The last thing the beleaguered public health system needs right now is a distracting debate about which language hospital staff should use when communicating with patients.  There should be no argument that English, the most widely used language in New Zealand, is the one that should be used in all communications with or about patients, unless they do not speak English and need to be communicated with in a different language. But, at the same time, how, and in what language, hospital staff talk privately to each other, away from their patients, should be their own business. This is not a question of cultural respect, but simply a matter of practicality. As such, it does not deserve the attention it is currently receiving.

At a broader level, it is symptomatic of the wider problems facing the health system where the focus has too often been on side-issues, ahead of more critical matters like access to, and quality of, services provided, and secure funding.

Labour’s bold health reforms, announced three and a half years ago, have long since been dead in the water.  In fact, they were virtually stillborn when Labour refused to commit to the long-term funding that its plans would require to be implemented.

I well recall attending a briefing shortly after the reforms were announced. Promises were made then there would be substantial increases in nursing and medical staff numbers, although there was no indication of where all these new staff would come from, or how their positions would be funded. When I raised questions along these lines, there was no answer. 

The recent debacle over nursing positions is a direct and tragic consequence of this woolly thinking.  Labour’s mid-2023 decision to boost nursing numbers, without adequate future funding, has caused two immediate crises. The lack of long-term funding has led to understandable fears of significant nursing cutbacks in hospitals to meet budget shortfalls. At the same time, the climate of expectation the projected increase in nursing positions created led to a substantial glut of overseas nurses being lured to New Zealand who are now unable to find work here and seem set to join the job exodus to Australia.

So, instead of the bold, new 21^st century, fit for purpose health system that Labour promised in 2021, we are now faced with a hurried patch-up job on the current dysfunctional system, before any substantial reforms can be even considered. Health Minister Reti’s quiet tones of reassurance sound more and more despondent as each week goes by. For his part, Health Commissioner Levy is becoming increasingly bogged down firefighting the health system’s day-to-day problems, leaving him less time to focus on the strategic and organisational future of health services that he was appointed to oversee. Those on the Health New Zealand Board who were pushed aside to make way for the Commissioner might now be forgiven a quiet feeling of “I told you so.”

Commissioner Levy’s staunch commitment to retain key frontline services is admirable but is likely to become increasingly difficult to sustain. While nursing and medical staff have shown extraordinary patience, commitment and professionalism over the years, as the uncertainties around them have unfolded, their confidence is being stretched. Many are now threatening to leave the system altogether because they are exhausted and frustrated. The strictures the system is already facing mean there is no guarantee that adequate replacements could easily be found for those choosing to move on. And the dire warnings the government has been receiving from the Treasury and other key advisers that New Zealand’s budget deficit is structural and unlikely to be overcome in the short term bluntly mean that the health system cannot rely on hefty annual funding increases indefinitely.

Reti’s and Levy’s immediate priority is therefore to rescue the public health system and restore an air of stability within it, before they can even begin to think of what the best structure for the future might be. That may not be as dramatic or exciting as the bold mission of reform Labour imagined it was starting on in 2021, but in its own way, it will be just as challenging an assignment. A key part of getting the health system “back on track” will be restoring confidence and trust within it. That may not have been the role both Reti and Levy thought they were signing on for, but it is the outcome they are now both expected to deliver.

Labour hoped that the prospect of bold health reforms would pay a political dividend in 2023, but they were wrong. Today, National hopes its more limited objectives will work for it in 2026.

How times change!