New mental health and addiction targets have been included in the Government's policy statement on health, setting out a three-year roadmap for the public system. Photo / 123rf
Five new mental health and addiction targets and a nod towards possible alcohol law reform are among the revelations in the Government’s “challenging” three-year plan for the public health system.
The Government Policy Statement (GPS), released to the Herald, reveals how the coalition wants to improve health services in five priority areas - access, timeliness, quality, workforce and infrastructure.
That’s alongside a focus on reducing the impact of cancer, cardiovascular disease, respiratory disease, diabetes and poor mental health.
The five new targets concerning mental health and addiction included faster access to specialist and primary services, increasing workforce development and having a greater focus on prevention and early intervention.
However, it comes with the Government’s expectation Health New Zealand is financially sustainable and achieves an “operating breakeven or surplus position” against a budget in the neighbourhood of $85 billion, all while dealing with critical workforce shortages and degrading infrastructure.
Health Minister Dr Shane Reti and Mental Health Minister Matt Doocey admit their roughly 77 expectations across the priority and focus areas will be challenging to deliver on.
“We acknowledge that some of the expectations will be challenging to achieve over a three-year period but we are committed to achieving better health outcomes for all New Zealanders,” the ministers said in the GPS.
The GPS detailed what the Government wanted from the public health system between July 1, 2024 and June 30, 2027. Health NZ will later publish a national health plan articulating how the Government’s expectations can be met.
The Herald recently reported how the GPS covered about $27b to $29.5b of annual funding, or about $85b over three years.
Targets were at the centre of the Government’s desired health improvements. Five have already been announced - faster cancer treatment; better immunisation rates; shorter emergency department wait times; shorter waits for specialist appointments; and shorter waits for elective surgery. The new mental health and addiction targets were:
Doocey wasn’t available for an interview but Reti told the Herald the targets wouldn’t have been confirmed if they weren’t thought to be achievable.
He said Doocey would reveal more details about the targets shortly.
The 10 collective targets would sit alongside a focus on five diseases: cancer, cardiovascular disease, respiratory disease, diabetes and poor mental health.
“Together, these conditions account for around 80% of deaths from non-communicable diseases in New Zealand and considerable health loss experienced by New Zealanders,” the GPS said.
It identified alcohol, tobacco, poor nutrition, physical inactivity, and adverse social and environmental factors as five key factors that needed to be addressed if the impact of the diseases was to be reduced.
The reference to alcohol indicated the Government could be open to legislative reform in the area. Thus far, Reti hadn’t detailed any potential reform, aside from addressing the causes of Fetal Alcohol Spectrum Disorder (FASD).
Reti echoed his focus on reducing FASD but said any wider reform hadn’t been considered by Cabinet or coalition partners at this stage.
The GPS highlighted how Ministry of Health studies had shown Kiwis were not satisfied with the standard and delivery of public health services. However, it sought to manage people’s expectations.
“Given the range of challenges facing the health system, there is a limit to what changes the system can deliver over the next three years ... while being feasible within resources and system capability.”
Of the priority areas, workforce and infrastructure were among the primary challenges facing the health system.
The GPS said shortages existed across all professions, leading to “increasing attrition rates, workforce burnout, fatigue, emotional distress and job dissatisfaction”.
It acknowledged New Zealand’s reliance on medical professionals trained overseas. Since 2008, 43% of doctors had been educated elsewhere. The proportion of international nurses had increased steadily over the past decade from 25% in 2012 to 32% in 2022.
While the Government had set expectations of a more “culturally competent” workforce that better reflected New Zealand’s population, it said overseas health workers would be needed to “meet pressing needs”.
Infrastructure related to the country’s public hospitals being in “poor condition and no longer fit for purpose”, with outdated information technology systems unable to manage cybersecurity threats or support new health service delivery methods that were closer to home, such as telehealth.
The Government sought to address this by developing a 10-year national infrastructure and investment plan before the end of the year, as well as progressing virtual care initiatives.
Regarding access, the GPS pointed to the 2022/23 NZ Health Survey that found 13% of people had difficulty accessing primary and community care. Cost was a key factor, particularly for disabled adults, women and Māori, who were found to be more likely to not have visited a GP due to cost.
The biggest barrier was the time taken to get an appointment, with 21% of adults and 15% of children being unable to see a GP when they had a medical problem because the wait was too long.
Strategies to improve access included delivering immunisation services that met the needs of particular communities and stabilising the general practice sector.
The area of timeliness concerned elective treatment waitlists, which had grown from about 42,000 people in 2018 to about 75,000 people in September 2023, according to the GPS.
“In some places, people are waiting longer to access screening and immunisation services or home and community support services, particularly for older people. Wait times for accessing mental health and addiction services also continue to be a challenge.”
Prioritising quality referenced the Government’s intention to address health inequities. It used maternal, infant and fetal deaths as an example.
“Māori, Pacific peoples, Indian people, people under 20 years old, and people living in areas of high deprivation experience worse pregnancy and childbirth outcomes than the New Zealand European population.”
The GPS outlined priorities for high-needs people, highlighting Māori and how services should be “outcomes-driven” by moving decision-making and resources closer to communities, noting how Iwi Māori Partnership Boards would play a greater role in service delivery.
Life expectancy for Māori was about seven years lower than for non-Māori. There was no mention of the gap or how it might be addressed in the GPS.
Reti said a specific gap reduction target could be looked at in the future. However, he noted how it was an “all of Government” issue, given the social determinants of health like housing.
The GPS made it clear its expectations must be delivered with financial sustainability, given pressure to increase health spending was likely to rise as health issues became more complex with an ageing population.
“The health system needs to increase the use of evidence in decisions about how to get best value for money from existing resources and new investments to ensure the best use of resources over time,” it said.
“In the short term, to ensure the health system delivers on its commitments within budget and avoids running a financial operating deficit, entities need a strong focus on fiscal responsibility.”
It outlined how Health NZ would require approval from Reti and Finance Minister Nicola Willis before costs in hospital and specialist services were funded from underspends in other areas.
One expectation said Health NZ would deliver on “minimum service coverage expectations” while also achieving an “operating breakeven or surplus position against this budget”.
Adam Pearse is a political reporter in the NZ Herald Press Gallery team, based at Parliament. He has worked for NZME since 2018, covering sport and health for the Northern Advocate in Whangārei before moving to the NZ Herald in Auckland, covering Covid-19 and crime.
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