Healthcare and social assistance

A health worker adjusting a bedside monitor


The Healthcare and Social Assistance sector is fundamental to the health and wellbeing of the people of Otago. The services provided, and the quality and retention of those services, are of the utmost importance to urban and rural communities alike, and also for attracting new residents to our region. The sector is a large source of employment in Otago and is projected to grow rapidly in the future as an ageing population places increased demand on it. Otago plays a significant role in training the nation’s Healthcare and Social Assistance workforce through a wide range of education and training programmes delivered across Otago’s tertiary education institutions.

In 2021, the Healthcare and Social Assistance sector contributed $949 million (6.5%) to the Otago Region’s GDP and employed 13,695 people, 10.6% of the region’s workforce. The sector has more older workers in its workforce than the rest of Otago’s labour market, as well as a large share of recent migrants. There is a high proportion of professionals, as well as community and personal service workers, in the sector. Employees in the sector are more likely to work part-time hours than the average worker in Otago.

A woman walking on a path with her elderly motherThe sector is defined by sub-regionality and diverging population growth trends. About three quarters of all employment in the health care and social assistance sector across Otago is in Dunedin City (73.9%), due to the large majority of the region’s health infrastructure being located there, including Dunedin Hospital. However, the Healthcare and Social Assistance sector is growing rapidly in Inland Otago, primarily in primary and aged care, as a result of fast population growth and an ageing population. The sector is a substantial employer in Coastal Otago, with provision centred on primary and aged care also.

The sector is reliant on migrant labour. While some higher skilled roles may be easier to recruit for under the Immigration Rebalance policy changes, lower skilled roles will be harder to fill from overseas. Prior to the pandemic, migrant workers made up approximately 12% of Otago’s workforce, higher than in other regions and significantly higher than an average of 8.4% in the sector nationally. Under immigration policy changes highly skilled occupations in the sector will be easier to recruit for from offshore, while it will be more difficult to use migrant labour to fill lower skilled roles.

Attracting, retaining, and developing a right-sized and appropriately skilled health care and social assistance workforce is an ongoing challenge, not only at the regional level, but also nationally and globally. Skill and labour shortages are prevalent across all aspects of the health care and social assistance sector, from highly trained specialists right through to essential cleaning staff. These persistent recruitment difficulties have been exacerbated by the COVID-19 pandemic and in particular the impact of the pandemic on Aotearoa New Zealand’s immigration and border settings.


Across the sector

  • Demand for health and social services will grow in Otago over the years ahead. A key driver of demand will be the region’s ageing demographic.
  • As new technologies and drugs emerge, expectations about health services may rise, but automation may also improve workers’ productivity. The international context will continue to shape New Zealanders’ experience of health which means our system needs to be aware of developments and then effectively draw on and absorb global ideas and evidence.
  • More locally, there are intra-regional pay parity challenges, with pay gaps significant for rural and non-DHB healthcare providers.
  • The ongoing pandemic environment requires a focus on wellbeing, adaptability, and resilience, both for employees and organisations. The impact of the upcoming health system reforms remains unknown.
  • Workforce pressures and the declining hours that New Zealanders are spending volunteering is a factor, as the Social Assistance sector relies heavily on volunteer labour.

Employers told us

  • There are significant shortages across all areas of the sector, both for the required number of staff, and in specific skill areas. These challenges are exacerbated by the highly mobile nature of the global health sector, and the older demographic within the New Zealand health workforce.
  • Many in the health workforce trained overseas. Clarity is needed on immigration policy changes.
  • There is a need to continually invest in training so that the health workforce has the skills needed to meet the health needs and expectations of caring for New Zealanders – these needs and expectations are themselves changing.
  • The sector often has a large funding gap between what the organisations receive through government funding and contracts, and the services they deliver. These challenges have intensified with pay equity claims. The social assistance sub-sector responses to funding gaps have implications for workers, including reduced hours in some cases.
  • Attraction of workers can be challenging when there are a lack of wider employment opportunities nearby for partners or family members, especially when there is a need to relocate.

Workers told us

  • As with many other sectors, the Healthcare and Social Assistance sector is facing its own issues around personal health, mental health, recruitment, and retention.
  • Staff shortages means burnout may become more prevalent. Of particular concern are rural hospitals and the aged care sub-sector, where a lack of pay parity for nurses is creating significant issues for recruitment and retention of staff.
  • Many people in low-skilled roles (that do not require formal qualification) are not provided with career or development pathways to upskill and progress.