When it established Health New Zealand, or Te Whatu Ora as it was then known, in July 2022 the previous government took an enormous risk that ultimately failed. It gambled that, although its planned reforms of the public health sector would take years to fully implement effectively, it would be able to demonstrate enough progress by the time of the 2023 election to satisfy voters that the reforms were broadly a step in the right direction and worth persevering with.

It proved unable to do so, and the state of the health system, with all its attendant symptoms of long waiting lists, medical and nursing staff shortages, overworked general practitioners, and run-down facilities provided fertile ground for then Opposition parties to till. They did so effectively, adding in the commitment to fund a new range of cancer drugs to cement the impression that National and its allies could manage the health system better than Labour was.

But, in its enthusiasm to appear much better than Labour, National has ended up building up expectations of its capacity to deliver that exceed its capability to do so, just the same way Labour did.

The fiasco over the new cancer drugs funding was the first example. Most people believed that this year’s Budget was going to include the announcement of that funding, and National did little to dispel that belief before the Budget. The public outrage that followed when these drugs were not funded in the Budget was substantial and a deep blow to the government’s credibility. Its subsequent announcement of a $604 million package over the next four years to fund around 54 new cancer drugs goes well beyond the pre-election commitment which has provided some solace and reassurance to affected patients and families. But it does not soften the blow to the government’s credibility caused by the initial pre-election commitment and subsequent Budget under-delivery.

It is a similar story with Health New Zealand (Te Whatu Ora). Before the election, National’s promise was of an urgent major shake-up, including clearer directions and purpose for the public health service, and the abolition of the Māori Health Authority (Te Aka Whai Ora). But nearly eight months into the life of this government, little of substance has happened. Health New Zealand has been shorn of its Māori name and the Māori Health Authority abolished, but otherwise, the overall direction of the health reforms remains as uncertain as ever.

Health New Zealand has become dysfunctional. Most of its board have either resigned or indicated they do not want to carry on. Currently, only two Board members remain in place, a situation Associate Health Minister David Seymour has admitted is “quite chaotic.” Beyond that confusion at the top, critical shortages remain in many key areas. Nurses are still fleeing to Australia in search of better pay and conditions, and the crisis in general practice is growing, with some practices on the brink of closure altogether. Like its predecessor, the government seems bereft of immediate answers or solutions to these problems. And patients are becoming more disillusioned, given National’s commitment last year to sort out Labour’s health reforms mess.

Only in the medicines area is there a glimmer of light. As the Minister responsible for PHARMAC, Seymour has boosted its budget by $1.7 billion over the next four years, in addition to the cancer funding referred to earlier. He has made his clear his expectation that while PHARMAC should continue to be politically independent in the purchase of medicines, its basic function must remain “procuring medicine for people who need it, to the best of its abilities.” And he has appointed former Deputy Prime Minister Paula Bennet as chair of PHARMAC to oversee its work.

Nevertheless, the jury remains out on how effective these changes will be and whether the explicit commitment to medicines being procured based on need will mean equality of access to appropriate medicines for all patients, regardless of ethnicity or other factors. In the short term, the only difference many patients will have noticed is that from the start of July they have been paying a part-charge for their prescriptions again.

For the remainder of the health changes, the clock is ticking for the government. To avoid falling into the trap which ultimately sunk Labour’s credibility on health, the government has about twelve months from now to demonstrate some tangible results. The smooth-talking and reassuring Dr Reti we saw before the election, but who has largely disappeared from the public view since he became Minister of Health, needs to become much more visible as the leader of change. He needs to be spelling out reasonable short, medium and long-term goals for the public health service and then publicly holding Health New Zealand accountable for meeting them.  He must step-up from the quiet, almost backroom approach he has adopted so far, and make both his aspirations and expectations for the health sector clear.

Otherwise, many health professionals, from surgeons to specialists, general practitioners to nurses, and new graduates, will continue to vote with their feet and go elsewhere.

And the disillusionment and frustration of patients, so evident under the last government, will become even greater under this one.