The Coalition government has been relentless in its cuts to public services across the board, all while pumping out policies that uphold the status quo and benefit the wealthy few. Health has been especially targeted, with funding cuts, moves towards privatisation, and deregulation of professions being three methods through which this government is prioritising profit and its own interests over the people and their health and well-being.
From reinstating prescription fees to cutting hundreds of jobs from health infrastructure, this government has not been shy in slashing funds, services, and people. Instead of the billions allocated to tax cuts for the capitalist class, the blame for budget issues was placed on meagre pay rises for our chronically underpaid nurses, or on New Zealand’s COVID response that outperformed countries in the OECD in terms of cases, hospitalisations, or deaths. Despite Christopher Luxon’s claims that there’s “a lot more money being spent on healthcare” and of the billions being set aside for health, our health spending per capita in Budget 2024 was actually cut by 3 percent. With our health expenditure budgeted to drop to just 6.6 percent of GDP by 2029, far less than comparable countries in the OECD such as Australia or Canada, there is no doubt that working class New Zealanders will suffer as a result of this government’s continuous de-prioritisation of healthcare.
The Association of Salaried Medical Specialists Toi Mata Hauora (ASMS) stated that New Zealand needs $2 billion in additional health funding this year just to remain functional, due to increasing costs and a growing and ageing population. Budget 2025, however, includes only $1.78 billion in new operational spending for health. That’s hundreds of millions less than the bare minimum required, and nowhere near enough money needed for a thriving public system. These cuts will lead to poorer health outcomes and deaths, particularly for Māori who are already disproportionately affected by higher rates of disease and consequent deaths. Targeted approaches that prioritise hauora Māori are essential to address these ongoing inequities caused by colonisation and systemic racism. Te Aka Whai Ora (the Māori Health Authority) was co-designed with Māori to do just this, however was disestablished under urgency by the Coalition through the Pae Ora (Disestablishment of the Māori Health Authority) Amendment Act 2024. This racist disestablishment, which was deemed a breach of Te Tiriti o Waitangi by the Waitangi Tribunal, “saved” the government $35.5 million.
These cuts are draining our health system of money, resources, and staff. We’re losing healthcare professionals from public providers and from the profession altogether due to the lack of action to address continuously poor working conditions and worker burnout. The future of the public system is looking bleak, with the new Dunedin Hospital seeming more and more unlikely to be adequate to meet the needs of the region. Once the public system has been driven to rock bottom, private healthcare will be presented as an acceptable alternative. Privatisation worsens health outcomes and increases avoidable deaths, while public funding of health reduces them. Despite the evident harms, we’ve seen privatisation in aged care, food and cleaning services, medical imaging, and we see it now in surgery.
Private hospitals are undertaking over 200,000 elective surgeries a year. These are often the more straightforward and cheaper procedures, for patients who could afford the initial check-ups and appointments. This leaves the more complicated or expensive acute treatments to be dealt with in the bleeding public sector. If a complication arises from a private surgery, that patient will rely on the public system to address their issues. Our doctors and nurses are trained in public hospitals, with private hospitals threatening the sustainability of the health workforce by poaching these staff away. Taxes that are disproportionately paid by the working class are being used to subsidise the private health system, which benefits the wealthy few. Privatisation further worsens financial inequity with money being directed away from public good towards private greed.
The doctors, nurses and allied health professionals who directly deliver healthcare play a major role in patient safety and health outcomes. In addition to financial cuts and this government’s broader attacks on healthcare, hiring freezes and chronic issues in retaining trained professionals are key pressures on the workforce. Rather than directly addressing the causes, deregulation is being proposed as a roundabout means to alleviate these pressures. In a discussion document misleadingly titled “Putting Patients First: Modernising Health Workforce Regulation”, Simeon Brown’s Ministry of Health uses made up quotes and false claims to try and justify deregulation of who can practise as a healthcare professional in New Zealand and what roles they can take on. Instead of having credible, regulated practitioners delivering health services, deregulation cuts corners and puts patient safety at risk.
“Putting Patients First”, designed for consultation on amendments to the Health Practitioners Competence Assurance Act 2003, suggests that cultural competency is a distraction from “real issues”. The existing regulatory bodies for the various health professions recognise the importance of having culturally competent practitioners and the effect such competency can have on improving health outcomes. This attack on cultural safety is a surefire pathway to the delivery of inappropriate healthcare and poor clinical outcomes.
The document suggests that political decisions made by Ministers could overrule clinicians’ expertise. We’ve recently seen what this could look like with Brown’s announcement that physician associates will be recognised in New Zealand, despite concerns and warnings of safety issues from the ASMS and the Resident Doctors’ Association (RDA). Doctors who are already burdened by the workforce shortage must now take on additional roles as supervisors for physician associates, who have been the cause of misdiagnoses and even patient death overseas. The ASMS emphasises the risk of relying on “assistants” to alleviate workforce pressures due to their relative lack of training. As the RDA puts aptly, “we need more health professionals not more health professions”.
“Putting Patients First” also proposes that service providers, i.e. employers, could have regulatory powers and control over the scope of health professionals instead of existing bodies such as the Medical Council or Nursing Council. This could mean disciplinary action from the employer could lead to not only termination, but also the loss of registration and ability to practise in New Zealand. Regulatory bodies prioritise patient safety, however employers that prioritise cost-cutting measures could direct healthcare assistants to deliver healthcare in high-risk medical situations which should be the domain of trained practitioners. All of these potential changes, if legislated, would mean patient safety would not be at the forefront of regulatory decisions.
The differences between the approaches towards health of parties like Labour and the Greens compared to National, ACT, or New Zealand First are clear. This government’s countless attacks on health and the workers who uphold our health system are unprecedented. However, the challenges faced by the public health system have been ongoing, with many systemic issues tracing back beyond the term of this current coalition. It was Labour at the helm in 2023 when almost half a million New Zealanders went without GP services because they couldn’t afford it, or when senior doctors went on strike for the first time in history after being given “pay rises” that did not keep up with inflation. Even in 2018, before the pressure of the COVID pandemic on the health system, nurses went on a nation-wide strike for the first time in almost 30 years, fighting for fairer pay and better working conditions. It was the Labour government’s turn then to give excuses about a supposed lack of funds, while simultaneously over $2 billion was being budgeted to buy planes for the Air Force. Health has been chronically underfunded, and the workers who keep the healthcare system afloat endlessly disrespected and neglected. Labour may have allowed some wins for health and healthcare workers, but there’s no doubt that without industrial action from unions and the united working class, they would never have willingly done so.
Health is influenced by so much more than the care we receive at the GP, hospital, or pharmacy. It’s determined holistically by financial security, a clean environment, warm homes, affordable food, and so much more. Funding cuts, privatisation, and deregulation directly impact both the provision of healthcare and health outcomes for patients. But attacks on health may also look like attacks on pay equity and environmental protection. Factors beyond the healthcare system are pivotal in preventing disease and death. New oil and gas exploration, transphobic “bathroom bills”, increases to public transport fees – these are just a few examples of non-health policy changes that can harm physical, mental, and emotional health both directly and indirectly. These attacks on public sectors from the ruling capitalist class who prioritise profit over all else hurt the working class, including the people in our hospitals and communities doing the work to actually deliver healthcare and uphold the health infrastructure. It’s definitely not the unqualified mouthpieces like Brown who are keeping our hospitals running.
Health professionals have demonstrated the power they wield as the working class through industrial action and the withholding of labour, and this has successfully pushed the Government to make positive reforms. In addition to organised action by the health workforce, support and rallying from communities has also been powerful. In March this year, hundreds of Napier residents protested against cuts to their local after-hours urgent care provider, and successfully influenced the government to retain 24/7 opening hours. But reforms are not enough. We want free, high quality, and timely healthcare from practitioners unburdened by poor working conditions and workforce shortages. We need clean, breathable air and unpolluted waters. We deserve accessible, healthy food and warm homes that don’t cause recurring respiratory disease. Healthy public policies to make these things a reality are achievable, but not under the current capitalist system where profit for the ruling class is prioritised over healthy people. Struggle from below and a revolutionary approach are essential to achieve the healthcare system we want, need, and deserve.
Banner image: Exhausted healthcare worker sits on the floor. Credit: Photo by Mulyadi on Unsplash
