A breakdown of the main political parties' major policies - compiling all you need to know. In the third of our limited series, we look at what could be done to tackle the healthcare crisis.
Video / NZ Herald
The Herald’s political and specialist reporters examine the big issues facing New Zealand and how the main political parties plan to deal with them. Today, Isaac Davison looks at health.
Healthcare is usually among the top concerns for New Zealanders leading into an election, but has been overtaken by the cost of living, crime and housing.
Chronic doctor and nursing shortages mean the fragile state of the system is now more visible. Some patients are waiting weeks to see their GP, hospital wards and emergency departments are heaving, and there are long wait lists for surgery.
While the sector limps along, the biggest health reforms in a generation are taking place. The 20 district health boards have been scrapped and replaced with a single, national entity, Health NZ/Te Whatu Ora, and a dedicated Māori agency, Te Aka Whai Ora.
The rollout of the reforms will take years, but there have been glimpses of some of the potential benefits – in particular the initial moves to address the “postcode lottery” for some surgeries.
Te Whatu Ora is still unable to produce up-to-date national health data, but the most recent available figures show nearly all key indicators – immunisation, wait lists, cancer treatment – heading in the wrong direction or flat-lining. The Government claims at least one of those indicators – people waiting over a year for surgery – is now improving.
The central issue for the health system remains the lack of staff. The problem has been building over successive governments but was turbo-charged by the Covid pandemic as New Zealand’s steady pipeline of foreign doctors and nurses was shut off.
All parties say they will fill workforce gaps, but their plans differ in method, scale and timing.
National would train an extra 225 doctors a year by 2030, partly by establishing a new medical school at the University of Waikato – a plan previously rejected by the Labour Government. The new med school – a graduate-entry, four-year course – would supply 120 more doctors a year, and the other 100 would come from existing schools in Auckland and Dunedin. National would also offer incentives to nurses who stay in New Zealand after they graduate.
Dr Shane Reti, the National Party's spokesman for health, wants to build a new medical school, lift immunisations, and reintroduce health targets. Photo / Bevan Conley
Labour would train more doctors, more quickly – 335 extra a year by 2027 – by boosting the capacity of the two existing medical schools. It also wants to ensure 300 graduates (out of around 875) head into general practice to address chronic shortages in that sector. Both major parties would offer incentives to doctors who work in the regions.
Labour’s manifesto has a special emphasis on universal, preventative healthcare, with promises of free dental and cervical screening and raising the breast cancer screening age from 69 to 74 (matching National’s policy).
Labour's health spokesperson Ayesha Verrall has promised more medical graduates, free dental care for under-30s and a $1 billion funding increase for Pharmac. Photo / Mark Mitchell
On the preventative front, National wants to lift immunisation rates by offering bonus payments to GP clinics which increase vaccinations within their clinics. It also wants to reinstate a national health target for immunisation, along with four other targets (health targets were scrapped by Labour).
The Greens go much further, promising fully-funded care for all illnesses and injuries, including GP and dental checkups, aged care, ambulance and emergency services, mental health services and palliative care, all paid for with a wealth tax. The party would overhaul ACC and create a new comprehensive care system which pays 80 per cent of the minimum wage for anyone who cannot work because of injury or disability.
The Māori Party also wants free primary and dental care but would limit it to low-income families. The party would massively increase funding for the Māori Health Authority and create dedicated mental health and ACC services for Māori.
However, the Māori Health Authority will not survive a change in government, with National, Act and NZ First all promising to scrap it. National would also reduce the powers of influential iwi-Māori partnership boards, which have a say on local healthcare plans.
While the Government has made huge investments in lifting pay for hospital nurses and is negotiating pay rises with senior doctors, GPs and community nurses say they have missed out. General practice warns of a looming crisis because of an underfunded, ageing, burnt-out workforce. One report showed the sector needed $600m more a year to address unmet needs.
The Labour Government says it is looking at the funding model for GPs, but has not made any promises in its manifesto. Act and NZ First have both promised an increase in funding for general practice. The Greens and the Māori Party want to review the way GPs are funded, saying it does not properly address social and ethnic inequities.
Several parties want change at the bulk-buying drug agency Pharmac, which procures subsidised medicines for patients.
National would boost Pharmac’s funding to allow it to fund 13 cancer treatments that are available in Australia. It would pay for this by reinstating the $5 fee for prescriptions.
Labour has also promised an increase: $1b over four years, including $200m for new treatments. It is critical of National’s approach, saying the independent agency should not be told by politicians what drugs to buy.
The Māori Party and NZ First also say they would lift Pharmac’s funding, while Act wants the agency’s operating model to be reviewed.
As Covid’s shadow retreats, no party has promised any pandemic-related measures. NZ First is the only one to mention Covid in its manifesto, saying it will rehire unvaccinated health workers and pay them compensation.
Increase medical school places by 335 by 2027 and nursing places by 700 next year
Increase dental and psychiatry places and settle midwives’ pay equity claim
Free dental care for under-30s, introduced gradually between 2025-26
Free cervical screening for 25-69 year-olds
Raise free breast cancer screening age from 69 to 74
Implement a national endometriosis action plan
Cap number of vape stores to 600 licensed stores, with stricter advertising requirements and penalties
Build a new hospital in Hawke’s Bay
National
Reintroduce national health targets for ED wait times, cancer treatment, immunisation, specialist wait times and surgery wait times
Pay GPs $10 per patient if they lift immunisation rates by 5 percentage points
Reinstate $5 prescription fee, use income to pay for 13 cancer treatments not available in NZ
Pay nurses and midwives up to $4500 a year for their first five years if they agree to stay in NZ for five years, and make it easier for foreign nurses to come to NZ to look for a job
Lift medical school places by 225 a year by 2030 by establishing new medical school at Waikato University
Scrap Māori Health Authority and reduce power of iwi-Māori partnership boards
Greens
Universal, fully funded care for all illnesses and injuries, paid for through wealth tax
Transform ACC into a comprehensive care system, paying 80% of minimum wage for anyone who cannot work
Implement remaining recommendations of He Ara Oranga mental health inquiry and integrate mental health services with social services
Implement recommendations of the 2021 Pharmac review and ban direct-to-public marketing by drug companies
Phase out alcohol advertising – except at point of sale – and alcohol sponsorship
Act
Order an independent review of Pharmac’s operating model
Pay private practices to carry out elective surgeries through a competitive tender
Redirect $2b in annual mental health funding into a centralised commissioning agency which will be in charge of assessing patients and contracting with providers
Create easier immigration pathway for doctors from similar jurisdictions
Increase GP funding by 13 per cent
Te Pāti Māori
Free primary and dental care for whānau earning less than $60,000 a year
Māori Health Authority funding lifted to 25 per cent of total health budget
Create a Māori Health Card which allows funding to be tied to the patient, not the provider
$1b to train more doctors, nurses and medical staff and train non-clinical staff to do clinical tasks
Establish a dedicated Māori mental health service and free mental health care for all
Establish a dedicated Māori Accident Compensation Authority
Drop cancer screening age for Māori by 10 years
Lift Pharmac funding
Accelerate and protect Matauranga Māori models of healthcare
