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Under funding pressure.

Health funding, as a proportion of gross domestic product, has been shrinking for several years. The impact of that shrinkage is taking a severe toll on those working in the health system.

The reality of nurses' and health care assistants' (HCAs) working lives is at odds with the health system described by Health Minister Jonathan Coleman. The minister maintains there have been no cuts in health funding.

"Over the last eight years, health funding has kept up with demographic pressure and inflation. We're also focused on delivering results, ensuring New Zealanders can access more services." (1)

But the results being delivered in too many instances, according to nurses and HCAs, are a far cry from the health strategy's "value and high performance theme".

The minister's claim that health funding has kept up with demographic pressure and inflation has been challenged by Council of Trade Unions economist Bill Rosenberg among others. His analysis of Vote Health in last year's Budget, stated it was an estimated $248 million less than what was needed to cover announced new services, increasing costs, population growth and the needs of an ageing population. While the Budget listed services that would receive more funding, and new initiatives costing $117 million, these would need to be paid for by reductions in other services. (2)

"We conservatively estimate the funding shortfall in core government health expenditure for 2016/17 compared to 2009/10 is $1.2 billion. This shortfall has steadily grown over those years," the analysis stated. (2)

District health boards (DHBs) were underfunded by an estimated $152 million to cover increased costs and demographic changes, and to fund new initiatives worth $55 million and expenses of $45 shifted from central funding. The Ministry of Health was underfunded by $5.5 million. (2)

Rosenberg has calculated an increase of $1.85 billion will be needed in Budget 2017, due to be delivered next month, to return the operational Vote Health to the same level of gross domestic product (GDP) as it was in 2009/10.

An article in the New Zealand Medical Journal (NZMJ) last year shows Vote Health's total operational expenditure has decreased, as a proportion of GDP, from 6.32 per cent in 2009/10 to 5.95 per cent in 2014/15. (3)

Core government expenditure has been falling in recent years, according to the article and "the Government's trajectory is one of continuing cuts in health spending". (3) The continued under-resourcing of health services was not due to unaffordability, according to the article. "... it is a policy decision to reduce government expenditure overall and introduce tax cuts". (3)

Unmet need is another aspect of the health funding debate, r Results from the latest New Zealand Health Survey reveal 29 per cent of adults and 24 per cent of children experienced one or more types of unmet need for primary health care in the previous 12 months. These figures were up from 27 per cent and 20 per cent respectively in the 2011/12 survey. (4)

A pilot survey, reported in the NZMJ last month, revealed unmet need in secondary care that affected individuals' well-being and productivity. It suggested a national survey of such unmet need would be a valuable contribution to service assessment and planning. (5)

Whatever the minutiae of health funding, and unmet need and how they are calculated, the experiences of 6000 health workers, surveyed as part of the campaign, bear out what these figures are indicating (see box above). And the daily reality of NZNO members, and the NZNO staff who support them, indicates a health system under stress and struggling with increased patient volumes. Nurses and HCAs have been working hard to ameliorate chronic underfunding and understaffing in their workplaces. But they can't continue to do so. (See following pages.)

The survey of 6000 health workers found:

* 90 per cent say the health system doesn't have the staff or resources to give New Zealanders the health care they need, when they need it.

* 90 per cent say the Government's current health funding is affecting access to health care.

* 84 per cent say workload and work pressures have increased over the last five years.

* 82 per cent say the Government's current health funding is affecting their workloads and work pressures.

* 72 per cent say workloads and work pressures are unreasonable.

* 61 per cent say access to health care has decreased over the last five years.

By co-editor Teresa O'Connor


(1) Coleman, J. (2017). Speech to NZ Health Symposium. Wellington. Retrieved from

(2) Rosenberg, B. (2016). Working Paper on Health: Did the 2016 Budget provide enough for health? New Zealand Council of Trade Unions: Wellington.

(3) Keene, L, Bagshaw, P., Nicholls, G. M., Rosenberg, B., Frampton, C. M., & Powell, I. (2016). Funding New Zealand's public healthcare system: time for an honest appraisal and public debate. New Zealand Medical Journal, 129(1435),

(4) Ministry of Health. (2016). Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington: Ministry of Health.

(5) Bagshaw, P., Bagshaw, S., Frampton, C., Gauld, R., Green, T., Harris, C., Hornblow, A., . . . Toop, L. (2017). New Zealand Medical Journal. 130(1452), 23-38.
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Title Annotation:news focus; cuts in health funding
Author:O'Connor, Teresa
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Apr 1, 2017
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