Insights Report: December 2022

Top regional insights

Taitokerau has a critical doctor shortage. Urgent action is needed to solve a rapidly emerging crisis in primary care (community care) relating to a shortage of general practice (GP) doctors in Northland.  Attracting and retaining internationally qualified GPs, specialists and health professionals is critical to meet the immediate needs of the region while local pathways are clarified and established, and local taitamariki are encouraged to train.

Lack of participation of Māori in the health workforce needs to be addressed. The development of locality plans, and formal recognition of Iwi-Māori Partnership Boards being pioneered in Taitokerau will be instrumental in increasing the Māori workforce. The centrally enabled development of a rural and Māori health centre of excellence is a major focus for the RSLG and Te Pūkenga to address the Māori health workforce participation.

Burnout and fatigue are increasingly common among doctors in Taitokerau, and the mental wellbeing of the health workforce in the region is at risk. The Royal New Zealand College of General Practitioners survey pointed to the stress Northland's roughly 190 GPs are under currently with 34 percent, the third-highest number across the country, reporting 'burnout' or fatigue caused by overwork.

At a glance

Despite the clear need for more GPs in the region, Northland ranked fifth in the country for the number of GPs who intended to retire by 2023 which is about 33 per cent.  (Royal New Zealand College of General Practitioners survey)

The number of Māori in the Hauora workforce has increased but inequality challenges remain - over the last 20 years Māori are still under-represented in the higher-paid workforce, higher-skilled, and regulated Hauora Health workforce, and represent only 7% of health workforce population.  (Māori Health Authority, Māori Social Care (HSC) Workforce trends, Te Rau Ora Factsheet April 2022)

Top labour market opportunities

Activities are underway to meet the regional workforce plan (RWP) action of “Reimagining Health Care in Taitokerau and improving the future skills pipeline for health care and communities’ workforce”:

• Rebuild of Whangarei Hospital (Pihi Kaha Project) is due to complete by 2031 and will include expanded services like oncology radiation.  This will reduce the cost’s burden and travel time for whānau who currently travel from Taitokerau to Tāmaki Makaurau for these treatments.
• Māori Registered Nursing degrees and will be available at Te Pūkenga Taitokerau from 2023/24 and the number of students able to study nursing has increased. 
• As part of attracting GPs to the region final year medical students are being offered exposure to Māori and rural health provision in the Hokianga through the Rural Health Interprofessional Programme (RHIP2023).
• Training for podiatry, oral health, occupational health and mental health training will be available in the region, for the first time in the second semester of 2023.
• Taitokerau has a dedicated team who have Takawaenga roles to assist with engagement between Māori and clinical staff and Toitū te Waiora are developing a qualification for this role.

There are also activities underway to meet the RWP action of “Broadening apprenticeship provision and meeting the skills needs”:

• The Kaimahi to Enrolled Nursing apprenticeship model is expanding, supporting up-skilling in a supported work-based setting, ­and learning while earning
• Pilots to develop cultural competency training are being delivered by local Hapū/Iwi to meet the demand of the Aged Care Sector, and support advancement of L3 qualifications for Kaiāwhina.
• An entry point into a health career is being developed by Toitū te Waiora that recognises the value of lived experience. Micro-credentials for Kaimanaaki roles are in development to aid the successful roll-out of health monitoring in the patient’s home by Ngāti Hine Health Trust and Taitimu Taipari.
• Plans for local health and social services are being developed for the Taikorihi area (Ngāti Kuri, Te Aupōuri, Ngāi takoto, Te Rarawa and Ngati Kahu). The locality plan will offer local opportunities to existing health professionals to experience rural and Māori health delivery.

Top labour market challenges

Māori health equity is hampered by the immense lack of GPs across the entire region. Hospital hours have reduced in areas of very high deprivation; many GPs are now unable to take on new whānau/patients; and hospital emergency departments are now too busy and only able to see severely unwell patients. Urgent action is required to attract internationally qualified doctors and health professionals to Taitokerau.

Lack of Nurse Educators and particularly Māori Nurse Educators across the region. The need for Nurse Educators is much more than to simply fulfil teaching roles. These are important role models encouraging more Māori to be Nurse Educators and are essential in successfully attracting, training and retaining Māori nursing students.

Health workforce shortages are now impacting working hours of remote hospitals in Northland. A shortage of both doctors and nurses continues to keep Hauora Hokianga Hospital at Rāwene closed after-hours. In August, the Hospital stopped offering after-hours care, meaning patients would have to travel at least an hour further in an after-hours emergency.  The health workforce crisis meant there were still not enough doctors to provide after-hours care and some community clinics will now have reduced services. This includes reduced operating hours for doctors’ clinics in the remote communities of Tāheke, Ōmāpere and Panguru.

Demand for aged care sector is outstripping supply due to workforce shortages. There are currently not enough care beds in the Mid and Far North to meet demand. Kerikeri Retirement Village has a waiting list of 120 people for its 66-bed facility, its Chief Executive Hilary Sumpter says a shortage of elderly care beds in the town is breaking families apart.

Regional workforce plan actions

The Te Purunga ki Te Raki Regional Skills Leadership Group will lead and coordinate implementation of the Regional Workforce Plan over the next three years.  The plan consists of three Objectives Te Taiao, Mātauranga and He Tāngata. Under Te Taiao the plan focuses on Hauora -Health and Communities and contains the following three headline and sub-actions that the RSLG is progressing:

• Reimagine Health Care in Taitokerau and improve the future skills pipeline for health care and communities’ workforce
  • Accelerating the development of Hauora and particularly Hauora Māori programmes and pathways for Māori.
  • Develop a centre of vocational excellence for Health (Nursing and Allied Health as a first focus) to support the drive for innovation using insights from the Māori Health Authority, Health NZ and Te Kahu O Taonui.
  • Ensure Māori health leadership including Iwi Māori delivery –especially in rural areas.
• Broaden apprenticeship provision, participation, and completion of Nursing (Registered and Enrolled) programmes and broadening apprenticeship provision 
  • Considering, adopting and actioning recommendations arising from the Pre-registration Nursing Pipeline Project that address Māori student nurses’ concerns.
• Meet the skills needs of our region and employers, especially in Kaiāwhina roles
  • Identifying local workforce challenges and drivers to attract younger workers towards Kaiāwhina roles.

Te Purunga ki Te Raki Regional Workforce Plan [PDF, 4 MB]

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