Te Oranga| Health care and social assistance

Horopaki | Situation

The Health Care and Social Assistance sector is a fundamental service all Cantabrians rely on for their physical and mental wellbeing. It is also a sector that is experiencing ongoing pressure to meet increasing demand and expectation within the population. Demographic shifts in age profile, ethnicity and geographic spread are changing the way we need to think about the provision of healthcare services.

A masked female health worker holds a patient’s hands

Nationally we are seeing a move to provide better and more equitable health outcomes for all New Zealanders and to move the balance from treating illness to more of a holistic focus on an individual’s health and wellbeing. We know that within New Zealand there are significant differences in the health outcomes experienced by different demographic groups and the challenge to address this for everyone is clear.

In Canterbury the Health Care and Social Assistance sector is both a major employer in the region and is also one of the key services that people look for when considering migrating into the region. The sector employs nearly 11% of the Canterbury workforce and provides 36,125 jobs (as at 2021). The sector is also rapidly growing and over the past five years to 2021 grew at an average rate of 2.6% pa, compared to 1.1% pa average growth rate in employment across Canterbury as a whole. We know that this growth is going to continue and is forecast to increase to around 40,705 jobs by 2027. This expansion will be driven by both growth in the population and an ageing demographic within that population.

Within the Health Care and Social Assistance sector, the Canterbury RSLG has had a particular focus on mental health as a priority area. This is because, like the rest of the country, Canterbury has a growing demand for mental health services and there are significant shortages in specialised staff. This has led to increased wait times for those who need to seek specialist help and has particularly impacted the ability of those with mild to moderate issues to receive the help they need in a timely manner.

Given the life changing events Canterbury has faced in the last 15 years (Christchurch and Kaikoura earthquakes, terrorism and most recently the COVID-19 pandemic) access to mental health support is a particular concern and priority for the wellbeing of Canterbury’s people – particularly its rangatahi. This is evidenced in more rapid growth and acuity of those being provided with specialist care.

Ngā taero | Complications

Attracting, retaining, and developing a strong health care and social assistance workforce is one of the biggest challenges facing the sector. There are already widespread global labour shortages, and this has been thrown into stark relief by the COVID-19 pandemic and the impact of this on New Zealand’s immigration and border settings.

Whilst skills and labour shortages are endemic across all aspects of the health care and social assistance sector, the Canterbury RSLG has decided to take a particular focus on issues and actions for the mental health sector in the region. This sector has been under a national media spotlight in recent years and is an acknowledged area of significant concern in need of support. However, focusing on initiatives in this space is expected to highlight several common, cross over solutions that can also be applied to other areas within the wider health care and social assistance sector.

Providing the level of mental health services to meet the demand is a significant challenge in Canterbury. From an employee perspective we know that workload demands can create understaffing issues, with high workload and employee stress being reported. We also know uneven pay rates and the lack of progression pathways for some staff create attraction and retention issues.

From an employer perspective we are seeing the difficulties providers face in keeping up with demand for their services, particularly with increasingly higher levels of care and complexity required. There are funding gaps and pressures they must work within, and the risk of burn out and the associated impact of that on workers is high. Reports indicate that staff in the mental health sector are up to four times more likely to be required to work overtime compared to the broader health care workforce.

From a systems perspective we need to focus on improving the wider health workforce training system to ensure it is better coordinated. We need to increase the numbers of rangatahi we train, and focus on initiatives that will help lift course completions and skills development. To enable this, we need to identify training pathways that focus on future delivery models which rely on a mix of specialist and generalist roles working together to deliver the necessary outcomes. The Canterbury RSLG has highlighted some key issues and actions for this sector below:

Ngā mahi | Actions

See Hei mahi | Summary of actions for full details 

Cross cutting actions on:

Migration settings – Promote migration settings that enable Canterbury to recruit the skilled and experienced international workforce that they need (that cannot be found nationally) to thrive.

Promote Canterbury – Support industry- led campaigns to attract more workers across key priority sectors to Canterbury as an ideal destination to live and work – both from within New Zealand and overseas.

Workplace diversity – Support programmes that aim to improve diversity in under-represented workforce sectors. In particular this includes groups such as women, Māori, Pacific peoples and the neuro diverse.

Training pathways – Facilitate the development and uptake of new training pathways that provide ways of recognising prior learning, upskill new or returning staff and support meeting immediate training needs in a cost-effective way.

Up-to-date training – Facilitate closer connections between training providers and industry to ensure training courses are up-to -date, use relevant tools and methods, build current worker capability, and develop work -ready graduates.

Best practice workplaces – Research and map best practices that foster supportive workplace environments and a positive culture among staff, where diversity and safety in the workforce is valued.

Sector perceptions – Work with sectors and industries to educate and change outdated perceptions of the focus sectors, promote why they could be a good choice, and the diversity and range of opportunities available in them.

Area-specific actions:

Map mental health system – Co-ordinate the mapping of the mental health workforce eco-system to understand labour market barriers and enablers in the sector.

Rangatahi mental health – Support the development of an holistic mental health plan for rangatahi, encompassing principles like Te Whare Tapa Whaa.

Health and disability system review – Promote benefits of the Health and Disability System Review – Final Report – Pūrongo Whakamutunga, March 2020 ¬– particularly with regard to initiatives that will improve services within the mental health sector.