Turia Tariana: Budget Debate 
Turia Tariana: Budget Debate 
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Hon TARIANA TURIA (Co-Leader—Maori Party) 
: 
 Tena koe Madam Assistant Speaker tena tatou katoa. I would like to thank Labour and National for allowing me to give my speech. Tena korua. 
The World Health Organization has revealed that we have broken another record. New Zealand has the highest ratios of foreign-born and foreign-trained doctors in the OECD countries and amongst the highest for nurses. As well as that it reports that the retention of health professionals is a key issue because attrition rates for doctors and turnover rates for nurses are so high. But it gets worse. The number of health workers who are actually New Zealand born has also deteriorated as they leave our shores for other lands. In fact the number of New Zealand-born nurses living in other OECD countries is matched by the number of foreign-born nurses in New Zealand. It is not just those who are currently in the system who are our concern. The 2005 study  
Doctors and Debt: The Effect of Student Debt on Doctors 
 revealed that two-thirds of respondents in the study stated they would consider leaving New Zealand within 3 years of graduating such is the level of pressure in the health workforce. 
The effects of a system under stress are felt in many forms. We have heard about the desperate shortages that are affecting waiting lists up and down the country. In the Auckland District Health Board region for example the average wait for treatment for heart disease has increased from 27 days in 2002-03 to 64 days now. We recall the litany of sentinel events—major medical mishaps or incidents; mistakes that in some cases cost patients their lives. The report of 182 serious and sentinel events showed us that if someone enters a public hospital he or she has a 15 percent chance of suffering an adverse event. In maternity health we know that 15 of the 21 district health boards say their communities are at least 85 midwives short. All of this in context leads the World Health Organization to conclude that New Zealand faces serious challenges with demand from health professionals set to outstrip supply by 2011. 
What can we do about the situation? Three years is not much time to overturn the health system. The 2008 Budget contained a mere $60 million to improve the health workforce—not much in the context of the additional $2 billion allocated to Vote Health. The Budget also included a specific allocation for Maori nursing workforce development and Pacific health provider and workforce development. I want to be quite clear that we in the Maori Party welcome the initiative to increase the numbers and skill base of Maori nurses and to develop and encourage secondary students to take a health career pathway. We are also pleased to see the support for Pasifika health providers included but our concern remains with the analysis put forward by the World Health Organisation which stated: “Despite the key role of the health workforce in the health system it has not been at the core of the various health system reforms in New Zealand.” Such a concern was mirrored by the comments of the New Zealand Medical Association which was extremely disappointed that the Budget failed to provide comprehensive funding to address health workforce shortages. 
We ignore at our peril the advice of our medical specialists and our health professionals. In March this year a pan-professional medical forum was called which concluded that the New Zealand medical workforce is in crisis because of its inability to train and retain enough doctors to provide the health services that New Zealanders deserve. We think too of the criticism from the New Zealand Nurses Organisation that the Budget failed to include wage increases for aged-care workers—those workers who fall into the lowest paid part of the health sector—or for Maori and iwi primary health care providers to be funded adequately so that workers will achieve pay parity with district health board professionals. It is little wonder that the World Health Organization warns that our health system is vulnerable and that the Government needs to take urgent action to address the chronic workforce shortages. 
There are some particular crisis points for Maori and Pasifika health workers. We know that Maori and Pasifika health workers are concentrated in less senior and less well-paid positions such as in the community work health promotion and health education fields. The Ministry of Health suggests that half of the full-time public health workforce earn less than $43000 per annum and most of these are Maori and Pasifika workers. Pay is important as are conditions but it is also vital that the health workforce is viable and has patient safety at its core. 
There is no shame in admitting that we are in a crisis and that we must call on all parties to turn the situation around. So where to begin in addressing an already stressed workforce? I think that this is an area where we can look to our communities—particularly to tangata whenua—for leadership. One of the areas in desperate need is that of recruitment. I have been extremely impressed by the programmes offered at Victoria University—Te Ropu Awhina Putaiao and Te Ropu Awhina Waihanga Hoahoa—which are the whanau support systems for Maori and Pacific nation students enrolled in science technology architecture and design. There is the work being led by the Auckland University of Technology with Nga Pae o te Maramatanga—the National Institute of Research Excellence for Maori Development and Advancement at University of Auckland—in expanding our knowledge about the participation and retention in the Maori health and disability workforce. For those practising doctors there is the intensive clinical training programme offered by Te Ohu Rata o Aotearoa—the Maori Medical Practitioners Association—and the Royal New Zealand College of General Practitioners to enhance the number of Maori doctors training as general practitioners. There is the network known as hauora.com which brings together Maori health professionals health providers and health workers to strengthen the capacity and capability of the workforce and there is also the excellent work being led by Health Care Aotearoa. Another Maori-led collaborative venture focused on workforce is Te Rau Matatini which is singularly focused on enhancing the capacity of the Maori mental health workforce in order to improve the health of Maori communities. In short Maori are providing huge leadership in the area of health workforce development and it is one that maybe the Government could look to. 
There are many excellent initiatives already in place that must be called on to recruit and retain staff. It is evident to all of us that the health workforce is under increasing and relentless pressure in our hospitals and accordingly the quality of the service provided is compromised. I know from my experience as Associate Minister of Health how willing Maori health providers and Maori health professionals are to share their networks their experience and their expertise to make the change happen. Calling on their leadership would be a big start in turning the crisis around. Perhaps then we will come to a time when the health workforce will be placed at the core of the health system. Kia ora.