Taumata Rau Conversation: where next for our health workforce?

Speakers with deep experience of the health system had some advice to the incoming Minister of Health at the inaugural Taumata Rau Conversations event: model the values you want to see; take on the challenge of radical humility and remember a traditional African proverb that says: “Health is made at home, hospitals and clinics are for repairs.”

Taumata Rau Conversations, hosted by the Vice-Chancellor Professor Dawn Freshwater at Waipapa Taumata Rau, University of Auckland, aim to spark meaningful discussions from multiple perspectives on the major issues confronting Aotearoa New Zealand.

The inaugural event held at the Faculty of Medical and Health Sciences (FMHS) was moderated by Professor Sir Ashley Bloomfield, director of the University Public Policy Impact Institute with panellists Dr Jenny Parr, chief nurse and director of patient and whānau experience at Te Whatu Ora; Associate Professor Matire Harwood, head of general practice and primary healthcare at FMHS and a general practitioner; Tamzin Brott, chief allied health officer and acting general manager of Diagnostics and Clinical Support Services at Te Whatu Ora Waitematā.

Dr Lloyd McCann, CEO of Tāmaki Health, was a panellist and delivered the keynote address.

In his keynote Dr McCann had two themes, the need to grow the health workforce and how Covid had delivered valuable lessons.

“We rapidly pivoted away from a complete reliance on a professional workforce, a regulated workforce to empower and enable many people within our communities.”

Tāmaki Health is the country’s largest privately owned health care group with more than 40 general practice and urgent care clinics and community services.

McCann outlined the valuable role of health coaches from the Brown Buttabean programme established by ex-boxer Dave Letele.

“The clinical and health outcomes from this team are incredible,” he said, noting an evaluation that showed sustained weight loss of between seven and 10kgs and a decline in blood glucose levels. Patients are saying that while they value the health professionals, the real difference to their health had come from working with someone with the same lived experience."

McCann said, “They say they don’t feel judged, and don’t feel there is a rush to get through things.” There was power and potential, he said, in extending the traditional structure of the health sector to advocates and coaches in the community, referring to the African proverb that, “Health is made at home, hospitals and clinics are for repairs.”

He said that India, recognising the global shortfall in health workers, had embarked on a national strategy to train a million healthcare workers in the next two or three years, not only for the Indian health system, but as a workforce to be exported. New Zealand and the University needed to factor in global health workforce needs and shifts into its own planning.

His message to the incoming minister? “Minister, you are important, but what we actually need you to do is remove obstacles and barriers for us and stay out of our way, because it is the people who are going to make the real difference.”

The expert panellists each made a pitch and a plea for the future health workforce. Tamzin Brott said allied health professions, which include roles ranging from occupational therapists to sterile processing technicians, were the second largest group in the health workforce.

“Our workforce covers more than 45 professions and they each play an important part of the health journey.” Without sterile technicians, surgery would be impossible. “We need to raise the profiles of these roles and encourage people to consider the full scope of opportunities to have very rewarding careers in health."

Dr Jenny Parr said New Zealand’s problems were global. “By 2030 we’ll have 10 million less nurses than we do now if we stand still.” Along with the rest of the health workforce, nurses faced huge pressures during Covid.

“But they’re still busy, they are unprecedentedly busy, they are burnt out and even if they aren’t burnt out they may not realise they are.”

To cope with future need for nursing, the health sector needed to reflect on the need for self-care, to reward leadership at all levels and to bring in new people who reflected the communities they serve. Her plea to a new minister: We need to achieve the system shifts that we really need to enable local clinical professional leaders to be valued.

“Clinical leadership is strong and capable in New Zealand.”

A new Government needed to invest in growing strong leadership in nursing and budget for pay equity across the sector to attract the numbers of nurses the country needs.

Associate Professor Harwood was acutely and personally aware of how political leadership sets the values and tone of social discourse. She recounted how after the election she had used a Māori word at a supermarket. A bystander said, “Give it a rest. All Māori words are going to be gone soon.”

Her message: “Our Government and our minister set the tone for how we treat each other and whether or not we want to achieve justice, fairness and equity for all of our people.

"That’s what I want more than anything. I have just one message for the Minister. Please, please set the values for the nation to do well by equity.”

Professor Ashley Bloomfield, in thanking the participants for their kōrero, said if there was a value he would want the minister to consider it was that of radical humility.

“Radical humility is characterised by acknowledging complexity, understanding that answers are not obvious, and requires listening to other people’s ideas. It's about accepting that there will not be simple answers and to be willing to change one’s mind when new evidence is found.”

Most important, he said, was the resolve “… to stand up and be accountable when things don’t go right.”

Introducing Taumata Rau Conversations, Vice-Chancellor Professor Dawn Freshwater said in the aftermath of the pandemic, it had become more difficult to have the challenging conversations that need to take place for society to understand complex and sometimes fraught issues.

“We, as an anchor institution in society and particularly in Tāmaki Makaurau and Aotearoa, really need to step into these conversations.”

The Taumata Rau Conversations will be an ongoing event from the University. The Conversations, she said, were about listening as much as talking, about dialogue more than debate and her wish was for them to be an occasion where audiences and participants could listen while withholding judgement until the conversation had time to unfold and for people to properly weigh the layers of information and meaning that come with complex issues."