Aotearoa New Zealand has a new government. While only sworn in on 27 November, the National/ACT/NZ First coalition has been quick to show its intention to take the country in a new direction. What this means for the public health system, which is ailing and more than a year into major reform, is up for debate. In a briefing paper to the health minister, RACS in Aotearoa New Zealand outlines what it sees as the priorities for surgical services and what improvements it hopes to see in the short and long term.

National’s Dr Shane Reti is the Minister of Health. What is clear is that Dr Reti is well qualified for the role. A GP for 16 years, he spent three consecutive terms on the Board of the Northland District Health Board (now Te Whatu Ora – Te Tai Tokerau). His published research has won literary awards, and he spent time as an assistant professor at Harvard. He is serving his third term in parliament with roles including deputy chair of the Health Select Committee.

With Dr Reti at the helm, the health system is likely in for yet more change.

The previous government inherited an ailing health system and introduced a ‘reset‘ in the form of the Pae Ora (Health Futures) Act 2022. The aims of the reforms are to improve equity, access, remove the so-called ‘postcode’ lottery, and shift the focus from treating illness to promoting health. They created a centralised system, which brought the country’s district health boards together into a national public health agency, Te Whatu Ora – Health New Zealand. They also established Te Aka Whai Ora – Māori Health Authority to improve health outcomes for Māori.

In a briefing document to the incoming health minister, RACS in Aotearoa New Zealand affirms its support for the goals of the reforms but would like to see faster action in realising them. The paper also points to workforce issues affecting all parts of the health system, which it sees as the biggest obstacles to success.

It is unlikely Dr Reti will roll back the reforms, despite Ministry of Health documents, which suggest significant resource gaps are hampering them. There is speculation he may replace the Te Whatu Ora board, which would mean a change to the senior management team and thus a shift in direction or implementation.

Our briefing paper makes clear more change would not necessarily be welcome as the uncertainty around the reforms has already been destabilising. We suggest major change is not always the answer. There are existing initiatives our members are involved in that could be scaled up to put the health system on the path towards a healthy future.

One policy Dr Reti does seem likely to follow through on is his pre-election promise to disestablish Te Aka Whai Ora. He acknowledges that Māori do worse than non-Māori in almost any area of health. For this he blames unconscious bias and says cultural competency—delivered through medical and nursing school training, and through hospitals and medical colleges—is the best way to address it².

Cultural competency training is already being done around the country and it is one of RACS 10 competencies for surgical Trainees. Yet inequities still exist. Being Māori or from the Pacific community is, by itself, an independent risk factor for poor health outcomes. For example, research shows Māori women are more likely to experience delays in receiving breast cancer treatments, are less likely to receive radiotherapy and are more likely to be treated with mastectomy¹.

The College in Aotearoa New Zealand wants to see a strong and effective Te Aka Whai Ora and hopes to continue supporting its work through expert advice including from the Māori Health Advisory Group.

More surprising is the new government’s announced scrapping of tough new smokefree initiatives. The National/ACT/NZ First coalition says it will drop plans to crack down on smoking in order to fund tax cuts promised prior to the election.

The previous government, under Labour, planned to restrict smoking sales to around 600 outlets nationwide, reduce nicotine levels and progressively raise the age of purchase, effectively cutting off legal supply of cigarettes to the next generations.

RACS was in favour of these measures. When the crack down on smoking was announced last year, Associate Professor Andrew MacCormick—chair of the Aotearoa New Zealand National Committee (AoNZNC)—said: “Our young people deserve better than a legacy of addiction, disease and death. Tobacco use is a burden – for families, communities and our wider society – and the AoNZNC is relieved to see decisive action being taken to stub it out.”

Smoking causes around 5000 deaths a year through cancer, stroke and heart disease. Smoking rates are higher among Māori and Pacific peoples at 20 per cent and 18 per cent respectively, compared to 8 per cent for the general population.

RACS has sent its briefing back to the new Minister of Health. Other key insights from the document include:
•    RACS in Aotearoa New Zealand is the peak body for the surgical workforce, representing 1300 surgeons, Trainees and SIMGs from nine surgical specialties.
•    Aotearoa New Zealand has fewer surgeons per capita than Australia and a strong reliance on overseas-trained surgeons.
•    Waitlists continue to grow across the motu (country) widening the health inequity between those who can afford private health insurance and those who cannot.
•    RACS is ready to train more surgeons if the government funds more training posts.
•    The surgical workforce is becoming more diverse, with growing numbers of Māori and women surgeons; an important element in improving health equity.
•    Just because we can doesn’t always mean we should. We have ideas about when treatment isn’t always the best option and how wait lists could be cut by being more realistic about costs vs benefits
•    RACS wants the environmental consequences of health services to be a key consideration in health system change.

Read the full briefing paper.

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¹Lawrenson, R., Seneviratne, S., Scott, N., Peni, T. Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand. Wiley March 2016;25(2):225-230
² Forbes M. Episode 12: July 11th - Mata [Internet]. RNZ; 2023 [cited 2023 Nov 17].

Available from: https://www.rnz.co.nz/programmes/mata-with-mihingarangi-forbes/story/2018897731/episode-12 july-11th-mata