scope, by lifting burden off other workforces on our clinical teams.
• Because kaiāwhina and care roles have relatively lower qualification requirements than other workforces, many people can take on these roles and learn on the job. This makes these careers open to a wider range of people who might not want to – or be able to – take years out to study without earning.

As time goes on, these factors are likely to continue to drive growth in these workforces.

Growth to our kaiāwhina and care workforces is well aligned with our direction for health workforce:

• As New Zealanders come to have more complex, overlapping needs, having kaiāwhina and care workers available to spend time understanding those needs will only become more important.
• The low barriers to entry to practice as kaiāwhina means these roles can be a pathway into other health professions. By expanding and strengthening these pathways, we can support more New Zealanders straight into health work, where they can then build skills over time towards careers like nursing, midwifery, and allied health.

Short-term, we are less worried about workforce shortages in our kaiāwhina workforce – giving us space to focus on what we need medium- to long-term. Over the next three years, our attention will be on:

• Improving pathways and transitions. We have pockets of good practice where kaiāwhina and those in care roles are supported to progress into other roles over time – including enrolled and registered nursing. We want to grow these, both in volumes and in the range of professional pathways available, so our kaiāwhina can continue to up-skill over a career in health.
  Alongside this, we want to start to take steps to address care roles for which there are relatively few pathways to progress – like for orderlies.
• Creating advancement opportunities. At present, the significant training required to practice as a nurse, midwife or allied professional can present a barrier to kaiāwhina in growing their scope of practice. By growing the range of assistant roles in our health system, we can better enable more pathways into other professions over the medium-term.