Fact Sheet 14 : Health

This Fact Sheet was prepared for the July 2002 General Election campaign.

Progress made under the current Government

The CTU strongly supported the New Zealand Public Health and Disability Bill which signaled a fundamental change in direction from a contractual market-drive model towards a more co-operative and collaborative health system.

Primary Health Organisations (PHOs), working within their communities, will be a crucial part of this process. The introduction of largely elected district health boards (DHBs) also potentially increases the level of public participation on local health issues.

The Labour / Alliance Government developed a comprehensive strategic and planned approach in key areas of health to address the years of neglect and lack of planning for future needs.

This included the publication of strategy documents on health, disability, primary health care and health of older people - which to varying degrees included a focus on workforce development issues. The establishment of a Health Workforce Advisory Committee (HWAC) has seen the development of a stocktake report. A second report on options for addressing key workforce issues will be released after the election.

Late last year the Government announced a three year funding track for health, which increases the level of certainty and ability for the sector to plan. The introduction of the Employment Relations Act has made possible the multi-employer collective agreements (MECAs) which allow better recognition of the need for improved and standardised wages and working conditions in the health sector.

There have been a number of tripartite forums or projects bringing together unions, employers and Government in the health sector, for example within Auckland DHBs and in the aged care sector. As a model they provide a welcome contrast to the 1990s when health workers and their unions were excluded from such involvement in developing strategic policies for the sector.

What else needs to be done?

The CTUs health policy is built upon a fundamental belief in the importance of high quality, accessible public health care, and recognition of the economic and social impacts of health disparities.

It is crucial that there is a planned programme to ensure universal entitlement to free primary health care. The CTU remains opposed to the contracting out and privatisation of public health care, and supports re-establishing DHBs direct provision of contracted services (including cleaning and catering).

We are concerned about the need to address inequities in health outcomes, particularly those faced by Maori, Pacific peoples, and low-income groups. This will require a greater level of co-operation between DHBs working in partnership with their communities and with the active participation of health workers in decision making. We support the Primary Health Care Strategy but note that adequate funding is required to ensure quality care and labour standards within Primary Health Organisations.

The current shortage of nurses, doctors and health professionals is impacting on the delivery of basic health services. Long term planning needs to be undertaken to determine, and then fund, the required number of health care workers. Working conditions are affecting the current health workforce, with many health workers leaving because of excessive workloads, inadequate remuneration and low morale.

Recruitment and retention strategies are required that include steps to address unacceptable workloads, introduce safe staffing standards, improve pay and working conditions, and reduce student fees and debt. Furthermore, all health sector workers should have access to regular, industry-recognised, paid education and training. Any tripartite health workforce development strategy must have the ability to set and enforce labour standards and build the capacity of the Maori and Pacific health workforce.

Job security, pay and working conditions are areas of concern for those health sector workers (e.g. catering, cleaning and laundry workers) whose jobs continue to be contracted out. Many other health workers' conditions (for example in aged care and disability support services) are also indirectly determined by the level of contracted funding from the Ministry of Health or DHBs. All providers receiving Government health funding should be required to have responsible contractor policies setting out the quality labour standards required to provide quality care.

Such polices should also include a transfer of undertakings clause to protect job security and employment conditions, so that contracting out cannot be used as a means to drive down wages and conditions.

Overall, there is a pressing need to ensure greater financial stability and certainty across the health sector. Policy options may include investigating the merits of a dedicated health tax.

What could be lost under a National/Act Government?

Both parties propose cuts to taxes with Act explicitly stating that there will be a reduced public provision of health services and funding mechanisms will be designed to help increase competition from the private sector.

National is committed to public-private partnerships in health and allowing private providers to charge co-payments or extra charges. The CTU continues to oppose co-payments for work-related accidents as it contravenes the International Labour Organisation Convention requirement that workers receive free treatment for such accidents. Act is also attacking health unions, calling for health professionals to be freed from "the constraints imposed by professional unions".