Verrall Ayesha; Reti ShaneHon Dr AYESHA VERRALL (Labour): Thanks to the Minister in the chair Shane Reti for that opportunity. The issue here is that one of the benefits of having Te Whatu Ora our largest employer in the country being able to flex its muscle when it comes to getting what it needs out of the education sector was the opportunity to turn around to the Tertiary Education Commission and local training organisations and to say This is what your community your country needs." and we did that work in 2023. We have an estimate of the number of nursing placements we need to grow our domestic workforce. There is a commitment in the workforce plan to have an increase of approximately 1000 nursing placements around the country and I'm surprised that that would've dropped off the radar of the Health New Zealand workforce plan because this is a critical workforce. Having domestically trained nurses is an incredibly important issue for us because of the nursing shortage but also because—and this is a second question for the Minister—there have been recent reports of challenges of absorbing further internationally qualified nurses into the sector.So my second question for the Minister is: what is his view on those reports? There has been substantial international recruitment of nurses. Is his view that that is an avenue that needs to continue at its current volume or should we be switching to a greater focus on domestic training?Hon Dr SHANE RETI (Minister of Health): Thank you Mr Chair. Those are very good questions. First of all I'm on record as saying that I believe that what we should be doing and the ambition we should have for our health workforce is to grow our own homegrown culturally competent doctors and nurses. I'll know in a moment if those plans changed in any way over the period under review.The question of internationally qualified nurses (IQNs) during the period of review: there was a slow ramp-up. Outside of that period there has been a substantial change. We do need to have some caution here now around several areas: first of all that the internationally qualified nurses that we bring in are qualified to actually meet some of the positions that we have. I can recall a news article a few weeks ago: I think it was an emergency department (ED) in Invercargill saying they've had multiple internationally qualified nurses apply for an ED job but none of them were actually qualified to meet that requirement. It would also create a challenge if our internationally qualified nurses were to squeeze out our domestic supply in any way; surely they must have preference.So certainly in the period of review what was happening was the Green List the pathway to residency had just been turned on I believe in the previous December and that had shown an increase in internationally qualified nurses. And don't get me wrong; I'm very grateful for them. We wouldn't be able to do what we do without our IQNs or our international medical graduates. We have been very dependent on them and we will continue to do so. It was after the period in review that there was a significant ramp-up and the question the member is raising is actually a question between institutions—Health New Zealand Immigration New Zealand—as to what a future path might look like. But certainly in the period of review we were still ramping up IQNs after the pathway the Green List to residency had been created."