NZ Herald: Health NZ unveils plan, Te Pae Tata, to tackle wait times, worker shortages with range of ‘performance measurements’


This article was written by Michael Neilson for the New Zealand Herald. Published October 27, 2022. To access the original article, click here.

The Government has unveiled an “initial” health plan to guide the new system it says will tackle everything from hospital capacity and surgery wait times to workforce shortages.

The National Party meanwhile has criticised it as little more than a “discussion document” and asked where the “action, dates and accountability” are.

Te Pae Tata includes a vast array of expectations and “performance measures”, covering everything from addressing inequities for Māori and Pasifika to immunisation coverage and accessing specialist care.

The performance measures appear similar to the concept of “targets”, promoted by the National Party, but with a differing approach to accountability and enforcement.

Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority came into being on July 1 this year, replacing the old system and centralising the 20 district health boards.

Te Whatu Ora chair Rob Campbell said Te Pae Tata was an interim document to cover operations over the next two years while a broader health plan was developed.

He said it “marks a new level of transparency and accountability for the health system”.

The benefits of the new system would “take time to be realised”, Campbell said.

“But the changes we start in this interim plan build a momentum where working as one system, with our workforces, our providers and our partner agencies becomes the platform for innovation, changes and excellence.”

The plan unveiling comes amid major pressure on the health system.

New data shows one in four people waiting over six hours to be seen in emergency departments.

Across the June quarter in MidCentral DHB just 54.8 per cent of patients were seen within six hours, and Capital and Coast 56.2 per cent.

Nationwide the figure sat at just over 76 per cent – down from just over 90 per cent in June 2020 as the Covid-19 response ramped up.

In 2009, the then-National government implemented a Shorter Stays in Emergency Department target of 95 per cent of patients being admitted, discharged or transferred within six hours.

While Labour officially dropped this target, it has kept track of the measurement.

Pressure meanwhile is being applied across the entire health system, with tens of thousands of people waiting for planned – or non-urgent – surgery, with wait times worsening due to the Covid-19 pandemic.

In June, there were over 35,000 people who had been waiting longer than four months for surgery, nearly triple the number there was in December 2019, just before the pandemic.

The number of people waiting longer than 12 months for a first specialist appointment – after being referred by their GP – has increased over the course of the pandemic by 17-fold, from 253 to 4255 patients.

A Planned Care Taskforce, set up in May to address these pandemic-related backlogs, on Tuesday delivered 101 recommendations to Te Whatu Ora/Health New Zealand to cut surgical wait times – but no targets for when they would be achieved.

The figures and announcements also come as pressure mounts over the death of a 4-year-old boy in a Wellington hospital last month.

National Party health spokesman Dr Shane Reti said it was unclear how today’s plan would address the current challenges.

“What we need is a crisis plan with clear actions and targets.

“If you are waiting seven hours in the emergency department I am not sure how this plan is going to help you.

“I just see increasing confusion.”

Reti also questioned the “performance measures” and how they related to the 12 “health indicators” from last year.

“This comes after [Health Minister] Andrew Little derided the concept of using targets.”

Reti has advocated for a return to using clear targets that are publicly accountable. Little has criticised these, saying with punishments attached they could lead to “gaming” of the system with true results covered up.

Reti said he agreed poor performance should not be punished with funding cuts.

“The most important part is making them publicly reportable, brings management into compliance. But you also need to have the people and then give them the tools and the policies to succeed.”

Little said today’s plan would guide national service coverage and nationally consistent operating policies.

“This plan puts into action the Government’s record investment in health from Budget 2022,” Little said.

“This Government has increased health spending by more than 40 per cent, to $24 billion, since coming to office in 2017.

“The plan has been put together by clinicians and health experts and sets out the range of tasks that will be taken over two years to strengthen hospitals, primary care and tackle the longstanding challenges including workforce shortages.”

National has committed to not cutting any health funding and maintaining it in line with inflation.

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