What a sustainable workforce looks like

The plan highlights changes to models of care and service delivery models as tools to make better use of our workforce, alongside the need to grow it. There are some things to consider when we talk about changes to models of care or service delivery models.

• We know growth is needed. New care models can ease pressure, but will not replace the need to grow our workforce, especially in specialist areas.
• We need to use our workforce better. Shifting tasks across different roles can be more efficient and help support workforces that are harder to expand.
• 'Top of scope' practice means freeing up time for high-impact work, allowing for safer, more productive care. It is not about asking staff to work harder.
• Change must be clinically driven and led. Clinical networks will lead these changes, and they must be safe and evidence based.

In this plan we refer to, or explicitly identify, needed model of care changes in a range of service areas. In most cases we do not outline the model in detail. This is because we still have to design these models based on clinical expertise.

Shifting to new models of care will take time, and may change what we ask of our workforce in some services, including:

• rosters
• workforce and skill mix
• what kinds of services are delivered in different places.

As we shift to these models, we will ask our people and unions to come with us in working differently, and work through in partnership the implications for:

• the work environment
• terms and conditions
• how we deliver care.

We need ongoing workforce growth across our health system to provide New Zealanders with exceptional care. In the past most investment has gone to hospital-based roles, but now we must shift toward:

• public health
• primary and community care
• early intervention and prevention services.

This shift helps people stay healthier and reduces future demand for hospital care.

Growing these services requires a workforce to match. To make this shift possible, we need to:

• improve workforce planning in the community sector
• support growth in funded services
• grow workforces focused on public health, primary care and community care
• target long-term conditions
• empower whānau to care for preventable and long-term conditions at home.

For a sustainable health workforce, we need to change a few things about how we work as a health system today. We need to:

• better value our people’s time, making work more rewarding and efficient so staff can focus on quality care
• grow our workforce across a range of areas, some long-term, some immediately
• increase growth in our primary and community workforce over time
• make sure our workforce models have more focus on prevention, public health and early intervention
• manage workforce costs, so while our workforce grows, we continue to live within our means
• build teams that reflect the communities they serve
• tailor care to meet the needs of high-need groups
• strengthen skills in customer service, compassionate care, and advanced technology for a consistent experience
• make sure staff are equipped for modern, complex care environments.

Before we can reshape our health system, we need a clear picture of our workforce. That means knowing:

• what care New Zealanders will need in the future
• how we will organise services and staff to meet that demand
• what skills and roles we currently have, and what we are missing.

The Health Status Report helps outline future care needs. But we still have work to do to define what future health services will look like.

Our workforce data is imperfect.

• There are gaps in workforce data. Especially in primary and community care roles not covered by registration systems.
• Shortage estimates are rough. These are based on Health NZ vacancies, which do not always reflect true need.
• Future projections assume we keep working the same way, even though this plan calls for change.
• Models rely on assumptions about population demand and care delivery that may not hold true.

Over the next 3 years, we will improve the quality and scope of workforce data so future planning is more accurate and responsive.

Productivity measures the output from a set of resources, such as:

• people
• technology
• infrastructure
• knowledge
• the quality and safety of care provided — if measured properly.

Improving productivity requires a range of shifts across our services, including:

• using technology to treat people more effectively and closer to home
• centralising specialist services to improve efficiency
• better balance of investment in tools and infrastructure to support care in primary and community settings
• expanding digital tools to help patients easily move through the system
• hiring more permanent staff to reduce reliance on temporary workers
• reducing admin tasks so staff can focus on patient care
• adopting new medicines and technologies faster.

These efforts are part of the broader New Zealand Health Plan, which aims to grow the workforce and improve how we deliver care.

Hiring more health workers is essential, but we must do it in a sustainable way.

The health workforce plan states that having enough staff leads to safer, better, and more affordable care.

Evidence on the relationship between workforce sufficiency and health system expenses is limited. But we know that it is expensive having an unsustainable workforce.

Why not having enough staff costs more

• We need to fill gaps with short-term supply. Such as hiring locums at higher rates or paying over-time and other benefits to employees.
• Replacing staff adds training and recruitment costs. This often leads to a less efficient skill mix in our clinical teams.
• Shortages disrupt teamwork — missing only one person can stop procedures like surgeries.

Sick leave adds up — one extra day per worker per year costs about $50 million.

A more diverse health workforce leads to better, fairer care for all New Zealanders. But our health workforce does not reflect the diversity of our communities.

• Māori and Pacific peoples are underrepresented across all workforces, except kaiāwhina and support roles.
• We have poor data on the proportion of our workforce who identify as disabled, tāngata whaikaha or whānau haua. This makes it hard to measure how well disabled people are represented in our workforce. But we know they are consistently underrepresented.
• Asian communities are inconsistently represented in the health workforce. The aggregation of ethnicity data to 'Asian' disguises significant under-representation for some communities.

Why this is a problem

• Care decisions may overlook the needs of diverse communities, leading to poorer outcomes.
• It is harder to provide culturally safe care that respects people’s backgrounds and preferences.
• People may avoid seeking care if they don’t see themselves represented in the workforce.

Improving workplace culture and staff capability is key to better healthcare. Te Mauri o Rongo | The New Zealand Health Charter lays out the pou or values that are important to us. We aim to embed across the health system to support strong, team-based work environments.

We will be looking to address these challenges through this plan over the short- and long-term:

• poor culture in some teams due to staffing shortages or weak leadership
• a need for more collaboration and best-practice teamwork
• gaps in skills, especially in digital tools and technology
• pressure to reduce support roles while keeping specialist skills to help frontline staff.

Staff surveys show a 3% increase in workplace culture and engagement. Real scores remain low in areas which matter to us a lot, so more progress is needed.

Strengthening culture and capability will help deliver safer, higher-quality care for patients and whānau.