A focus on earn-as-you-learn initiatives in the new health workforce plan ignores the need for consistent quality training – meaning potentially grim results
Comment: The Government’s recently-announced Health Workforce Plan 2023/24 calls attention to a problem that has been discussed for years: Aotearoa doesn’t have enough healthcare workers to meet current needs. While efforts to address the shortage of health professionals are welcome, some aspects of the Government’s plan need further scrutiny.
One key concern is the Government’s decision to reduce reliance “on classical, academic models of training” and move to earn-as-you-learn initiatives. This seems to ignore the need for consistent quality training. Against a backdrop of proposed restructuring in tertiary education institutes across the motu, it’s a potentially grim tiding.
While it’s important to make healthcare education more accessible – for example, through financial incentives to study nursing – earn-as-you-learn pathways may not provide healthcare professionals with the necessary skills and knowledge to offer quality care. Moreover, placing the task of educating the future workforce on an already-overburdened health sector does not seem prudent.
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The plan’s aim to train more health professionals, or to train health professionals faster, will only be achievable if there is effective tertiary education funding for health science disciplines. The Government will need to ensure that any earn-as-you-learn pathways are rigorously scrutinised by academics, and health professional groups, so they meet the same standards as formal education.
The plan highlights the need to invest in the country’s next generation of clinical leaders. As healthcare becomes increasingly complex, it is essential that our health leaders have the skills to navigate this complexity and drive innovation; this includes research and teaching skills, and policy expertise. Equipping people with these skills will also require investment in education.
Within the pharmacy profession, for example, only 2 percent (based on 2022 figures) currently work in teaching or research. Within nursing, approximately 1.5 percent of nurses work in a tertiary education provider and nurse academics are often older. Without investment in tertiary teaching and research, the ability to support nurses in their pursuit of both undergraduate and postgraduate education will be limited.
Of course, it’s not just nursing or pharmacist education where this matters. For a health system to function, we need academics capable of providing excellent education. However, no initiatives are detailed in the plan to ensure this essential component of an effective health workforce strategy is considered. As a result, learning and innovation will likely be hindered.
Much could be done to attract and retain a teaching and research health workforce by creating pay parity between those working in traditional clinical pathways and those clinicians working in academia. For example, the average annual salary for pharmacists in Aotearoa is $90,000-$100,000, while starting salaries for PhD-qualified lecturers are just over $80,000. Nursing has an even larger pay gap.
Notably, a key feature of the Health Workforce Plan is to draw on international recruitment to meet workforce needs. However, it is increasingly hard to compete in the international market for health professionals and retention is often difficult. Bringing in workers from overseas may be a short-term solution, but it will not plug the identified gap in the long term.
On the plus side, it’s commendable the Government has identified the need for better ways to recruit health workers from among underserved populations including Māori, Pacific peoples, and tāngata whaikaha (disabled people). Alongside this, in recognition of our ageing health workforce, the Government could usefully take steps to enable those close to retirement to continue working.
Retaining healthcare workers is critical to solving staff shortages and it’s essential we support people to stay in the workforce as they age or face other challenges. Burnout and job dissatisfaction are primary reasons why healthcare professionals leave. Discrimination and harassment are also significant issues for many.
While the plan calls attention to the need to support and retain the health workforce through, for example, establishing a Workforce Wellbeing Hub, one core aspect is missing –research into what is happening to the health workforce. Understanding workforce needs and evaluating approaches to meet these needs is vital to planning effectively.
Without this research (and funding to support researchers), existing problems could potentially get worse. Effective monitoring will also be needed to gauge whether the changes implemented are meeting quality and performance measures. Ongoing monitoring, a crucial aspect of policy evaluation, will let us know if the plan is working as intended.
There’s no doubt that health workforce shortages in Aotearoa are multi-layered, demanding a comprehensive approach to resolution. We must ensure health professionals receive the education they need to offer quality care, that future health leaders have the skills they need to drive innovation, and that support of our health workforce is research-led.
Addressing these challenges will ensure the system is not further burdened by the lack of current knowledge about what professions need. Our priority must be to ensure every New Zealander has access to high-quality healthcare delivered by a well-trained and supported health workforce.
Associate Professor Kathy Holloway and Professor Karen McBride-Henry from the School of Nursing, Midwifery, and Health Practice at Te Herenga Waka—Victoria University of Wellington contributed to this article.
