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- "We've made clear that we require additional funding" - health officials on targets
- The inability to fill workforce vacancies a "capacity constraint"
- Greens say warnings coming true as health workers left over-worked and under-resourced
- Health Minister Shane Reti says publicly reporting on targets will help identify problem areas and action needed
- Te Whatu Ora says it has a plan to meet targets by 2030
Officials warned the Health Minister that meeting the government's targets for emergency department wait times and elective surgery would be difficult without more money.
Documents obtained by the Green Party under the Official Information Act refer to "capacity constraints", including the inability to fill vacancies.
Emails between top officials at the Health Ministry in February, before the Budget, laid out their blunt assessment of what would be required to meet the proposed "planned care" target to have 95 percent of people wait less than four months for elective treatment.
"The cost of delivery likely to be the key topic of discussion with the Minister," one wrote.
"I think for that meeting it would be helpful to be clear on what element of the growth in planned care activity above existing production can be delivered within baseline funding in 24/25... the implications of the additional funding requirement for Budget 2024."
His colleague responds: "we've made clear that we require additional funding."
According to a post-Budget briefing dated 5 July to Health Minister Shane Reti about the targets for ED and planned care said "by nature of Health NZ's current financial situation, the detailed delivery plans for targets are still under development as work continues to align budgets with the turnaround plan".
The attached report noted that achieving those targets was "less likely" if the system did not deal with "capacity constraints", including the inability to fill workforce vacancies.
That analysis was supported by other documents related to Health New Zealand's financial situation, which were released by Treasury a month earlier.
"If the current trends and trajectory were to continue unabated, Health NZ indicates that it will need to use all, or nearly all, of the cost pressure uplift it received at Budget 2024 (which was intended to pay for inflation costs and price and volume uplifts throughout the year) to meet the cost of existing staff."
Unless it could "significantly restructure its cost base", Health New Zealand would only be able to meet cost increases (including primary care contracts and wage increases) by running operating deficits or receiving additional funding from central government, Treasury officials concluded.
Even so, Reti reported to cabinet that the incoming Health Commissioner Lester Levy was committed to working towards the five health targets agreed by Cabinet in March "within the available funding".
Health system 'under-funded, under-staffed and under-resourced'
Green Party health spokesperson Hūhana Lyndon, whose office obtained the documents, said the Minister was clearly told the health system would "struggle" to achieve the targets without more money and more staff.
"These warnings are now coming to fruition as we have a broken health system with the hiring freeze, staff overwhelmed with their workload and because of that underfunding and understaffing and under-resourcing right across the health system, these targets are really at risk."
The Government needed to stop treating health as "a business with costs to cut", and start recognising it as "a public good", Lyndon said.
'Just because you want it to... doesn't mean it's going to be'
Association of Salaried Medical Specialists executive director Sarah Dalton who represents senior hospital doctors and dentists said the targets would be impossible to meet without major investment in staff and hospital infrastructure.
"What the Minister has said is like saying 'I've got this big firework and I'm going to aim it at the moon and it's going to get there''. Just because you want it to be the case, doesn't mean it's going to be."
"There's plenty of evidence to show if your hospital is full of medical patients, you can't safely admit patients who need surgeries if there are no beds to put them in."
Blowouts in wait times for elective procedures was adding to the pressure on GPs left caring for those patients, and patients who could not get GP appointments were ending up in emergency departments, she said.
The College of General Practitioners said funding them to order scans and tests for patients in the community would be the fastest and most efficient way to meet those lofty wait time targets.
Its president, Wellington GP Samantha Murton, said emergency departments had a million patients a year through their doors, compared with 23 million patients seen by GPs.
"If we did one day less [a month], that would double their monthly work. If we made a six percent change in what we could do in the community, we could halve what they do."
Minister admits targets 'challenging' - but achievable
In a written response to RNZ, Health Minister Shane Reti said he had confidence in Health NZ as it worked towards delivering on the targets.
"I've been very transparent about the challenges the health system continues to face and as I said in March, when identifying those targets," he said.
"It is important that we are ambitious in trying to achieve better health outcomes for New Zealanders. The health system went backwards under the previous government and its failure to drive targets.
"Having effective targets, and reporting on them publicly, helps identify where there are problems - and how we can take action to improve them."
Health received $1.4 billion a year of new money for cost pressures in Budget 2024, he noted.
From next month, Health NZ would publish health target results every quarter.
Its director of health targets Duncan Bliss said Health NZ had received "more government funding than ever before".
In September, the agency published implementation plans about how it would meet the health targets for faster cancer treatment, improved immunisation rates, shorter stays in ED, shorter wait times for first specialist assessments (FSAs), and shorter wait times for elective treatment by 2030.
"We know that the targets are ambitious and will take time to achieve," Bliss said.
"That is why our plans include activities and milestones to help drive improved performance to deliver timely access to quality healthcare for all New Zealanders."
The Health Ministry, which has the job of "monitoring" Health New Zealand's performance, said the agency continued to make "good progress" on its year 1 milestones.
Deputy director-general of regulation and monitoring Simon Medcalf said the Ministry acknowledged the challenges from cost pressures, workforce shortages and resource constraints.
"The Ministry is monitoring the risks to the targets so that appropriate actions can be taken.
"The next round of reporting on these two targets up until June 2024 are expected in the near future which will show progress is being made in these two areas."
Last month, Health New Zealand released 450 pages of financial documents which showed much of the overspend was related to increased staffing, some one-off costs like the Holidays Act liability increase and Covid stock write-off, and ongoing costs like nurses' over-time.
Health New Zealand refused RNZ's earlier OIA request for communications between the Commissioner, the Chief Executive, Health NZ's executive leadership team and the Minister's office regarding HNZ's financial position, and how it went from a projected surplus to a deficit.
It said IT searches of emails generated more than 4,000,000 results.
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