If the half billion spent on 'ghost roads' had been spent on health

t was recently reported that the Government has spent nearly half a billion dollars creating business cases for so-called ghost roads that have now been in effect shelved. This includes $323m on Roads of National Significance projects that were quietly abandoned after sustained criticism of their high cost and low value. It has also spent $106m on an Auckland Harbour crossing business case that will now, extraordinarily, be recommissioned at further expense.

The Infrastructure Commission has been among those criticising the amount spent on roads. It points out that New Zealand spends more on infrastructure as a proportion of GDP than most of the OECD but is fourth from bottom in terms of the value gained from this expenditure. The National Infrastructure Plan 2025 recommends that New Zealand spends less on roads and more on social infrastructure, including doubling the proportion of GDP spent on hospitals.

Why is extraordinary waste seemingly normalised in transport, while funding a struggling health system is so difficult? Every other day brings headlines about our over-stretched health system and the consequences.

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One reason is the misconception that transport has its own separate, self-funding budget, paid for through petrol taxes. That was true in the past. But the present transport spend exceeds what can be raised by charges on road users. Most of the cost of large mega-roading projects must be covered from general taxation. This means that roads compete directly with health, education, defence and every other budget item – infrastructure or otherwise – that requires public investment.

This winter, the worst flu epidemic in years has overwhelmed general practices and hospital emergency departments. At its peak, demand reportedly tripled the usual load, creating what some described as ‘war-time conditions’ and waits in emergency departments stretch to six to 12 hours or longer.

Access appears to be the major problem. Once patients are in the door, they generally report they are satisfied with the treatment they receive. But getting through the hospital or clinic door can be a huge challenge – and delays may have serious consequences. 

Waiting times for specialist eye care have grown, with about 20,000 people in 2026 waiting twice as long as recommended to be assessed. This is concerning as late diagnosis and treatment of eye diseases may cause irreversible loss of vision.

Poorly maintained IT systems also create risks. A recent review found that almost a million cervical screening notifications have been missed or not sent in recent years because of flaws in the national screening register.

Old hospital buildings limit treatment options. Each year severe mental health problems affect tens of thousands of women during pregnancy and immediately afterwards, yet up to a third do not receive appropriate specialist care. One reason is the lack of facilities. Only Auckland and Christchurch have mother-and-baby units where mothers with serious mental health problems can receive treatment without being separated from their babies.

Pressure on health services is partly a function of growing demand, including demographic change. But there is also pressure on the supply side: medical advances create treatments that are effective but expensive and resource intensive.

Atrial fibrillation is one of the most common disturbances of heart rhythm, and a risk factor for heart attacks and strokes. Pulmonary vein isolation (a sophisticated medical procedure that creates tiny scars inside the heart to block disruptive electrical signals) is a treatment that is relatively new and has been shown to be effective, but it is time-consuming and expensive.

In New Zealand many more patients could benefit from the procedure, but this would require new funding. As is often the case with medical innovation, the first to benefit tend to be more socially advantaged groups. In 2026 Māori and Pacific patients with atrial fibrillation are around half as likely as New Zealand Europeans to receive catheter ablation and other heart rhythm-control interventions.

Inequity is evident throughout the health system. But three health problems are trademarks of poverty: rotting teeth, needless disability and untreated mental health disorders.

Around one in three people in New Zealand lives with untreated dental decay – an avoidable, distressing and costly condition that disproportionately affects Māori, Pacific peoples, disabled people and those on low incomes. A 2022 survey found that 40 percent of New Zealanders, and half of Māori and Pasifika respondents, could not afford dental care.

In child and youth mental wellbeing, New Zealand ranks last among 34 comparable OECD countries. Its suicide rate among 15-19-year-olds is higher than that reported by any other country, with Māori young people disproportionately affected.

The health minister claims the health workforce is growing significantly but he recently acknowledged that the number of nurses employed by Health NZ has increased by only 54 full-time equivalents since March 2024. The NZ Nurses Organisation says that fewer than half of those who graduated from nursing programmes in the past two years received offers of hospital jobs.

A leaked Health NZ analysis reported that the South Island health workforce had declined by 17 percent over four years. This was largely a result of cuts to administrative and support functions, but the report acknowledged there may be “downstream impacts on coordination, service delivery and frontline effectiveness”.

An investigation of the NHS in England in 2024 by Lord Darzi found crowding, queues, staff shortages and record-low public satisfaction. Darzi concluded the NHS was in critical condition, but this was not primarily a failure of management. He reported the biggest problem of all was underfunding – particularly a long-term failure to invest in capital infrastructure.

We think the story in New Zealand is similar.

Although the Government stresses the importance of reducing debt, lowering taxes and cutting public services, there is public support for spending more on health.

A study of public opinion carried out by the University of Otago and the Cancer Foundation found that almost two-thirds of respondents favoured paying more tax if it resulted in increased healthcare funding. A recent survey of business owners and leaders produced similar findings: tax relief ranked last among election priorities, while infrastructure, health and energy ranked highest.

How much more should be spent on health? There is no simple answer. But it is striking that one estimate as reported on by Newsroom estimates the funding shortfall is $600 million.

Which just happens to be roughly the amount we have wasted designing ghost roads in the last three years.