Health crisis - it's the term Andrew Little refuses to say and Shane Reti loves to. Advocate reporter Jaime Lyth sought answers on how far back issues with our health system go - and how to fix it.
Former Whangārei GP Shane Reti wants to be New Zealand's health minister and is ready to accept the National Party is at least partly to blame for the issue afflicting our health system.
The incumbent Minister of Health Andrew Little admits the issues are long-standing - and still exist five years into Labour's time in power.
While the current focus is mainly on Covid and the impacts it's having on our health system, the situation with which the system is grappling predates the pandemic.
A quick search through the Advocate's archive shows this.
"Late-winter woes are taking their toll on Whangarei Hospital," the Advocate reported in 2004, "demand for beds (is) almost outstripping supply as viral infections put a strain on health resources."
The New Zealand Nurses Organisation (NZNO) warned the Advocate "of a nursing crisis as primary healthcare workers flock to better pay with district health boards or overseas" in 2006.
Demand on the healthcare system and its workers continues to increase and the pandemic has further strained the struggling system.
But how did we get here? And how do we get out?
When did the crisis begin?
NZNO Northland organiser Julie Governor
"I believe since the 90s, which does coincide with the Employment Contracts Act changes to health. [There was] a huge loss in employment terms and conditions.
"This was the starting point where workers' rights were stripped back along with staffing. It was an immediate change.
"Over time it was stripping the fat out of the system that became leaner and leaner with no further investment and ever-expanding demand for the system."
Whangārei emergency doctor Gary Payinda
The radiology department at Whangārei Hospital often leaks when it rains - a state that has existed since Payinda began working there in 2007.
"The great irony is National really kept costs down for ... eight out of its 10 years. The percentage of government expenditure that was going to healthcare was held as a flat line.
"Of course, in retrospect, they were doing that by completely neglecting the system."
Whangārei GP Dr Geoff Cunningham
"Northland's problems have been quite unique and it started when our funding model changed 19 years ago.
"Our true costs run at roughly two times Consumer Price Index (CPI) every year and the amount we have our funding increased by the Government has for 18 out of 19 years has been less than CPI.
"As an end result the average income of a Northland GP, for nearly two decades, has been substantially lower than the national average."
Health Minister Andrew Little
"I don't know how long our system has been ... underfunded or under-resourced. But I do know that when we took office in 2017 there were some major long-standing problems.
"The investment in buildings, for example, had been under-par for a long time. We know that the funding itself had not kept pace with the growth in population and we know that there was a major shortage."
Opposition health MP Dr Shane Reti
"In my view, there's been a workforce shortage for decades ... and during a period of time in our hands as well."
It was a struggle to get doctors in Kaitaia when Reti was on the DHB in 2001.
"I can't explain or understand why, across multiple governments, we didn't turn on our homegrown domestic [health worker] pipeline."
How did Northland get here?
"I cannot cover all the reasons. However, it would have started with funding restrictions, growing bureaucracy [at MoH] and growing back-room to respond to the ministry."
The Ministry of Health's priorities have been "ever-growing and ever-changing" under different successive Governments for "political point-scoring", according to Governor.
"Multiple policy changes take time to consult on feedback and implement and educate on ... [it's] become so risk-averse that it brings the system to a halt and great ideas never come to fruition."
"[National] redistributed some of Northland's money, I think it was approximately $12 million, which isn't nothing in one annual budget, to less needy areas.
"We were the only DHB nationwide that they said ... you would have got this amount of money but we're going to reduce it because we think that's too much and give it to these other wider DHBs."
"We've been left with a legacy of major recruitment and retention problems in an area of incredibly high health need.
"GPs out here have got a far more difficult patient load. Patients are poorer, older and tend to have on average more diseases, more pathology, and [there is] a higher proportion of Māori with that sadly more disease.
"This Government looks to be wanting to radically change primary care and general practice does not feel as though we're part of that conversation."
"We have put a lot more into the hospital side of the health system and it's pretty clear to me we haven't put as much into the primary care side as we should do.
"The priority [of the reforms] is to be primary community care, if we're really going to make a difference in terms of access to healthcare, to make it more equitable and improve our health outcomes.
"It's actually what primary care is going to."
Opposition health MP Dr Shane Reti
"I will own everything we did that was good and not so good in those nine years [of National being in government] even though I might not have been there for the first six ... but this Government owns the last five, every single day of it."
"Here in Northland, like other smaller DHBs, we bear a larger burden in my observations around the health workforce trying to recruit and trying to retain people."
What do we need to do now?
"To immediately address the nursing shortage Health NZ/MHA needs to offer incentives to the nursing resources available to encourage them to pick up extra shifts until we can get more staff on board.
"Fast-track visas for overseas nurses to fill staffing shortages as we are unable to fill them with the nursing resources available to us.
"At the moment huge barriers exist for nurses wanting to bring immediate family over, causing overseas nurses to leave NZ and go to Australia where it is encouraged."
"Do we actually need almost revolutionary changes to improve primary care and hospital care in Northland? Absolutely.
"Are we getting that under Labour? Well, I don't know. I don't see it. But if you compare it to how bad things were under National - oh my goodness, it's night-and-day better."
"Ultimately, we can't attract GPs into the region because we can't compete for conditions and remuneration.
"The remuneration buys conditions obviously, you can afford to pay your doctors for paperwork time, you can afford to have more nurses on your staff.
"All of those things that make life a bit easier for doctors, but when you're working in Northland, you haven't got that luxury."
"The problems go back some time. The reality is we're in the situation that we're in and as a Government we've put considerable extra investment into health.
"We were spending about $16 billion a year on health when we took government. This year, we're spending $24b and we have a $7b building programme under way.
"That compares with $1b spent over the nine years of the last Government and we're still working to fill the vacancies that we have and what has been a pretty difficult international situation."
"First we have to change the immigration settings. It makes no sense that nurses wanting to come here have to wait two years for residency."
Reti also wants to see the domestic credentials of people with overseas qualifications fast-tracked.
"They're New Zealand residents, they've come here they've passed their NZ requirements and they can't get an intern position, we have to figure that out. They're already here for goodness' sake."
What's the long-term solution?
"The single health service, Te Whata Ora (Health NZ), is a great start along with the MHA, Te Aka Whai Ora (Māori Health Authority).
"[There should be] an audit of all roles to ensure they are aligned directly to community outcomes as opposed to feeding the bureaucracy."
"There is not a village in Northland that doesn't have either fast food, liquor or smokes on offer, very conveniently, within a few minutes' walk from the village centre.
"But you try to put a school nurse in there, or an alcohol and drug rehab facility, GPs or dentists ... there are none of these things. There's a drought.
"If we can put liquor store in every poor neighbourhood we could put a nurse in those neighbourhoods as well. And we were choosing not to do it."
"About seven years ago, there was a review called the Moodie report into GP funding, and it acknowledged that our funding model was beyond broken, it was grossly unfair, and beyond broken needed to change.
"With the hostilities that general practice is facing at the moment with the current Government, we have less than no confidence that we will get a fair funding model for general practice.
"What I see in the slightly longer-term future is eventually we do we have a range of services available in a single place. So not just the GP but the physiotherapist and a dentist and maybe a podiatrist.
"One of the features of the [Health NZ] reform process is what we're calling locality network planning. Community facilities where the specialist can go out and see people close to where they live as opposed to people having to travel long distances."
"We need to turn on our own domestic, homegrown, culturally competent doctors and nurses.
"The despair I have is that in the health budget four weeks ago, [there was] not $1 for one new medical school place in New Zealand ... which means there'll be nothing in the 2023 intake. There's no money for that. At best it will be 2024 before we start turning our own tap on."