by Rachel Smalley via Iride of the Kapiti Heath Action Group

The past few weeks have revealed our health system for what it truly is: a rudderless, wounded beast borne from a hierarchy of political mismanagement and apathy.

It is not a failing of our health workers. On the contrary, our nurses are slugging it out on the frontline, doing their best to counter a deeply flawed immigration system that has ripped a cavernous black hole in our health system.

No. It is a failure of the Ministry of Health and the Government to perform the simplest of undertakings: a horizon scan. Or perhaps they did?

Did the Ministry, in the process of managing our Covid response, identify emerging risks to the very structure of our health system? If not, why not? And if it did, why did it not act and implement a cross-government approach to mitigate those risks?

Staffing shortages

Today, our health system is short of 4000 nurses. That is a staggering shortfall that is, without question, costing lives. And it is a damning indictment on the Ministry of Health and this Government because it reveals a fundamental failure to lead, strategise, and plan ahead to counter the impact of its Covid response on the public health system.

It is true that Omicron and the winter ‘flu have played a part in staffing shortages, but they are short term. Our flawed immigration policy is what has truly devastated the sector, along with the Government’s stubborn refusal to accept the impact of its decisions.

If only, like the Australians, Immigration New Zealand had continued processing visas when our border closed. If only, like the Australians, we had offered nurses a direct path to residency. If only, like almost all of our peer nations, we had offered nurses a competitive incentive to come to New Zealand.

Jacinda Ardern is jetting off to meet with NATO and hold a series of meetings on security issues, including Ukraine. It cannot be lost on the Prime Minister that just as she leaves, our health system is shifting into an operational environment akin to wartime conditions.

Capital & Coast District Health Board MAPU unit healthcare assistants.

Media reports of incidents increase

Staff within the sector speak of a system at “breaking point” Senior specialists have told me they are “fearful of the months ahead” and patients are waiting months for elective surgery, oncology, and screening appointments. In the media, the stories of suffering and untimely deaths are beginning to filter through.

This week, Stuff published the story of a pregnant woman who was told her daughter had died in her womb. The woman was sent home because of staffing issues at Wellington Hospital. It was two days before she could return to deliver her stillborn baby.

It followed the story of a woman who presented at the emergency department of Middlemore Hospital with a severe headache. She left after being told it was an eight-hour wait to see a doctor. Three hours later, the woman returned in an ambulance. She later died from a brain bleed. She was my age.

And this week, the Capital and Coast and Hutt Valley DHBs cancelled all planned surgeries for a month. One orthopaedic surgeon said it would affect hundreds, if not thousands, of patients.

The list of cancelled surgeries in Wellington is extensive: hip replacements, back surgery, shoulder replacements, knee replacements, hysterectomies, hernias, gallstones, endometriosis procedures, vasectomies, tonsillectomies … and so it goes on. They have all been pushed out by a month because of staff shortages.

One surgeon said he could still perform hip replacements but he had cancelled every procedure because there were no nurses on the recovery ward.

The Prime Minister says the nursing shortage is a global issue but her government’s response can only be described as that of an interested bystander. Neither the Ministry of Health nor Immigration New Zealand have provided what Kiwis are usually pretty good at: finding a New Zealand solution to a global issue.

Instead, we’ve watched on as Britain, Canada and Australia have structured targeted schemes to attract the world’s nurses, including our own, to their shores.

Cruel irony

It is a very cruel irony that we have allocated billions to our Covid health response, but it is at the expense of investment in the everyday, critical health needs of Kiwis.

This situation was avoidable.

I interviewed Ananish Chaudhuri, Professor of Experimental Economics at the University of Auckland, this week. He has taught at Harvard Kennedy School, Rutgers University and Washington State University too.

His just-released book, ‘Nudged into Lockdown? Behaviour Economics, Uncertainty and Covid-19’ looks at the decision-making that drove New Zealand’s Covid-19 response.

Professor Chaudhuri believes the aggregate cost of lockdowns will ultimately lead to a greater loss of life than the virus.

He writes: “…worldwide, there was tremendous emphasis on calling upon epidemiological expertise without an adequate appreciation that Covid-19 was not merely an epidemiological crisis; it was an economic, social and moral crisis that required multi-disciplinary expertise to assess and address different facets of the pandemic.”

The election factor

Under this Government’s leadership, it is unclear whether we will ever consider what we could have done better, or the impact of lockdowns on public health, the economy and society. The Prime Minister has shown a reluctance to look in the rear vision mirror. There is an election next year, after all.

Instead, the Government says the new Pae Ora (Healthy Futures) Act is a once in a generation chance to reconfigure our public health system and it will address many of the issues raised here. Will it? It comes into effect in a matter of days and quite what it will achieve – and by when – is anybody’s guess.

There are some harsh truths we need to face but it will take bravery, transparency, and honesty on the part of this Government if we are to do so.


 Rachel Smalley is a weekly columnist for NBR and the 5am-6.30am host of First Light on Today FM.