Health sector under-funding unfair on patients and medical staff

By Associate Professor Margaret Brunton

Nobody wants an inefficient health system and, realistically, no country can provide unlimited health resources. But the business-focused model adopted by New Zealand’s public health sector in the late eighties has not delivered the improved quality it promised. Unsurprisingly, health sector funding has become a key election issue.

We are experiencing alarming rates of under-funding of vital services such as mental health. The social costs are exorbitant if you look at our suicide rate – it is the highest in the developed world. Families are not only dealing with depressed young teens, but also with what Shaun Robinson, the chief executive of the Mental Health Foundation, calls the ‘toxic mix’ that feeds into this – poverty and under-funding. 

The government argues it has never spent more on healthcare and claims various successes that do not always show the full picture. Perhaps we are doing more surgery, but population growth, especially of elderly high-users, means that it is now almost impossible to get onto a waiting list, let alone remain on one. In that way, some of the surgical activity statistics may look improved, but the service is not. Just emphasising efficiency doesn’t mean efficient outcomes. 

Under-funding affects healthcare professionals too

All this has a major impact on healthcare professionals, a subject that doesn’t get the attention it deserves. When you introduce a business model into a system that relies on a public service ethos, it creates an ideological assault on the internal values of those working there. Health professionals make difficult ethical decisions about life and death – treatment or no treatment – and this requires considerable judgment, autonomy, specialisation and knowledge. Yet, under-funding and restricted resources mean the service runs largely on goodwill.

Could this be the reason we have experienced ongoing strike action by junior doctors since 2006? Is it why senior doctors have also threatened industrial action? Perhaps it is the reason our health service relies so heavily on internationally-trained medics – over 40 per cent at last count and the highest level of any country in the OECD.

Along with a history of long-running disputes and strikes of radiographers, nurses, ancillary staff, high turnover of managers who report undue political pressure on District Health Boards to cut costs, it is arguably a health system in crisis.

My own research into the lived experiences of health professionals is revealing. The narratives of junior doctors show high levels of disillusionment, and many subsequent decisions to exit for better-funded and professionally-resourced hospitals in Australia.

Internationally-qualified nurse numbers are soaring

NZ also relies on the highest rate of internationally-qualified nurses (at 25 per cent) in the OECD, and a current study of the communication between New Zealand and internationally-qualified nurses highlighted numerous pressures. Our findings show that while the vocational love of their work still sustains most nurses, the complexity of practicing in a busy, resource-constrained environment with a high potential for misunderstanding and errors was creating a “perfect storm” of unrest. 

Interviews with nurses show the difficulties that come with negotiating between cultures and, despite everyone’s best attempts to provide a high standard of care, we identified low levels of morale.

One New Zealand nurse in our study described her decision to exit as she dealt with overload: “Relatives of patients would corner me to ask for information and/or complain about the lack of English speaking nurses. They were often emotionally upset, frustrated at a perceived lack of communication. I found this very challenging as a nurse… my own integrity was challenged as my own allocated patients were not able to be cared for as I would have intended… I left in frustration at a system where money and budget achievements came first, not people.”

Under-staff is causing additional pressures

Our research found that the high number of nurses having to work unpaid overtime and missing meal breaks was the norm more than the exception, alongside a perceived lack of support from their managers. When dealing with people suffering from chronic illness, acute events and life-changing decisions, you need a supportive working environment to sustain you, not one of perceived unfairness or lack of recognition. Managers as well as health professionals are struggling in the current environment and they acknowledge the constraints.

A sustainable public health service relies on retaining both medical and nursing staff – it is far more expensive to replace professional staff than to invest in existing staff and nurture the working environment. Some of the solutions offered by nurses were time-dependent. For example, one nurse told us: “We do not necessarily need courses and mentoring, we do need opportunities to get to know our colleagues and what motivates each individual… We are usually too busy to stop and analyse the sort of issues you are raising.”

Nurses tell us they are willing to help foster collaborative working relationships, but this requires time for reflective practise, to become familiar with differences and explore the potential for learning from one another’s perspectives. Meanwhile, nurses continue to report ongoing tensions with heavy workloads and little time and support to make things better. They certainly deserve better – let’s hope our political leaders, no matter who wins on September 23, are ready to address the health sector’s years of chronic under-funding.

Margaret Brunton is a former registered nurse and an associate professor with Massey University’s School of Communication, Journalism and Marketing. She is the lead researcher on a grant-funded collaborative project undertaken with Dr Catherine Cook and Dr Leonie Walker from Massey University’s College of Health and Dr Jill Clendon from the Ministry of Health.