Reti ShaneDr SHANE RETI (National): Thank you Mr Chair. The National Party desires to recognise the importance of the health workforce across the health sector by requiring the formation of a health workforce strategy. One of the key rate-limiting factors for today's health system—which as we speak has cancelled surgery at Auckland and Christchurch hospitals—is a lack of health workforce. During the peak of Alpha Delta and early Omicron it was a lack of ICU nurses that became a key rate-limiting step. Protecting the health system was code for protecting ICU beds and the 5.2 ICU nurses required for each ICU bed. New Zealanders paid a high price for a shortage of ICU nurses. Surgeries were cancelled so that unexpected delivery to ICU didn't happen. Travel restrictions occurred firstly to assist infection control and secondly to reduce road accidents ending up in ICU as well.Today we have a health workforce crisis in nearly every part of health. In terms of GPs we're 500 short and there's a tsunami of soon to be retiring general practitioners. Senior medical officers 1500 short; registered nurses thousands short; and aged residential care nurses a thousand short. We sought to change in our Supplementary Order Paper the part of this bill that looks specifically at six parts of the health workforce that we think need to be attended to. We were keen to do this very quickly in the first 100 days which is almost as long the Minister let the Pharmac report sit. In the first 100 days we would be looking to bring in information and actually enact a policy that would be implemented within the first year.The first point we're looking at doing is an assessment of the current state of the health workforce. The second point is to provide pathways in collaboration with relevant agencies such as Immigration New Zealand to improve our immigration settings. It is still unclear to me whether someone who comes in on the recently announced immigration pathway to residency—like a nurse on a two-year pathway—is committed to staying with the one employer or not. We would appreciate some clarification of that.We would be providing pathways for international medical graduates who are already in New Zealand and driving Uber Eats—how can we allow that? How can that happen? How can we allow qualified doctors who have sat their New Zealand Registration Examination and paid a large amount of money to do so not find a pathway into postgraduate year (PGY) 1 and PGY2? That seems disingenuous to take their money and know there is no hope for them to go into their intern years. Maybe we need to look at saying If you pass NZREX we guarantee and commit to an intern year." The same with the many nurses the hundreds of nurses who are here—well qualified and a $10000 competency assurance examination becomes the hurdle. Surely we can figure out a way for that.No. 4: we would provide pathways to increase the number of graduates turning on our domestic pipe so we have more culturally competent practitioners that we've grown ourselves. No. 5: we need to take into account urgent workforce requirements for senior medical officers GPs critical care nurses the rural care space and the aged residential care sector as a whole. The sixth point we need to take into account for a health workforce strategy is that we clearly need to focus on pay equity and when the DHB pay equity negotiation goes through I have grave concerns for aged residential care. Then there's pay parity: the issues we have with registered nurses out in the community community nurses GP primary care nurses and again aged residential care nurses. Then there's primary-care funding. The health workforce cannot stand alone. It must look at primary-care funding. General practice is broken. The gateway to expensive hospital care and what many believe including myself—and indeed this bill is a key solution. The propensity for primary care to do more to keep people out of hospitals and to reduce the length of stay—how can we do that when there is no alignment of funding with costs funding with complexity and any funding that takes into account the high-quality provision of care that general practice brings?This Government has shown its real intent around general practice funding in an advertisement a few weeks ago requesting that GPs and other primary-care practitioners contribute their time to help the Government figure out what the health reforms look like and to do it for free. To put aside full-time equivalents to do for free what the Government hasn't figured out is a disrespectful embarrassment to primary care and shows their real intent. This part of the bill needs a health workforce strategy and the National Party will stand for that."