Regular stories in the news of cost-cutting and redundancies at regional and district health boards give an impression the health sector is in the doldrums and always in a state of flux.
Yet in February Health Minister Tony Ryall said more money was being spent in the health sector than ever before but, of course, with an ageing population there is more to be done.
"Overall we are in pretty good shape," says Professor Des Gorman, chairman of Health Workforce NZ, which was set up in 2009 to provide national leadership in developing the country's health and disability workforce.
"Some of it is good management, some of it good luck," says the Professor of Medicine at Auckland University.
There have been specific problems in particular regions, community after- hours care has become more disintegrated and there are too few emergency department doctors, he says. But, at the moment, the supply of midwives, nurses and doctors is in hand.
There is no question, however, that health care leaders will have to try harder to make the health system more attractive. They are going to have to work to stop nurses from leaving. "Typically, when they get to about 50, they leave," Gorman says. Industry leaders must figure out why they would want to continue to give them responsibilities that shift with the role.
With babyboomers ageing and mature nurses leaving the workforce, the health sector will face a double whammy, says Gorman. And because of high salaries in Australia, the health sector will have to keep thinking about how to make New Zealand a more attractive place to work.
"As far as we can tell, the number of New Zealand doctors going overseas is at an all-time low. It's a mixture of good luck and an over-supply of doctors in Australia."
The flow of New Zealand doctors to the UK is also slowing. "It's more difficult for New Zealanders to get a job there. They have got to employ a European first."
The academic is looking at fundamental questions. How many doctors does society need? What should they be doing? General Practice is the most difficult to recruit in, he says. Its status is low. "We have to make it a sexy career."
New Zealand is one of the best places in the world to study medicine, he says. There's a career plan for every medical graduate, something Health Workforce NZ has pushed. Mentors have also been formally introduced. "By the time they have done a specialty, it costs $1 million to $1.5 million to train them. It's a huge investment by society."
In Auckland, the new education and research centre, Ko Awatea, has been launched in collaboration with Counties Manukau District Health Board, Manukau Institute of Technology, Auckland University of Technology and Auckland University to address the under-representation of Maori and Pacific staff in clinical roles.
Their research has found that Maori represent 6 per cent of Counties Manukau's workforce compared to the board's Maori population of 17 per cent. The area's Pacific workforce is around 8 per cent and the local Pacific population is 21 per cent.
Ko Awatea's workforce programmes are trying to "broaden perceptions" among Maori and Pacific children about what jobs in health are like, says Elizabeth Ryan, Workforce Development Manager, of Ko Awatea, CMDHB. Rather than guiding them to a particular health job, the message in the first instance is to achieve well and study the sciences, she says.
"The Health Could B 4 U programme is designed to raise awareness of the importance of science to studying health careers, as well as illustrating the diversity of health careers available, beyond the traditional nursing and medical roles young people most commonly relate to."
The Grow Our Own Workforce programme aims to develop a pipeline from education to health sector jobs.
The Counties Manukau board, with funding from the Tindall Foundation, has supported two pilot Health Sciences Academies, in Tangaroa College and James Cook High School. Otahuhu College is also funded by the Pasifika Medical Association.
The Health Science Academy model aims to develop health-focused curricula for direct entry into tertiary training, and is augmented by HCB4U activity where appropriate. Initial results are positive, says Ryan. The first cohort of Year 11 students last year achieved unprecedented NCEA levels of merit and excellence.
The flow of international health specialists into New Zealand continues as migrants seek better lifestyles.
Accent Health Recruitment's owner, Prudence Thomson, brings GPs in from overseas, especially from Britain and North America. She is just back from a recruitment conference in the UK where she met 400 British medical professionals. "Mental health, emergency and theatre staff I looked for and got," she says.
Thomson met radiographers, therapeutic and diagnostic mammographers, and anaesthetic technicians, all of whom are in demand here.
Sean Brunner, the director of Robert Walters' Wellington office, puts managers into the health sector. Hospitals want technical experts. In their back offices there is plenty of room for improvement, he says.
"Because it's a transforming environment, the health care sector is asking for skills around change management, people leadership, getting people on board with change, driving efficiencies in business and improving procurement procedures."