Health workforce plan 2024 context

The Government sees workforce as the biggest opportunity to improve healthcare.

The Health Workforce Plan 2024:

• sets out how we will grow and support the health workforce over the next 3 years and build long-term sustainability
• has a national focus to grow workforce capacity across the country, not just redistributing it
• covers the whole health system, not just Health NZ
• supports the workforce goals of the New Zealand Health Plan
• aligns with the Ministry of Health’s strategic framework and the Pae Ora (Healthy Futures) Act 2022.

While we have more control over our own workforce, we use contracts and funding incentives to influence community services.

Health system

'Health system' means all healthcare workers. This includes Health NZ employees and those working in funded providers such as:

• general practices
• agedcare facilities
• Māori and Pacific providers
• rural hospitals.

Primary and community care

'Primary and community care' covers workforces employed in the primary and community sector. These services are mainly funded by ACC and us. We include our rural hospitals in this group.

The private sector

When we refer to the 'private sector', we mean private hospitals that get significant funding from private health insurance. This workforce is not the focus, but we acknowledge the workforce overlaps.

A sustainable health system depends on a well-supported workforce that:

• delivers better care, closer to home
• reduces wait times
• is prepared for future challenges like ageing populations and climate change.

While the workforce has grown, productivity has not kept up. This highlights the need for smarter planning and new ways of working. To improve, we must:

• improve the quality of our data and analysis of the health system's workforce need
• share better data across sectors, such as education and immigration, to meet demands
• adapt care models faster
• invest in workforce growth and our workplaces
• realise the benefits of economies of scale and make the most of the workforce we have across the country
• work with global markets to deal with healthcare worker shortages, instead of competing against them.

We need to improve to keep our high-quality workforce and improve the healthcare for New Zealanders.

Since 2023, we have moved the dial for our health workforce in some areas — which has shaped our approach to this plan.

Improved nurse staffing

We made major progress to close gaps in our general nurse workforce. This was due to many internationally qualified nurses joining our workforce. While we still have need in some specialist nursing roles, we do not have significant general nursing vacancies. This growth has been greater in our hospitals than in primary and community settings.

2023

• 26,505 nursing FTEs working for Health NZ.
• Estimated 10.8% vacancies.

2024

• 29,400 nursing FTEs working for Health NZ.
• Estimated 6.8% vacancies.

Changes in immigration

In early 2023 we had relatively higher net migration of nurses to other countries. Since then, easier pathways through our immigration system have opened for overseas-trained health workers to move and work here. We have likely seen some slowing of post-COVID outbound migration of health workers, though this is hard to measure.

Stabilised allied pathways

We have expanded training pathways for several small, critical allied professions, including anaesthetic technicians and oral health therapists. This reflects both 2023 interventions, and the fruits of previous changes to training pathways, and puts us in better stead for 2024.

We expect many of the trends identified in the 2023/24 Health Workforce Plan to continue over the next 10 years. These shifts will reshape how we deliver care and what our workforce looks like.

Demographic change

Our population is aging and getting more diverse. This means people will be sicker on average, both acuity, how unwell people are, and care volumes will grow. This will impose a greater burden of disease on our health system

We expect more of the population to have long-term conditions, including:

• cardiovascular conditions
• cancer
• mental distress
• illness
• addictions.

Workforce change

Our workforce will get older on average alongside our population.

As other countries deal with the same challenges and developing nations improve their health systems, we may see:

• fewer international recruits
• more overseas efforts to attract our skilled professionals.

This means we will need strong strategies to grow and keep our own workforce.

Technological change

As our population changes, so does the technology around us. Artificial intelligence (AI) and robotics are becoming more common, and both private and public health sectors are starting to adopt them.

We expect technology to support our workforce, not replace it. We see it helping with:

• repetitive or unpleasant tasks
• complex decision-making and triage.

These tools will increasingly shape how health services operate, offering new ways to improve care and efficiency.

Reporting on progress

Each quarter we will report our progress on each of the initiatives in our plan — starting quarter 1 2025.

We will share detailed plans for each initiative in our first report. We will also include timelines for when we aim to complete key steps.

What good looks like

We will track key outcomes over time to make sure workforce initiatives are working. Most workforce changes take a while to show results.

• We can quickly deliver retention initiatives. They often rely on changing culture or how we work — which are usually gradual, slow shifts.
• Immigration is our fastest way to grow the workforce, but still takes 12 to 18 months to add capacity.
• Most training takes at least 3 years to produce new graduates.
• Updating models of care also takes time. We need to make sure they are safe and clinically appropriate.

Given this, the workforce plan will not solve shortages by 2025 or even 2027. Instead, success will be measured by long-term sustainability. By the next plan:

• the impact of changes we have made will show in our models of future supply — showing an improved picture
• we expect to see fewer vacancies in priority areas where we have focused our attention — this may be small compared to what we expect over the next 5 to 10 years.

Over time we will add more detailed measures to track progress, like workplace culture and productivity.

Alongside our Health Workforce Plan, we are working to improve our services and strengthen other care enablers. This work is outlined in the New Zealand Health Plan, but here are some of the most important ones.

Primary and community care

We are working with the primary and community sector to shape the future of care delivery. This includes:

• reviewing major contracts to better align funding, workforce needs and influencing growth
• improving communication and planning between us and community providers.

Clinical services planning

Our services were organised based on former DHB decisions about what kind of care should be available where. Some of those decisions no longer make sense as a national health service, and do not reflect our regional model. We aim to:

• reassess how hospital and specialist services are distributed across the country
• build a national model to make sure the right services are available in the right places
• balance generalist and specialist roles across urban and rural settings.

Clinical networks

We have created networks across a range of conditions and care pathways. These networks let clinical leadership improve models of care and outcomes over time. Over time this will improve whānau outcomes and shift workforce expectations.

Digital improvement and innovation

We are working on making better use of technology to improve healthcare. This includes:

• upgrading outdated systems and introducing new digital tools
• supporting remote care and specialist input from afar
• reducing administrative burden to free up staff for quality care
• fixing core systems like payroll and rostering for better accuracy and flexibility.

Iwi-Māori partnership boards

Iwi-Māori partnership boards are mandated under the Pae Ora (Healthy Futures) Act 2022. They represent local iwi and Māori in specific rohe across Aotearoa New Zealand.

Iwi-Māori partnership boards are still forming and shaping their plans for care in their rohe. There are significant opportunities for us to partner with boards on local Māori workforce development.

Infrastructure planning

With rare exceptions, most of our health workers need somewhere to work to deliver care. We aim to:

• address ageing facilities that limit care delivery
• building better work environments to support staff wellbeing and productivity
• make sure physical spaces help excellent care, not hinder it.