Public health system 'in intensive care,' experts tell Porirua forum

A panel of health experts, advocates and clinicians told a forum in Porirua on Monday night that New Zealand's public health system is in intensive care and starting to flatline. (RNZ)

The forum, held at the Porirua Hospital Campus — which provides mental health services at Te Korowai Whariki, 16 Hospital Drive (Health NZ) — brought together voices from general practice, intensive care medicine, patient advocacy, iwi-Māori partnership structures and youth mental health advocacy.

Malcolm Mulholland, of the advocacy group Patient Voice Aotearoa, told the forum that New Zealand now had a two-tiered health system: one for people with private health insurance and one for those without. He said he feared further privatisation, with essential hospital or community-care services being contracted out to private providers.

Doctor David Galler, a former intensive care specialist at Middlemore Hospital, said underinvestment in the health system was well documented and was driving away the workforce. Privatisation, spending cuts and staff shortages weakened the public system and pushed public-sector staff to move into the private sector as they became overwhelmed, he said.

General practitioner Lucy O'Hagan described a health workforce suffering from "a pandemic of burnout." She said the young GPs she teaches were choosing to work only three days a week because the mental and emotional demand was so high, while older, experienced GPs were retiring early or cutting back their hours.

Nursing workforce figures underline the pressure. According to the NZ Nurses Organisation, the nursing workforce grew by only 54 full-time equivalent staff — a measure that counts part-time roles as a portion of a full-time position — between March 2024 and March 2026, from 29,404 to 29,458. (NZNO) Health New Zealand, responding to the Porirua event, said the entire health system was under pressure. (RNZ)

Louisa Wall, chair of the Tūwharetoa Iwi-Māori Partnership Board — a body that gives iwi a formal role in local health decisions — said about a quarter of the Māori residents in her rohe (tribal territory) were not enrolled with a GP. People in her rohe waited until their pain became extreme and could not be ignored before seeking care, she said.

Youth mental health advocate Luca Zampese said too many young people were struggling to get help when they needed it. New Zealand had been ranked last among comparable wealthy countries for child and youth mental wellbeing, he said, and UNICEF's latest international report found Aotearoa had the highest adolescent suicide rate among the countries studied — almost three times the average for high-income nations.

Mental Health Minister Matt Doocey, also cited at the forum, pointed to survey figures showing that only 3.7 percent of young people said they could not get an appointment, while 29.4 percent said they did not know where to get help and more than 35 percent said they were too embarrassed. A recent survey found more than a quarter of young people did not know where to get help, he said. Doocey said the government would start reporting how quickly young people were accessing mental health support.

The government defended its approach to outsourcing. A government spokesperson said outsourcing was not new but the government was doing it differently, and that the patients helped most by outsourcing planned surgeries to private providers were those without insurance who were on the public waitlist. The spokesperson also said there had been record funding for general practice and a focus on growing that workforce.

The broader tension running through the forum is the gap between the government's framing and the view from clinicians and advocates. The government says targeted outsourcing — sending planned surgeries to private providers — gives relief to uninsured patients stuck on public waitlists. Galler and Mulholland do not dispute that outsourcing can move individual patients off waitlists. Their argument is that the cumulative effect of outsourcing, combined with spending cuts and staff leaving, hollows out the public system's ability to deliver care on its own.

The nursing workforce growth figure — 54 full-time equivalent staff over two years — gives that argument a concrete anchor. Whether a net increase of that scale is enough to meet demand across a population of roughly five million is a question the forum implicitly posed but did not resolve. Health New Zealand's own acknowledgement that the entire system is under pressure concedes the point without conceding the policy direction.

The youth mental health data adds a further dimension. Doocey's survey figures suggest the primary access barrier is not appointment availability but awareness and stigma — only 3.7 percent reported being unable to get an appointment, against 35 percent citing embarrassment. The government's commitment to begin reporting access timeliness is a transparency measure, not a service-delivery change in itself.