Source: New Zealand Government
Check against delivery.
Kia ora koutou. Thank you, Phil, for the opportunity to speak to you today to the Business NZ Health Forum. Since my appointment as Health Minister, I’ve spent time where it matters most – on the frontline, listening to the people our health system is here to serve. Let me tell you about just a few stories I have heard.There are many positive stories of people receiving exceptional healthcare:
A Tauranga woman who recently shared her gratitude with me that her chemotherapy drug is now funded because of the Government’s record investment in new cancer drugs.
A young person in distress, whose family isn’t sure what to do, being helped by compassionate youth mental health services to work through how to cope.
A security guard I met who said he went to an Emergency Department and was seen and discharged in 2.5 hours.
Review hospital systems from admission to discharge, ensuring patients flow smoothly.
But some are more grim:
An elderly man who requires hip and knee surgery and has been living in pain while they wait for their operations.
A cancer survivor who is overdue for their colonoscopy.
A person who is worried about a friend that has been waiting for surgery for over for 15 months, only to find out it has been cancelled.
The failure of our health system doesn’t stop at waiting lists.
I’ve heard of a grandmother sent home after waiting for hours in ED, only to return shortly after having had a stroke.
A grandfather lying in a hospital ward for days, sick and in pain, not knowing when—or if—a doctor would come to see him and tell him what is wrong.
And I’ve heard far too many stories over the past five weeks of people who are alive today, not because the system looked after them, but because their wives, husbands, daughters, and sons had to make lots of noise until someone paid attention.
That’s not a health system that works. And if you ask the doctors, nurses, midwives, and other health professionals who keep the system running, they’ll tell you the same thing. They are just as frustrated—because they got into this job to care for people and provide world-class healthcare to New Zealanders. But the system is failing their patients and them too. Somewhere along the way, our health system became desensitised to patients. There’s often too much focus on what the unions, the colleges, or professional lobby groups say, and not enough focus on what the patient says. Because in healthcare, the customer is the patient—the mum with the newborn, the tradie, the farmer, the kaumātua, the grandmother. They should be at the heart of every decision we make. People working in health have been conditioned to substandard management and conditioned to giving into groups which exert pressure on them.This is not the standard we should accept in New Zealand. That’s why we must fix the system—so that every patient gets the care they deserve, and every healthcare professional is empowered to do the job they trained so long and hard for. New Zealanders expect better. And under this Government, we will deliver it.
A long-term problem made worse by Labour
Let’s be clear—this is not a new problem. Our health system has been overloaded and under pressure for years. But the decisions of the previous government made it significantly worse. We inherited a health system in a state of turmoil.In the middle of a pandemic—when New Zealand needed stability—they ripped the entire structure apart. They forced through one of the biggest bureaucratic restructures in our history, abolishing 20 District Health Boards overnight and replacing them with a single, centralised bureaucracy. The reforms stripped decision-making away from regions and districts.They had no plan for how it would actually help patients. Key health targets – used to ensure the system was delivering for patients – were dumped.Instead of supporting frontline workers, they created another layer of bureaucratic management and confusion at the top. Instead of focusing on patient care and ensuring people didn’t get sicker languishing on ballooning waiting lists, they produced internal reports and shuffled job titles in the head office. Instead of keeping control of spending, they lost complete oversight of the system’s finances. To put it frankly, the previous government’s 2022 health reforms were rushed and poorly implemented, with disastrous results. Most importantly, those reforms eroded the trust and confidence of New Zealanders in getting access to the health services they need.It’s not just our view. It’s not just what frontline workers and patients say. It’s now documented fact.
The Deloitte Report – Labour’s health system failure in black and white
Today, a report by Deloitte titled the ‘Financial Review of Health New Zealand’—an independent report, not written by politicians, but by financial and operational experts – is being released on Health New Zealand’s website.It delivers a damning verdict on the state of our health system when we took office 16 months ago. The report shows, in black and white, that under the previous government, Health New Zealand lost control of the critical levers that drive financial and delivery outcomes.In simple terms:
The agency that was supposed to run our health system had no idea how it was spending its money or the results it was achieving.
Costs spiralled out of control, with deficits mounting each month.
Basic financial oversight collapsed, meaning no accountability, no performance tracking, and no ability to measure success or failure.
No systems in place to manage funds appropriately.
Meanwhile, Labour’s plan was to support unions over patients. As I mentioned earlier, they scrapped health targets, so they didn’t even know what success looked like.
The result?
Elective surgeries plummeted. In 2017, 1,037 people were waiting over four months for elective treatment. By the time Labour left office, that number had grown to 27,497. That’s an increase of over 2,551 percent.
Emergency department wait times blew out. When National left office, almost 90 percent of patients were seen within six hours. By 2023, that dropped below 70 percent.
Childhood immunisation rates collapsed. In 2017, 92.4 percent of children were fully immunised at 24 months. By 2023, that number hit 83 percent.
Primary healthcare was ignored. More people than ever couldn’t see a healthcare professional when they needed one.
This is a system under significant pressure and a system which was recklessly mismanaged under the past government, thrown into turmoil at the worst possible time, and left to drift without accountability. But that changes today.
Funding for Health
There is always a need for more investment in health, but more money isn’t the only solution.This Government has invested a record funding boost of $16.68 billion (over three years) in health to help the sector plan for the future, and that includes funding expected growth. The funding boost provided by this Government is enabling Health New Zealand to retain capacity at the frontline and deliver more services to New Zealanders.There are more frontline staff, including more nurses than ever before and more medical staff, allied and scientific staff, and care and support staff.Since it was set up, Health New Zealand’s frontline staff grew by almost 6,500 people, alongside achieving back-office efficiencies. Remuneration for health workforces has also increased.Since 2014, average salaries for nurses and midwives have increased by almost 70 percent, while average salaries for teachers and police have only risen by approximately 35-40 percent over the same period. The average salary of a registered nurse (including senior nurses) is currently around $125,660, including overtime and allowances. This aligns with nurses in New South Wales.Yet we are not seeing the results we have invested in.Productivity is declining and has not kept pace with historic levels of funding and workforce growth.For example, in the decade between 2014 and 2024, core Health operating funding almost doubled, but the number of first specialist assessments undertaken only increased by 17 percent. The waiting list more than doubled during this period to almost 195,000 people. And as at August last year, over 40 percent of adults needing to see a GP couldn’t get a consultation within a week of when they needed to see one. Every single dollar must deliver better outcomes for patients. More money going in must mean more results coming out. But under Labour, we saw more money with worse outcomes, longer waitlists, and declining service levels. That is simply unacceptable.
What we have done – A back-to-basics approach
Since being in office, this Government has been taking action and we are getting results:
We reinstated health targets—because what gets measured, gets done.
We’re doing more operations. Last year, the health system carried out over 144,000 elective procedures – 10,000 more than the previous 12 months.
We are moving resources back to the frontline, cutting wasteful bureaucracy.
The health workforce is being paid more.
We’re investing in health infrastructure—building new hospitals, upgrading existing ones, and modernising equipment. There are currently 66 Ministerially approved health infrastructure projects, worth a cumulative $6.3 billion in the pipeline.
We have begun stabilising the system, although there’s still a long way to go.
But let me be clear—this is just the beginning.
My five key priorities as Minister
Healthcare is a top priority for everyone in New Zealand. I see it every day as an electorate MP, a father of three young children, and as Health Minister travelling the country. Yes, there will always be a need for more money in healthcare, and as Minister, I will fight every single day to invest more and deliver more for you.I am proud of the investment this Government is putting into health. However, I will also be holding the system to account to deliver more for the funding that is being invested.Investing in primary care and funding additional operations are at the heart of my five clear priorities as Health Minister. They are:
Stabilising Health New Zealand’s governance and accountability allowing it to focus on delivering the basics
Reducing emergency department wait times
Delivering a boost in elective surgery volumes to get on top of the backlog and reduce waiting lists
Fixing primary care to ensure easier access
Providing clarity on the health infrastructure investment pipeline.
1. Focusing Health New Zealand on delivering the basics
My first priority is getting the basics right. It follows years of worsening results being the only thing being delivered.We are going to turn this around by focusing on delivery and achieving targets. Our health targets matter because they demonstrate performance. But it’s not enough to have them on paper—we must deliver real results. Over the last few years, the previous Government’s decision to restructure in the middle of a pandemic—and to remove those targets—led us to where we are now. Too many people are waiting too long for critical assessments and treatments.Health New Zealand should run a health system, not a bureaucracy. Instead of focusing on patients, it got lost in process. That changes now.No more excuses. We measure success in one way: better outcomes for patients.Health New Zealand has struggled to come together as a cohesive team that supports the organisation to deliver for patients. Senior Leadership Team members have only just begun weekly in-person meetings, and have continued to operate from different offices, despite the majority living in Auckland and the organisation being two and a half years old.This has meant the organisation has failed to create a cohesive team to lead the organisation forward.Today, I’m outlining my expectations for Health NZ to deliver a nationally planned and consistent, but locally delivered, health system. I expect core services (infrastructure, data, digital, HR, comms) will sit at head office, with national executive leadership focused on national programmes, shared services, overall governance and planning and empowering districts. I have directed the Commissioner to accelerate the shift to local decision-making and service delivery, and set a requirement for local delivery plans to be developed. I expect this to be done by July.This will enable local leaders to plan effectively, be clear about their budgets, allocate resource to where it’s most needed, and deliver better outcomes for their communities.Because all healthcare is local.I expect there to be strong regional coordination to support local delivery, with singular lines of accountability flowing from the national executive level through to the frontline.Under Labour, financial controls vanished, clinical input was lost, and local districts were disempowered. We are restoring that.Today, I have issued a new letter of expectation and Health New Zealand has released its delivery plan to reflect this.I will also bring back a board for Health New Zealand. Now that the plan is set, it is time to begin the process of transitioning to traditional governance.In the coming weeks, nominations open for the new board. If you have passion for healthcare and a demonstrated track record of delivery, we need you.I’d like to take this opportunity to thank the Commissioners for their work to date and I look forward to working with them as they deliver on their plan and as we transition to a board.
2. Fixing Primary Healthcare – easier access for everyone
My second priority is ensuring timely GP access. New Zealand has a shortage of family doctors, who play an important role in helping Kiwis to stay well and out of emergency departments.But last year a third of GP practices had their books closed, forcing people to emergency departments. And if you can’t book in to see your GP or nurse when you need one, you end up in ED when you shouldn’t have to. No one should wait weeks to see a GP and we are set on fixing that.Historically, more funding has been invested in more costly hospital and specialist services at the expense of primary and community care. Over the past five years, hospital funding has increased at a higher rate than primary and community funding. Hospital funding went up by almost 53 percent, while primary and community funding increased by 41 percent.This means we’re missing opportunities for earlier and less costly interventions.We must shift the dial towards primary care, both to improve access for New Zealanders and because it is the fiscally responsible thing to do.We have already made a number of important announcements this week about how we will improve access to primary care including:
Making it easier for New Zealanders to see a doctor. We’re providing up to 100 clinical placements for overseas-trained doctors to work in primary care. This will support their transition into GP practices that need them most.
We are also ramping up the number of trainee GPs to give Kiwis better access to healthcare in their communities. We’re introducing a funded primary care pathway to registration for up to 50 New Zealand-trained graduate doctors each year from 2026.
We’re training more new doctors. During the term of this Government, medical school placement have increased by 100 places each year.
We’re investing to increase the number of nurses in primary care. This includes supporting GP practices and other providers outside hospitals to hire up to 400 graduate registered nurses a year from this year.
Improving access to 24/7 digital care. This will provide all New Zealanders with better and faster access to video consultations with New Zealand-registered clinicians, such as GPs and nurse practitioners, for urgent problems, 24 hours a day, seven days a week. People will be able to be diagnosed, get prescriptions, be referred for lab tests or radiology, and have urgent referrals organised.
These measures focus on giving our primary care workforce the numbers and support they need, so that when you or your whānau need to see a GP, you can—without facing weeks-long wait times or closed books.Strengthening urgent and after-hours care will also be a focus of mine as part of our plan to enable faster access to primary care, and work on this is underway.This week I also announced that Health New Zealand has agreed to deliver a $285 million uplift to funding over three years for general practice from 1 July, in addition to the capitation uplift general practice receives annually.This will be incentivise GPs to improve access and patient outcomes – especially around improved vaccination rates and supporting family doctors to undertake minor planned services. This is just the start – there is more to do. Health New Zealand has work underway to rethink how we fund primary care to make it faster, more accessible, and more sustainable.
3. Reducing ED wait times
My third priority is emergency departments, which have seen lengthy wait times continue to increase since targets were scrapped. The ED target is not just about making sure patients are seen quickly but it pushes every part of the hospital to work smoothly.Emergency departments are the beating hearts of hospitals – if they are operating efficiently and effectively, that reflects the effectiveness and efficiency of every part of the hospital. If wait times are too slow in the ED department it indicates problems throughout the hospital. I expect Health New Zealand to:
Empower clinicians at local levels to fix bottlenecks in real time.
Integrate the primary care reforms, so fewer preventable cases end up in ED. This will be done by hiring and training more doctors and nurses and ensuring New Zealanders have access to round-the-clock care.
The relationship between our hospitals and primary care is critically important, but has broken down in recent years and needs to be fixed. Empowering the primary care sector can help keep people out of hospital and manage patients much more cost effectively in our communities.We need our hospitals working with our primary health care providers to achieve this, and we need many more hospital services delivered locally in communities rather than centrally in our hospitals. We are restoring a focus on ED shorter stay targets, forcing real improvements across the entire hospital. We want to see 95 percent of people admitted, discharged, or transferred from an emergency department within six hours.
4. Clearing the elective surgery backlog
My fourth priority is elective surgeries, where 27,497 people were waiting more than four months for surgeries they desperately needed in September 2023—a number that was 1,037 under National in 2017. This backlog is unacceptable and has unfortunately grown since we came to Government.But we have arrested the decline in the number of operations. As I mentioned earlier, last financial year, the health system carried out 10,000 more elective procedures than in the previous 12 months. However, we must still urgently increase the volume of surgeries.The elective surgery wait list target isn’t just about measuring performance of the system, it is about people. Behind every number is an individual, a family, many waiting in pain and families anxious for their loved ones to have the surgery they need. We can’t keep doing things the way we currently do it. At the moment Health NZ undertakes both elective surgery, and also responds to acute need, with planned elective surgery often being disrupted by acute need, leaving patients waiting for treatment and waitlists continuing to grow. At the same time, the small amount of planned care that is outsourced to the private sector is often done on an ad hoc basis, meaning Health New Zealand is paying premium prices.This practice must stop. Kiwis waiting in pain for an operation aren’t worried about who is delivering the operation, they just want it done as quickly as possible. I want to see Health NZ both lifting its own performance on elective surgeries, but also partnering closely with the private sector to ensure we can get on top of the waitlists and get kiwis the operations they need as quickly as possible. By partnering with the private sector, we can ensure people get the care they need, and Health New Zealand can achieve value for money through long-term contracts with the private sector. I expect Health New Zealand to work closely with ACC – which already has many of these arrangements in place – to ensure value for money for taxpayers and faster treatment for patients.Today I am pleased to announce the first part of this plan with Health New Zealand investing $50 million between now and the end of June this year to reduce the backlog of people waiting for elective surgeries. That will see an extra 10,579 procedures carried out between now and the middle of this year, with work also underway now to negotiate longer term agreements. This will improve the quality of life of thousands of New Zealanders. It will mean people can return to work, take up hobbies again, and continue to build precious memories with loved ones. I can also announce that I have asked Health New Zealand to work with the private sector to agree a set of principles that will underpin future outsourcing contracts. This will include:
Ending the use of expensive ad hoc, shorter-term contracts for elective surgeries.
Negotiating longer-term, multi-year agreements to deliver better value for money and better outcomes for patients.
Agreeing on plans to recruit, share, and train staff which already bridge both the public and private hospitals.
Long term, I want as much planned care as possible to be delivered in partnership with the private sector, freeing public hospitals for acute needs. However, this needs to be done in a way which is mutually beneficial for our public health system and our workforce. To be clear, the system remains publicly funded, so everyone has access, but this will allow Health New Zealand to leverage private capacity to reduce wait times for patients.
5. Investing in health infrastructure – building for the future
My fifth priority is infrastructure—physical and digital. Our hospitals and data systems are in dire need of upgrade. Health New Zealand is grappling with an outdated infrastructure that is inhibiting changes to models of care that improve patient outcomes and drive efficiencies.Currently:
Health New Zealand has about 1,200 buildings – some have significant seismic risks, other older buildings are not clinically fit for purpose.
Digital infrastructure is also fragmented. There are an estimated 6,000 applications and 100 digital networks. That equates to roughly one application for every 16 Health New Zealand staff members, which is unsustainable.
We need solutions. That includes:
Investigating creating a separate Health Infrastructure Entity under Health New Zealand, to manage and deliver physical and digital assets.
Publishing a long-term plan for health infrastructure so Kiwis know what’s being upgraded across New Zealand and can see a 10-year pipeline of capital projects
Putting all funding and financing options on the table—this will require bold, sustainable investment.
Health infrastructure has been neglected for decades.We’re turning that around. There are currently health infrastructure projects, worth a cumulative $6.3 billion in the pipeline.That includes:
A new hospital in Dunedin.
Modern cancer treatment facilities in Hawke’s Bay and Taranaki
The extensive facilities infrastructure remediation programme at Auckland City Hospital and Greenlane Clinical Centre, and
Manukau Health Park and Hillmorton specialist mental health services in Christchurch.
Hospitals don’t run on press releases; they run on real investment. We are delivering that.
Stripping out bureaucracy, demanding delivery
At the end of the day, you can’t manage what you don’t measure. It comes down to results, accountabilities, and every single person in the health system playing their part. My message to Health New Zealand is simple: I expect delivery. I expect a back-to-basics approach, with less talk and more action.I expect a relentless focus on improving health outcomes for New Zealanders and for Health New Zealand to reallocate baseline funding to implement immediate action.We’ve had enough talk. It’s time to fix this system.
A health system that delivers for every New Zealander
New Zealanders don’t want more reports or more excuses—they want action:
Health targets are back.
We’re taking action to stabilise surgery waitlists.
More doctors and nurses are being trained and recruited.
Hospitals are being upgraded.
Primary care is being strengthened.
This isn’t just talk; it’s real change. And I promise every New Zealander: we will not stop until our health system delivers timely, quality care to all.We are embarking on this shift with urgency.Patients come first. And this Government will not rest until that’s a reality.Thank you very much.
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