Hauora and hapori whānui health and communities

It is of significant strategic importance to the members to address hauora/health inequities for Māori whose differences in life expectancy and experience of illness is stark. 36% of the region’s population identify as Māori. Essential to delivering on the objectives of the Mātauranga Māori Framework is He Tāngata which can be a means to building resilience through support and thus help to develop sustainable and decent mahi with respect to cultural and heritage values.

The current lack of services, and therefore the current need for services, is great. Alongside our high dependency population (aged under 14 and over 65) there is also a long tail of hauora hinengaro/mental health needs that are not currently being met. As well as a pre-existing lack of services, this is also due to an increased use of methamphetamine (P) during COVID-19. It is now time to train or recruit more than 2,000 people – which we must do in the next 5 years - especially in nursing, kāiawhina/caregiving, and allied hauora/ health roles.

Opportunities and manaakitanga have emerged from the establishment of Te Whatu Ora / Health New Zealand and Te Aka Whai Ora / Māori Health Authority. This has built on the work of Te Kahu O Taonui in the region and formalises the Iwi Māori Partnership Boards to address equity issues and have the system address gaps in delivery for Māori.

The whanaungatanga began some time ago in the community with kaupapa Māori health delivery already a prominent operating model, allowing students immersion in Māori and rural hauora/health. What’s more, engagement with hapori whānui/local communities and strong links with rural Māori and rural communities - including partnerships with local iwi - are already in place. Furthermore, the whanaungatanga between Te Pukenga, Auckland University of Technology and Auckland University ensure sustainability and a strong educational foundation.

"It is now time to train or recruit more than 2,000 people — which we must do in the next five years - especially in nursing, kāiawhina/caregiving, and allied hauora/health roles."

Labour market insights

With a focus on kaiāwhina in aged and community care settings and with an objective to increase Māori in training and in the workforce, the RSLG, with the Northland District Health Board facilitated several hui. The key areas addressed in these meetings were:

• Ways to ensure clear pathways for career development so that skills and training opportunities to meet whānau aspirations, and especially wāhine, are accessible.
• Tautoko/support for upskilling over people’s lifetime.
• The development of recruitment and retention strategies that support ōritetanga.
• Ensuring a kaupapa Māori response.
• And finally, the promotion of the sector to secondary schools.

Poor working conditions, including remuneration and conditions of work; limited and unsociable rostered hours; along with having to use their own vehicles and phones, while receiving incomplete reimbursement in the face of rising costs, all join together to act as a significant barrier to attracting workers.

Currently, according to the industry, there is limited ability to learn while you earn or undertake an apprenticeship. Significantly, fees for students in hauora/ health, and particularly nursing and kāiawhina/carers, are higher in comparison to trade sectors like building and construction while funding available to training organisations is lower. These are significant barriers obstructing both demand and supply.

Once in training, a lack of science study at secondary school causes a delay in direct entry into bachelor’s courses. Pre-study and/or foundation courses are instead required, often using fees free allocations. Drop-out rates are high and if they do drop out there is currently no pathway to credit to another health qualification, and/or work in an associate health role, until they are ready to advance along the career path again.

Poverty also remains an ongoing barrier to achieving ōritetanga and attracting the future workforce/ potential students. In a geographically-dispersed and remote rohe like Taitokerau, some ongoing challenges faced by residents include: high cost of travel; digital connectivity and affordability issues; cost and access to child and whānau care; the financial burden incurred with student loans, and the need to move away off the whenua and away from whānau to access further education and training.

The health care sector is the largest employing sector with a workforce size of 9,815 people. It will grow 13.2 per cent by 2027, meaning over 2,000 people are required to fill job openings in the next 5 years. 90% will be in nursing and caring roles.

The health care sector is the largest employing sector with a workforce size of 9,815 people.

What are the jobs and skills in the sector?

• Registered Nurses - 946 people are required to fill job openings over the next 5 years, 631 to replace those leaving or retiring from the sector, the balance for new demand arising from an aging and growing population.
• Midwives - 44 are required, with 30 people required to replace those leaving or retiring.
• Enrolled Nursing – 40 job openings will need to be filled by 2027, with 24 people to replace those leaving.
• Aged and disabled persons carers - 132 are required (level 1-4), 90 for replacement.
• Kāiawhina/personal care assistants (level 1-4) – 701 people are required to fill job openings with 297 people required to meet new demand and 404 to replace those leaving.
• Physiotherapists – 67 job openings, with 43 from those leaving or retiring from the sector.
• Occupational Therapists – 37 job openings over the next five years, 24 from those retiring or leaving the sector.
• Demand from other health job openings include dentists, podiatrists, speech therapists, radiographers, sonographers, laboratory and pharmacy roles. While the numbers are not as many, it takes longer to train.
• Job forecasts are detailed in the appendices and include estimates for each year up to 2027.

What are the labour market gaps?

By 2027, there will be a shortage of Registered Nurses, Nurse Managers, Nurse Practitioners, GPs and Physiotherapists currently being trained in New Zealand to meet demand which includes both new jobs due an increase in demand for services and replacement roles due to current workers expected to retire from or leave the sector.

Those being trained at level at 1-3 (Health Care Assistant (HCA), Aides and Kāiawhina) will be more than sufficient to meet the demand, making the need for upskilling a key labour market gap to close.

What skills for we need for these jobs?

We will need a higher technically-skilled (more at Level 4) workforce to meet higher and increasing care needs for Māori and rural locations, as well as the needs of an older population. The industry reported the requirement for the following skills:

• Cultural competency, with an emphasis on Te Ao Māori.
• Critical thinking skills, including problem solving and decision making.
• Organisational skills, including communications, ability to work under pressure and self-motivational skills.
• Secondary school science past year 10.
• Recognition of L4 learning, gained from life skills and lived experiences.

Overall action plan

Reimagine Health Care in Taitokerau and improve the future skills pipeline for health care and communities’ workforce by:

• Accelerating the development of Hauora and particularly Hauora Māori programming 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 by:

• Considering, adopting and actioning recommendations arising from the Pre-registration Nursing Pipeline Project that address Māori student nurses’ attrition rates, including: establishing a pathway to Enrolled Nursing for those who exit Bachelor of Nursing programme; supporting and assisting with Aged Residential Care (ARC) workforce planning including migration settings; nursing recruitment programme; and review of clinical placement model (as a barrier to more training places).
• Supporting and expanding (if successful) the Kaimahi to Enrolled Nurse apprenticeship model currently being piloted and supported by Mahitahi Hauora, AUT and Te Pūkenga which is supporting Māori Kaimahi to become enrolled nurses and work for their local health providers within their areas of domicile.
• Endorsing alignment and career staircasing across all health roles.
• Support options to “step on, step off” studying while being able to work in the sector at their current qualification level.

Meet the skills needs of our region and employers, especially in Kāiawhina roles through:

• Identifying local workforce challenges and drivers to attract younger workers towards Kāiawhina roles.
• Employers and agencies agreeing to provide decent working conditions, e.g. address employer pay inequity; cover employee costs on the job; support individual development plans; and better working conditions to enhance workforce attraction and participation.
• Acknowledging prior learning and highlighting career pathways for Taitamariki who have undertaken whānau care of kuia and kaumatua under a Kaupapa Māori framework that is developed in conjunction with local hapū

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