Verrall Ayesha; Henare Peeni; Reti ShaneHon Dr AYESHA VERRALL (Labour): Thank you Mr Chair. Can I acknowledge my colleague from across the House and the chair of the Health Committee Sam Uffindell in guiding our newly formed 54th Parliament Health Committee through our first major undertaking as a committee which is the annual review process. We had the opportunity to dive deep with officials into the very important matters that my colleague has outlined. I do want to reiterate my colleague's point that we spent a lot of time on workforce and I do recall one of the answers to questions about Health New Zealand performance raised by a committee member was that it is the workforce which is the major limit on the health system's ability to meet its targets at present. So in that light I'd like to start with questions on the health workforce.In particular in the year under review a workforce plan was created that identified areas of the workforce where there were shortages quantified those shortages and identified key strategies in order to address them. Our largest workforce group in the health sector is nurses and we know that we have to increase the domestic training of nurses. In the year under review a plan was made that could have increased the number of nurses in training placements in New Zealand by a thousand. My question to the Minister of Health is: what updates has he had on progress with the ability to increase our training placements for nurses so that we can increase our domestically trained nursing workforce?Hon PEENI HENARE (Labour): Kia ora thank you Mr Chair. Just in support of my colleague my first line of questioning to the Minister of Health is also very similar in the vein of workforce. The committee heard with respect to Māori health outcomes the plan to stick to Whakamaua its principles its pillars in Whakamaua and how strong it was. One of the key pillars in there is of course the workforce in particular the Māori workforce—both those who are seeking jobs in the health profession but also for those who continue to support the likes of Māori health providers in the administration of their particular services within their community skills which are highly valued—and of course were recognised once again through the COVID-19.My question simply to the Minister is with respect to Whakamaua and the targets that it had on recruiting more Māori into the healthcare sector and secondly supporting those who do wish to go on to tertiary studies to study the likes of nursing degrees or to become doctors and specialists and surgeons within the sector. And finally with that particular Whakamaua report there was a Whakamaua strategy. There was also the intention to make sure that we are able to grow administrators Māori administrators through health and whether or not the Minister can give us a particular update on those. We note that some of the report back has been a little bit vague on Whakamaua and I'm asking the Minister if he can shed a bit of light on those matters.Hon Dr SHANE RETI (Minister of Health): Thank you Mr Chair. I'd like to thank the members for contributing to this debate which is for the period of 1 July 2022 to 30 June 2023. This is the first year of the health reforms which was completely in the hands of the previous Government and so substantively this becomes a critique of that work. I will do my very best to use independent resources to address questions and may well cluster various questions together to pass to my delegates so we don't come and go from the podium.First of all to set a context and a good context for this debate is the report of the Ministerial Advisory Committee for Health Reform Implementation which completed their work looking back over that year and it does see the context for this discussion. Some of the things that they have raised is the ability for the health system—this is in the period under review—to continue to progress workforce development:The organisations should build on the progress they have made to date to address immediate workforce pressures and workforce sustainability."—and I will come back to the member's question more specifically about health workforce."Continue to build enabling foundations": "Corporate systems are critical (and transformative) in enabling staff to do their job efficiently and effectively. The current HR systems infrastructure inherited by [Health New Zealand] consists of 200 … systems … and some [of those] systems are out of support and/or close to end of life.""Utilise the Joint Leadership Group (JLG) …": "The JLG does not currently routinely or systematically monitor progress of the reform. It should monitor a ruthlessly prioritised programme of work that is aligned to the Reform Roadmap but also key prioritised collective action items.""Coordinate the approach to addressing social determinants": "Socio-economic and rural issues contribute and compound existing inequities in health outcomes. A strong theme has come through from all three organisations (from system stewardship to local delivery) that there is a need to address social determinants and work proactively and systematically with wider government partners and other social sector organisations. Achieving coordinated and agreed national mandate"—I'll summarise some of these now. "It could be beneficial to establish a coordinated organisational and system level approach …"."Ensure the workforce understands what the transformation means for them and their role in it"—I think this is an important part of the health reforms in that first year and the goal towards success and the independent Ministerial Advisory Committee is pointing it out here as one of the issues: "It is important for the frontline to understand not just the vision but how the reform impacts them and what opportunities the new arrangements bring for new ways of working … There needs to be ongoing focus on workforce communications".There are a number of things further in this independent report that was commissioned and I want to acknowledge the chair and thank her for doing that.The health workforce summary that came out in July 2023 at the end of the period in review here had the following gap: 4800 nurses; 1050 midwives; 1700 doctors including GPs; 170 pharmacists; 120 stenographers; 200 anaesthetic technicians; 220 dental and oral therapists; 30 radiation therapists; and 30 clinical and cardiac physiologists.Now the question was around the health workforce plan and its implementation. This report and this plan—I believe it had 54 recommendations; I'd have to check that. But this plan came out July 2023 at the end of the period in review and so all I can say to that is that a number of the recommendations that were proposed are and have been implemented. I've already commented on the increasing number of general practice registrars but certainly the health workforce plan which is due for renewal has been the template and is the template that I'm still currently working with. And over the period of this debate I may well come up with further descriptions of exactly which parts of the plan are progressing and to what degree; it'll just take me a moment to get some information on that.I'd then like to move to the second question which was of progress on Whakamaua the Whakamaua: Māori Health Action Plan. To which I would say the same: at the end of the year 37 of the 46 actions are on track with no issues. Of the remaining nine actions four are completed four are being monitored and one is being rescoped. Quantitative indicators highlight continued inequities as well as improvements in some key areas including a substantial increase in funding to kaupapa Māori providers. Overall the ministry believes that the implementation of Whakamaua is on track. I hope this answers the member Peeni Henare's question."