Health New Zealand commissioner Dr Lester Levy. Photo: RNZ
The man in charge of turning around Te Whatu Ora's financial situation is adamant they can do more with less, despite the organisations ballooning deficit.
A briefing released this week showed the forecast deficit at Health New Zealand had risen from $1.4 billion, to $1.76 billion.
And there are accusations of reneging on promises not to cut front-line medical roles with plans to reduce the number of chief medical officers from 18 to 14 nationwide.
Health New Zealand commissioner Dr Lester Levy told Morning Report the four roles were an operational matter and it wasn't appropriate for him to talk about it.
But he stood by his promise that "overall" frontline expenditure would not be cut.
As for the forecast deficit, Levy said the organisation should be able to increase productivity to make the best use of existing resources.
"I can say quite definitely that there's an opportunity to get more out of the resources we have."
Te Whatu Ora was employing 3000 more nurses than it had budgeted for, Levy said.
That was part of the financial problem, he said.
He blamed that on fruitful international recruitment and a previous lack of internal oversight.
But Levy would not say whether the 3000 nurses were needed to keep the system safe for patients.
"The reality is we have got them."
Levy said he had received a clinical and patient safety review, that was requested to establish baselines.
He was "busy going through it" and would release it publicly once he was done.
"We're spending more money... there's been a lot of talk about hiring freezes and vacancies and the like and people are often talking about quite different things."
In the financial year that just ended, there were more clinical roles hired than in the previous eight years, he said.
Nurses Organisation chief executive Paul Goulter told Nine to Noon Health NZ's own workforce planning found hospitals needed 4400 more nurses last year.
"Those increases have been driven by data which Te Whatu Ora has worked on themselves so I can't for the lord of me understand why having more nurses at a time of acute need is a problem."
There were still hospital nursing vacancies, particularly in mental health, women's health and emergency departments, he said.
Association of Salaried Medical Specialists director Sarah Dalton told Morning Report the so-called waste in the system was the result of long-term underfunding.
"The biggest picture here is ongoing refusal by the government to properly fund the health system.
"So, yes we've got more nurses but they're not wanting to pay for those nurses, yes we need more doctors, but they don't want to pay for it."
A lack of doctors employed permanently meant a reliance on expensive locums, and overflowing emergency departments were also increasing costs, she said.
"When you've got hospital wards and emergency departments that are stuffed full of patients, where there aren't enough beds, where they're always operating at 100 percent plus - and a lot of our hospitals are like that now - that in itself is inefficient, you can't run good hospital flow, so that creates costs."
