Workforce context

Since 2023, we have moved the dial for our health workforce in some areas – which has shaped our approach to this Plan:

Much improved nursing staffing

We have made huge progress to close gaps in our generalist nursing workforce due to many internationally-qualified nurses (IQNs) joining our workforce. While we still have need in some specialist nursing roles we do not have significant generalist nursing vacancies. This growth has been greater in our hospitals than in primary and community settings.

Changes in immigration

In early 2023 we had relatively higher net migration of nurses to other countries. Since then, easier pathways through our immigration system have opened for overseas-trained health workers to move and work here, and we have likely seen some slowing of post-COVID outbound migration of health workers (though this is hard to measure).

Stabilised allied pathways

We have expanded training pathways for several small, critical allied professions – including anaesthetic technicians and oral health therapists. This reflects both 2023 interventions, and the fruits of previous changes to training pathways; and puts us in better stead for 2024.

Several of the trends we identified in our 2023/24 Health Workforce Plan are likely to endure over the next decade – changing our care context and the composition of our workforce. For a more detailed picture of expected demographic and health status change, our Health Status Report 2024 outlines the trends we expect to see.

Demographic change

Our population is aging and getting more diverse. This means people will be sicker on average; both acuity (how unwell people are) and care volumes will grow.

We expect an increasing proportion of New Zealanders will have long-term conditions, imposing a greater burden of disease on our health system – including from cardiovascular conditions, cancer, and mental distress, illness and addictions.

Workforce change

Our workforce will get older on average alongside our population.

Our workforce will also come under mounting global competition. As other nations face the same challenges as us, and developing nations’ health systems and care expectations shift, some of our pipelines for international talent will dry up – and other countries will work even harder to recruit our exceptional workforce.

Technological change

Alongside change in the profile of New Zealanders, our technological context is changing. Artificial intelligence (AI) and robotics are increasingly features of our world – and overseas health systems and New Zealand’s private and funded health sectors are already moving to adopt them as tools.

We still expect a future where technology complements and enhances our workforce, rather than replacing it. But we think these technological changes will have a mounting impact on health services: offering opportunities to alleviate repetitive or unpleasant tasks, and to support more complex decision-making and triage.

Alongside our Health Workforce Plan, Health NZ is progressing a range of work to improve our services and strengthen other care enablers.

The breadth of these initiatives are set out in full in the New Zealand Health Plan; but several of them bear reflection here, because they are so important to the change the Health Workforce Plan aspires to:

Primary and community care

Health NZ is working with the primary and community sector on the future of our primary and community care sector, including reviews of major contracts over coming years.

As we do so, there are opportunities to:

• Improve our workforce planning with the primary and community sector, and establish better ways for the primary and community sector to communicate its workforce needs to Health NZ.
• Better apply our funding levers – and what our contracts incentivise – to grow the workforce we need in partnership with the primary and community sector, and to support improvements to models of care and service delivery in the community.

Clinical services planning

Our hospital and specialist services have previously been organised based on former DHBs’ decisions about what kind of care should be available where. Some of those decisions no longer make sense in the context of a national health service, and don’t reflect our regional model.

With regional leadership in place, we are working on a model for our future hospital networks, so we can get the right services in the right places for all our communities.

Through this, we will be able to:

• Better understand what workforces we need at different hospital and specialist sites in the future.
• Get the right blend of generalist and specialist capability across urban and rural settings, and across different types of services – so New Zealanders get better access to great care close to home.

Clinical networks

We have established clinical networks across a range of conditions and care pathways. These will be the vehicle for clinical leadership to change models of care over time, improving whānau outcomes and shifting workforce expectations – and will aggregate expert clinical voices by service.

Digital improvement and innovation

Health NZ is working on making better use of digital technology to improve healthcare. Some of these improvements are relatively functional – modernising dated systems and out-of-support services – whereas others offer more opportunities for change, such as improving access to care through digital platforms.

For our workforce, these changes will make a difference by:

• Unlocking new models of care – for example, having specialists support the delivery of care while physically based elsewhere; or enabling new treatments through better technology.
• Creating opportunities for more people to be cared for close to home, including by whānau, supported by technology and remote clinical expertise – lifting the load on our services, so we can ensure timelier in-person care for those who need it.
• Allowing us to achieve more with the workforce we have – using technology and administrative efficiency to give people more headspace and capacity to focus on quality care, rather than low-value administrative tasks.
• Addressing problems with our core people systems, such as aging payroll and rostering systems, which make it hard to pay people accurately and roster flexibly and efficiently.

Iwi-Māori Partnership Boards (IMPBs)

IMPBs are mandated under the Pae Ora (Healthy Futures) Act 2022, and represent local iwi and Māori in specific rohe across New Zealand. Iwi-Māori Partnership Boards are still forming and shaping their plans for care in their rohe – and there are significant opportunities for us to partner with IMPBs on local Māori workforce development.

Infrastructure planning

With rare exceptions, most of our health workers need somewhere to work to deliver care. In some parts of the country infrastructure is a barrier to our people working well; for example, because we are working within aging facilities that are older and no longer fit for purpose for modern delivery of care.

By getting the right infrastructure in the right places, we can:

• Have better work environments which are more pleasant to work in – and allow people to focus on providing great care.
• Be more productive, by ensuring that our physical spaces are an enabler of, rather than a barrier to, being able to provide excellent care to the people who come through our doors.