SBOIA25 663 Attachment.pdf

Contents
Director-General Foreword . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . 4
Overview of health outcomes and services . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . 5
The New Zealand health system today . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . 6
Achieving the health system New Zealanders need . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . .  7
Taking action across the health system and other sectors . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... .  11
Health system trends and chal enges . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . 13
Delivering on your immediate priorities for health  . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . .  14
Achieving health targets . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... 14
Delivering Budget 2025 . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ...  15
Overseeing implementation of the Health NZ reset plan . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... 15
Transforming Primary Care. . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . .  15
Opportunities to reset legislative settings  . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . 16
Further progressing the Government’s health priorities . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . .  17
Next steps for the New Medical School . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . 17
Cancer medicines implementation . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . 17
Infrastructure . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . .  18
Public health   . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . 18
We expect to provide you with further advice on public health within the next two weeks
for your consideration. . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... .  19
Providing Government Direction for Māori Health . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . .  19
Improve aged care settings . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . 19
Responding to the Abuse in care inquiry . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . .. 20
Puberty blockers . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . .  20
Precision health . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . .  21
Opportunities for change . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . 22
Primary and community healthcare . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . 22
Better leveraging private services . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . 23
Medicines . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . 23
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Workforce . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . 24
Wider system changes . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . ... . 24

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Director-General Foreword
Congratulations on your appointment as Minister of Health.
The Ministry of Health wil  support you in continuing to progress towards a health system that works
wel  for everyone and with improved patient experiences at its heart. We wil  help you to set
direction, direct investment and resources, and monitor and advise you on progress against your
priorities.
The health system is a dynamic, complex, interrelated system that supports New Zealanders everyday
with their health and the health of their loved ones. We understand you wil  be continuing this
Government’s focus on lifting the performance of the health system for all New Zealanders that need
care. We can support you to take action on your immediate priorities for health, including:
•  Focusing the health system on achieving health targets; shorter stays in emergency
departments, shorter wait times for elective treatment and first specialist assessments, faster
access to cancer treatment, and improved childhood immunisation rates.
•  Directing and overseeing Health New Zealand performance and their return to baseline.
•  Advancing policy and regulatory changes to enhance health system performance, including
enabling a more flexible workforce and better access to medicines.
•  Changing system settings to improve timely access to primary health care that New
Zealanders need.
•  Confirming health priorities for Budget 2025 investments.
We recognise that while early progress has been made against some long-term challenges, more
work is needed. We have included opportunities to go further and faster, including further changes
to support more patient-centric primary and community care, better leveraging private services,
improving access and innovation in medicines, growing, and better utilising the health workforce.
We understand the need to prioritise our existing investments in health careful y to ensure the best
use of resources to manage access and system performance while achieving better health outcomes
for al  New Zealanders.
This document and subsequent briefings aim to provide you with a broad roadmap for discussions
on your key areas of focus and how to achieve your priorities. My Executive Governance Team and I
are looking forward to working with you as you take up your new portfolio.
Yours sincerely,
Dr Diana Sarfati
Director-General of Health
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Lifting the performance of the
health system
Overview of health outcomes and services
Overall, the health outcomes of New Zealanders are in line with comparable
countries.
Our health system is delivering for most New Zealanders, and against many measures, it delivers
good outcomes when compared against other developed countries.
New Zealanders are living longer, and life expectancy is projected to continue rising for al  groups of
people. For those born in 2023, the estimated life expectancy for males is 80.3 years and 83.7 years
for females. However, New Zealanders are spending, on average, over a decade in poor health. This
period of poor health is slowly increasing as New Zealanders age adding pressure to health systems.
Like similar countries, non-communicable diseases such as diabetes, cancer, heart disease and
chronic respiratory diseases are the leading causes of health loss. It is anticipated that 9 of the top 10
conditions contributing to health loss over the next 20 years wil  be long term conditions. Rising
levels of mental distress are a further area of major concern, particularly among younger New
Zealanders.
The health system delivers thousands of services to New Zealanders every day.
The health system is delivering more services than it ever has before. Every day, the public health
system delivers approximately:
•  11,000 hospital beds
•  55,000 general practice visits
•  172,000 laboratory tests
•  257,000 pharmacy dispensations
•  7,000 urgent care visits
•  3,500 emergency department visits
•  1,000 radiology studies
•  1,700 first specialist assessments
•  500 elective surgeries

Our workforce is the biggest it has ever been, with approximately 250,000 New Zealanders
working in health. However, despite record volumes and workforce numbers, the health system
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is under significant pressure, as many other health systems are with ageing populations,
workforce shortages and increasingly costly health interventions and changing technology.
These pressures are expanded on later in this document.

The New Zealand health system today
The New Zealand health system
Most core health services in New Zealand are publicly funded and universal y available to eligible
people. New Zealanders access the health system in many ways. This could be by visiting a
pharmacy, seeing a physiotherapist, having an appointment with a general practitioner or a nurse
practitioner, being supported by many different community health providers, seeking specialist
treatment for an ongoing condition or by accessing urgent care at a hospital.
A more detailed description of the system can be found in Part B of this document.
Sitting behind these experiences is a varied and dynamic ecosystem of health professionals,
providers, and organisations. Successful delivery of these experiences is dependent on the
organisations, processes, and relationships of al  players in the system working wel  together. The
government plays a significant role in supporting this, through direct provision of services, funding,
or co-funding, regulating health providers and services, and commissioning health services and
medicines.
A range of organisations deliver health care, including community organisations, private businesses,
or individual health professionals, as wel  as hospitals and related services. Some are ful y or partly
funded by the government or funded privately through health insurance or direct out of pocket
payments. There is some targeting of additional financial support to access services, such as
supporting patient payments based on socioeconomic factors.
The health system is in a period of change.
Since the Pae Ora (Healthy Futures) Act came into effect on 1 July 2022, the health system has been
adapting to, and evolving with, the significant structural changes.
While the role of other specialist Crown health entities1 have remained constant, 28 organisations
have been merged into Health New Zealand (Health NZ). As a national level entity that accounts for
over 92% of Vote Health funding, Health NZ is accountable for commissioning and delivering health
services in our communities at national, regional and local levels. Health NZ is now the largest
employer in New Zealand, with over 80,000 ful -time equivalent employees within the entity.

1 Pharmaceutical Management Agency (Pharmac), Health Quality and Safety Commission, New Zealand Blood and Organ
Service, Health Research Council, Mental Health and Wellbeing Commission and the Health and Disability Commissioner.
You can find more information about these entities and their roles in Part B.
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While early progress has been made, further work is required
Health NZ is facing significant service and financial performance challenges. Given its dominant role
in delivering or commissioning health services across New Zealand, this affects the sector and patient
outcomes.
On 22 July 2024, a Commissioner was appointed for Health NZ due to concerns around oversight,
entity overspending and a significant deterioration in Health NZ’s financial outlook. Health NZ has
developed an implementation plan for responding to these issues (the Health Reset Plan). The Health
Reset Plan sets out a multi-year pathway to financial sustainability, as wel  as a process to embed
appropriate governance arrangements, risk management and organisational model changes to
address immediate performance chal enges and realise the longer-term benefits expected from
system change.
The Ministry is working closely with Health NZ to monitor progress of this reset. We have provided
you with a separate briefing on this topic. This briefing provides you with further information on
current issues and risks, and levers for change (‘Performance of Health New Zealand and specialist
health Crown entities’ H2025059429 refers).
Achieving the health system New Zealanders
need
There are key areas of focus to improve performance of the health system.
The Government invests almost $30 bil ion into the health system per annum. Despite this level of
investment, current demographic trends such as population growth, ageing and diversification, mean
that, the pressure on Government contributions is likely to increase. New Zealanders are facing
access and timeliness chal enges in accessing primary and community care, and long wait times for
some hospital services.
There are opportunities to adjust the health system settings to enable the health system to perform
more productively, improve efficiency and facilitate flow through the system. Maintaining and
increasing health care productivity is an international challenge, including in New Zealand.
While we consider that the current structural settings are appropriate, further changes to system
settings wil  be required to improve performance and achieve the benefits of system change. These
additional changes include, for example, the balance between national, regional, and local models,
improvements in the network wide use of data and digital tools, and the interaction between publicly
and privately funded healthcare options.
As Minister, you have key levers to further direct the health system, including:
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•  Investment of public funding through Vote Health – in 2024/25, almost $30 bil ion was
invested between operating and capital. This includes the ability to set multi-year funding for
operating expenditure across three years.
•  Setting direction and policy settings within the health system, significantly through:
o  A three-yearly Government Policy Statement on Health 2024–2027 which sets
priorities for health agencies and entities, and the services commissioned from public
funding.
o  A three-yearly costed New Zealand Health Plan for the delivery of publicly funded
health services developed by Health NZ, which must give effect to the Government
Policy Statement on Health 2024–2027.
•  Monitoring system and entity performance and intervening when issues arise.
•  Setting the regulatory environment. This includes overseeing current legislation and
opportunities to make enhancements.
Further information about the levers you have available to you is included in Part B.
The Ministry’s role is to support you to use a range of levers to achieve your policy priorities for
health and as a steward of the health system. advise you on overal  health outcomes, options for
investment, system performance and opportunities to improve outcomes over time.
There are opportunities to address the affordability and sustainability of the
system...
New Zealand public health spending is comparable to many developed Organisation for Economic
Co-operation and Development (OECD) countries. The latest OECD data shows New Zealand’s health
spending, as a share of Gross Domestic Product (GDP), is above the OECD average, alongside other
high-income countries like the United Kingdom and Canada. Our spending per capita is also above
the OECD average, alongside other developed countries (estimated at $6,061 USD per person of the
population in New Zealand, compared to the OECD average of $4,986 USD per person of the
population).2
Public spending on health care as a share of GDP is forecast to increase. In New Zealand, the
Treasury's long-term fiscal model projects that health expenditure wil  grow from around 7% of GDP
in 2020/2021 to over 10% of GDP by 2061 if there are no changes to our current health service
model. These projections align with similar international model ing. These rising costs are driven by
the increasing cost of health care and increasing demand, including due to an ageing population.
The Government has options to change this dynamic and address the affordability of the health
system, such as investigating a greater role for user pays health care or insurance, changing models
of care or increasing targeting of services. We can provide advice on these topics as requested.

2 OECD (2023), Health at a Glance 2023: OECD Indicators: Health expenditure in relation to GDP; Health expenditure per
capita.
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...while also improving timely access to quality health care.
There is particular room for improvement in access and timeliness:
•  More people are visiting emergency departments and waiting longer to be seen. The number
of patients waiting less than 6 hours in our emergency departments has decreased from
71.2% in Q4 23/24 to 67.4% in Q1 24/25, mirroring data from the Q4 22/and Q1 23/24
period. In 2023, there were 1,315,000 visits to emergency departments. This compares to
1,246,000 emergency department visits in 2022.
•  Performance data from Q1 24/25 shows that 67.4% of patients waited less than four months
for a first specialist assessment.
•  Primary care is becoming less accessible, with the 2023/24 New Zealand Health Survey
finding that 25.7% of total adults and 25.2% of Māori adults reported experiencing barriers to
visiting a GP due to wait times. In 2021/22, 11.6% and 14.8% of people reported wait time as
a barrier, respectively.
•  While addressing these issues, we need to maintain our focus on improving the quality of
health services.
To improve the performance of the health system, the Government has prioritised access,
timeliness and quality of health services in the Government Policy Statement on Health 2024–
2027:
•  Access ensures that every person regardless of where they live in New Zealand, has
equitable access to the health care services they need.
•  Timeliness ensures that people can access the health care and services they need, when
they need it, in a prompt and efficient way.
•  Quality ensures that health care and services delivered in New Zealand are safe, easy to
navigate, understandable and welcoming to users, and are continuously improving.
The health system is built around the services it provides and could better focus on the people it
serves. By focusing on what New Zealanders want and need, the health system can get better
outcomes.
Achieving our long-term ambitions for health wil  require better integration between hospitals and
primary care, as wel  as other areas of the system. This means improving service efficiency,
redesigning models of care and breaking down siloes between service areas to ensure people have
access to the care they need.
There are opportunities to introduce new models of care and technology so people can have more
choice and more readily access health services in a timely manner. This can then free up the capacity
of health professionals to have face-to-face consultations with people who have higher needs. For
example, in providing digital access to primary care, urgent consultations could be available with
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health clinicians 24/7, and other technological advances may free up capacity in other areas of the
health system.
Continued attention on the critical enablers of workforce and infrastructure is
required.
Workforce
The health workforce is made up of tens of thousands of committed health practitioners who deliver
high quality care for their patients, but they are under a variety of pressures.
The health workforce has grown significantly over recent years. However, there are gaps in critical
areas. Available evidence also suggests that our health system is less productive than it used to be –
meaning the health system is not translating workforce capacity into better, faster care for New
Zealanders. Greater investment in health technology (such as diagnostics), digital infrastructure and
data governance could increase the effectiveness of the workforce and reduce additional
administration for patients and the system, as wel  as making diagnosis or treatment faster for
patients.
There are opportunities to improve efficiencies and shift models of care and delivery to better utilise
the talents of those working in the health system. We can remove some regulatory and other
operational barriers that prevent more flexible use of different workforce skil s, such as
physiotherapists supporting some emergency department assessments or orthopaedic referrals, or
different models of care.
In some areas of New Zealand, population growth has outstripped capacity increases to maintain
service delivery. Our operational processes could support better patient flow to support the
workforce to focus on treatment and not waiting for other parts of the system. This is already a focus
of work within Health NZ to support short stays in emergency departments and reduce elective
waitlists. In some areas of New Zealand, population growth has outstripped capacity increases to
maintain service delivery.
Addressing workforce challenges wil  require growing and changing the mix of health professionals
in the system, while increasing their capabilities and range of skil s. This Government has already
taken steps to grow the health workforce through actions to retain, train and attract new health
professionals across areas of critical shortage such as primary care. International recruitment and
improving the ability to transition to New Zealand registration are stil  a focus in the short-term,
given the current workforce gaps.
Work is also underway ahead of Cabinet deciding on the additional medical school. This training
option would be focused on primary and community medical roles, including within rural
communities, that have ongoing shortages and have not been served wel  by the current training
models,
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We wil  provide you with further advice on opportunities to further address pressures and system
barriers to realise our health workforce potential.

Infrastructure
Much of the physical and digital infrastructure which supports our health system is in poor condition
or no longer fit for purpose. Demand for acute services has outstripped hospital capacity, with an
estimated national deficit of 500 hospital beds. Many of our digital infrastructure networks and
security systems are outdated, do not talk to each other and are unable to manage increased
cybersecurity issues, or support evolving health service delivery in the home and within community
facilities. Having broader digital options can also help with access and timeliness. These factors are
likely to be an important driver in the productivity, efficiency, and effectiveness of the health system.
This Government has set clear expectations for a national approach to planning and investment
infrastructure to ensure that projects are delivered within budget, on time, and meet the needs of the
communities they support. As part of this, Health NZ is developing an Infrastructure Investment Plan
(I P) which wil  set investment intentions for the next 10 years and prioritise resources to ensure the
health system is resilient and has the digital and physical infrastructure it needs to meet people’s
needs now and into the future.
Taking action across the health system and other
sectors
Improving the underlying determinants of poor health
Social, economic, and physical environments strongly influence our physical and mental health and
wel being, as wel  as our ability to adopt and maintain a healthy lifestyle. The conditions in which a
person is born, grows up, lives, learns, works, ages, and the wider set of forces and systems shaping
the conditions of daily life, has a large influence on a person’s health status. For example, smoking,
poor nutrition, lack of exercise, harmful alcohol use and lack of social connection are risk factors.
In New Zealand, over a third (38.6%) of health loss is potential y avoidable by reducing exposure to
modifiable risk factors. Investments in housing, education, and balanced settings for commercial
activities, such as alcohol, tobacco, unhealthy food, and gambling can create lower demand for
health services, with the associated avoided costs.
Enhancing prevention
Enhancing our focus on prevention is essential to create the best possible chance of good health across
the life-course.
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Our experience shows that public and population health approaches that prevent, reduce, or delay
the onset of il ness (such as screening and immunisation) lead to better health outcomes.
Improving collaboration across sectors
To protect, promote and improve health, the health system needs to work with our partners to
ensure health concerns are considered alongside economic, social, and environmental improvement
initiatives. This includes working with stakeholders, providers, and communities to address the wider
determinants of (good or poor) health, as wel  as improve the timeliness, accessibility, and quality of
health care available.
Improving Māori health outcomes
Achieving the Government’s targets and expectations for health requires significant shifts in Māori
health outcomes, achieved by improving how the health system partners with Māori to understand
and respond to Māori health need.
Māori life expectancy is increasing at a faster rate than other populations. However, the increase is
not fast enough to reach the life expectancy of other populations in the next 20 years. As a
consequence of living longer and developing long-term conditions earlier, more Māori wil  be living
longer with health complications.
The Government has stated an intent to shift decision-making around resources closer to people and
communities, enabling local leadership, col aboration, and innovation to meet needs. This is
reinforced with a continued focus on Māori health monitoring at all levels of the system. The Hauora
Māori Advisory Committee and Iwi-Māori Partnership Boards are key mechanisms for monitoring
system performance for Māori health and identifying opportunities for improvement.
Responses led by Māori communities and Māori health providers have demonstrated ingenuity and
adaptability to in assessing and meeting the diverse needs and strengths of the whole community,
and there are opportunities to further expand and scale locally led initiatives to improve outcomes
for al  New Zealanders.
Improving access for higher needs groups
Some people have higher health needs. Māori, Pacific peoples and the disabled population
experience greater inequity and poorer health outcomes compared with the general population.
Examples include lower life expectancy, lower self-rated health, higher rates of anxiety and
depression, and higher rates of unmet need.
These are shown across many indicators, and particularly in long-term conditions such as diabetes,
cancer, and cardiovascular disease. These conditions contribute to higher mortality rates, particularly
for Māori, and those spending more time living longer in poor health, particularly women. In
addition, women, those living in rural communities, and those in lower-income households have
higher health needs.
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Health system trends and chal enges
Our population is growing, ageing and becoming more diverse.
From 2014 to 2024, the population living in New Zealand grew by 18%, with around 817,000
additional people. Overall population growth, from net-migration and longer life expectancy,
increases demand on health services and health funding.
The number of older people is also growing. The number of people who are over 65 has grown by
almost 37% since 2014, equating to an additional 240,000 people. Older people general y require
more health services than younger people, due to spending longer in poor health. This results in a
substantial increase in the burden of poor health and disability for the health system. For example, an
increasing proportion of people presenting urgently are older, have more complex needs, and more
likely to stay longer in hospital services. The average 80-year-old uses 10 times more hospital bed
days per year than the average 45-year-old.
Our population is becoming increasingly diverse with faster growing Māori, Pacific and Asian
populations. Diverse ethnic groups have different preferences and ways of accessing and using
health services. New Zealand’s health services wil need to adapt to the future health needs and
aspirations of these groups. Māori and Pacific populations, who generally have poorer health
outcomes, also have a much younger age structure than the New Zealand European population. This
presents a significant opportunity for targeted health initiatives to those with high health needs,
early in the life course, to support these populations to age with good health and improve their
health outcomes, as wel as New Zealand’s overal .
Technological advances create opportunities to make care more accessible, timely
and at a lower cost, while reducing pressures on the workforce.
Technological advancement and emerging technologies, such as artificial intel igence and genomics
based on high quality patient-centred data, create potential opportunities to help the health system
work more efficiently and cost-effectively, while reducing pressures on the health workforce and
improving sustainability of delivery over time. These technologies have potential to increase access
to targeted health services, and enable earlier detection and management of disease, particularly for
groups that experience disproportionate burden of diseases like cancer, stroke, and heart attacks.
However, maximising these technological gains requires robust data and digital infrastructure
investment plans. Work is underway to identify the settings needed to enable our infrastructure to
support efficiency and effectiveness across the health system, as the current capabilities sometimes
restrict our ability to take up and gain from technological advancements.
While some of the people and providers in our system are quick to adapt and innovate, our systems
settings and culture often do not yet support us to take full advantage of new and emerging
technologies. More work is required to enable agile adaptation to advancements throughout the
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system and address known risks, such as the potential for a digital divide and data privacy concerns.
There is, however, a risk that improvements in technology reveal latent demand for health services.
Mitigating these chal enges over the long term wil  require immediate and longer-
term actions.
The Ministry and the health system has work in place to anticipate and address opportunities and
chal enges. We need to look at innovative ways to adapt our health care models, to intervene earlier
and to take advantage of exciting opportunities new technologies like artificial intel igence and
genomics, to improve efficiency and effectiveness of health care delivery.

Delivering on your immediate
priorities for health
Achieving health targets
The Government has set five health targets to provide focus and support public trust and confidence
in the health system. Annual milestones have been set for each target and published in the
Government Policy Statement on Health 2024–2027 in June 2024.
Two health targets (shorter stays in emergency departments and shorter wait times for elective
treatment) are included in the suite of Government Targets, for which you are Lead Minister.
Delivery is underway with implementation plans set for each target. We are seeing signs of early
progress against each of the five health targets. However, the targets for shorter wait times for first
specialist assessment and shorter wait times for elective treatment are unlikely to meet their year 1
milestone. The latest results for Q1 2025 are:
•  Faster cancer treatment (target 90%): 84.6%
•  Improved immunisation for children (target 95%): 75.3%
•  Shorter stays in emergency departments (target 95%): 67.4%
•  Shorter wait times for first specialist assessment (target 95%): 61.2%
•  Shorter wait times for elective treatment (target 95%): 62.3%
We wil  provide you with further advice on achieving the health targets this week as part of
information on our monitoring approach and current performance of the system., We understand
that Health NZ wil  also provide you with an update on progress toward the health targets within
their Briefing to the Incoming Minister.
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Delivering Budget 2025
Budget 2024 was a significant milestone for the health system as it was the first substantive Budget
for Vote Health fol owing the health system reform. Budget 2024 marked a change in the way the
Government funds Health NZ’s cost pressures, with the provision of multi-year funding across three
Budgets.
s 9(2)(f)(iv)

Overseeing implementation of the Health NZ reset plan
Overseeing the implementation of Health NZ’s reset plan and return to financial baseline is a
significant priority for the Health portfolio. While maintaining oversight of their ongoing reset plan
implementation, the Ministry is also ensuring that Health NZ remains able to deliver on their
statutory functions in delivering the health services all New Zealanders expect.
We wil  provide you with further advice on key areas of focus through the reset, including assurance
of:
•  Health NZ operating model (including appropriate governance arrangements)
•  Financial strategy (including visibility of trade-offs being made to ensure financial
sustainability)
•  Front line service levels being maintained or enhanced.
•  Delivery of the government’s policy direction through the reset.
A separate briefing has been provided on this topic (‘Performance of Health New Zealand and
specialist health Crown entities’ H2025059429 refers).
Transforming Primary Care
Improving access to primary care wil  significantly improve patient experiences of the health system.
Cabinet is soon to consider the implementation of the Primary Care Tactical Action Plan to improve
access to primary care. This includes initial actions to get people faster access to the care they need
through the introduction of a new digital service providing 24/7 primary care, and actions to grow
and retain the primary care workforce.
Achieving primary care transformation wil  require further changes to system settings. There is a
need to improve how performance is driven, through sharper focus on accountability settings,
changing the way we commission services, and targeting investment to ensure services are meeting
New Zealanders’ needs. We wil  look to support you to progress a Strategic Plan that wil  further
transform primary care for consideration by Cabinet.
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We wil provide you with further information on this plan and potential decision-making points in the
coming weeks.
s 9(2)(f)(iv)

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Further progressing the
Government’s health priorities
Below, we outline key work underway to further progress the Government’s health priorities. We look
forward to further discussions with you around many of these priorities in due course.
Next steps for the New Medical School
In September 2024, Cabinet directed the preparation of a Detailed Business Case and further Cost
Benefit Analysis for the proposed new medical school.
s 9(2)(f)(iv)

The Ministry is also undertaking a broad range of work to retain, grow and diversify the health
workforce, including targeted action to strengthen the primary care workforce, and possible changes
to regulation to reflect the way modern healthcare is delivered. We wil  provide you with further
information on these activities in the coming weeks.
Cancer medicines implementation
In June 2024, the Government committed an additional $604 mil ion over four years into the
pharmaceutical budget for Pharmac to procure an estimated 54 new medicines, including 26 new
cancer treatments. It also provided $38 mil ion for 2024/25 to Health NZ to support implementation
of the cancer medicines and set aside a further $171 mil ion in contingency for outyears.
The contingency is to support Health NZ’s plans to reconfigure cancer services to provide better
cover to al  regions of New Zealand, to provide more services closer to people’s homes and to better
utilise capability across health practitioner groups.
As of 22 January 2025, Pharmac has funded 19 new cancer medicines, and 19 non-cancer medicines.
A further 18 medicines (including 10 for cancer) are either out for consultation, or Pharmac is
considering consultation feedback.
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Infrastructure
Health infrastructure comprises the physical and digital infrastructure that supports public health
service delivery. Significant future investment wil  be needed to address the condition and capacity
challenges in the current health infrastructure estate. Health NZ is also finalising a National Asset
Management Strategy and a 10-year Infrastructure Investment Plan. These wil  outline investment
options in the medium to longer term. You should receive these documents in the coming months.
You wil  have the opportunity to clarify your priorities and expectations for investment through
budget processes and your review of these Health NZ documents.
s 9(2)(f)(iv)

Public health
Public health operates at the population level to prevent, reduce, or delay the onset of il  health,
using a range of levers such as screening, immunisation, legislation, and community-based health
promotion. Evidence shows that public health approaches are highly cost-effective and can reduce
healthcare costs in both the short and long-term.
The Government outlined expectation of increasing focus on prevention and early intervention to
improve health across the life-course and reduce demand on the health system in the Government
Policy Statement on Health 2024–2027.
Work underway to progress toward key public health priorities includes:
•  Increasing uptake of immunisation to reduce vaccine preventable diseases with a
particular focus on children. A range of initiatives are underway, including investing in
vaccination outreach services, communication campaigns to increase uptake, enhancing data
col ection and improvements to the vaccinator workforce pathway.
•  Reducing the burden of non-communicable diseases (such as cardiovascular disease,
cancer, and diabetes) on individuals and the health system through reducing our exposure to
modifiable risk factors. Work is underway to develop a prevention framework for non-
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communicable diseases to take a more coordinated and col ective approach across the
health system, s 9(2)(f)(iv)

•  Increasing system preparedness to identify, mitigate, protect against, and respond to
infectious disease outbreaks and to plan for future health threats. Current work includes
surveil ance and management of the current whooping cough (Pertussis) epidemic and the
risk of imported cases of measles seeding an outbreak, as wel  as system preparedness for
Highly Pathogenic Avian Influenza (HPAI) (also known as ‘Bird flu’). The Ministry is also
considering the phase 1 report of the New Zealand Royal Commission of Inquiry into COVID-
19 and wil  be supporting phase 2 of the Inquiry into COVID-19.
Under current delegations, Associate Ministers of Health hold responsibility for certain public health
areas. Minister Doocey holds the delegation for nutrition, physical activity and alcohol, and Minister
Costel o holds the delegation for tobacco and vaping.
We expect to provide you with further advice on public health within the next two weeks for your
consideration.
Providing Government Direction for Māori Health
Improving experiences and health outcomes for Māori wil  be essential to meeting Government
priorities for health, particularly achieving the health targets.
There are opportunities to improve Māori health, and work is already underway as part of the
Government’s alternative plan fol owing the disestablishment of the Māori Health Authority, as
agreed by Cabinet in June 2024.
s 9(2)(f)(iv)

s 9(2)(f)(iv)

We look forward to an opportunity to discuss your priorities for Māori health in the coming weeks.
Improve aged care settings
There are a range of chal enges in delivering support for older people, including inequitable access
to care, lack of capacity within aged residential care services and community-based services,
workforce shortages, and an increasing number of people with neurological cognitive conditions,
such as dementia, who have high needs and require specialised care. A high functioning aged
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residential care sector is an important aspect of hospital flow when moving patients out of hospitals,
where capacity impacts on health targets that focus on timeliness.
There is currently work underway to ensure the long-term sustainability and effectiveness of aged
care:
•  Health NZ's review of Aged Care Funding and Service Models. This work began in July
2023. The second phase of the review is currently underway, focused on developing
recommendations for service and funding models.
•  The Health Select Committee inquiry into the provision of aged care, focused on the
aged care sector's current and future capacity to provide support services for people
experiencing neurological cognitive disorders. This was a commitment as part of the
Government's coalition agreements. The Ministry is assisting the Health Select Committee
and wil  report to the committee with advice in February 2025. The Ministry wil  provide your
office with this report.
s 9(2)(f)(iv)
Responding to the Abuse in care inquiry
On 24 June 2024, the Royal Commission’s final report ‘Whanaketia: Through pain and trauma, from
darkness to light’ was presented to Parliament. Of the 138 recommendations 79 have been identified
as broadly relevant to health, including mental health. There is cross-Government work underway to
respond to the final report, including through the Budget 2025 process.
The Crown Response Unit provided advice to Ministers pre-Christmas on the draft response plan.
The Ministry is working on the plan with the Crown Response Unit, which is expected to be shared
with responsible Ministers (including the Minister of Health) in coming months. As Minister for
Mental Health, Hon Doocey has been involved in this work.
Puberty blockers
In November 2024, the Ministry published a Position Statement alongside an Evidence Brief that
reviewed the effectiveness and safety of puberty blockers in young people with gender dysphoria.
This review found a lack of good quality evidence to say that these medicines improve the longer-
term outcomes for young people with gender-related health needs; nor what the risk for using
puberty blockers in this context are. The Ministry’s Position Statement sets expectations that
treatment should be initiated only by experienced prescribers who are working as part of a multi-
disciplinary team.
s 9(2)(f)(iv)

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s 9(2)(f)(iv)

Precision health
Precision health3 technologies such as genomics and AI are developing rapidly. These technologies
provide present innovative opportunities for the healthcare system such as enabling the rational use
of targeted cancer drugs and relieving workforce pressures by automating administrative tasks.
The Ministry is progressing a work programme alongside key partners such as Health NZ and the
Cancer Control Agency to establish national leadership and direction for AI and genomics to ensure
the safe adoption of these technologies in our health system.
The work programme has a range of focus areas, including identifying case studies for scalable
adoption, developing trust and social license, and ensuring the appropriate infrastructure is in place
to adopt genomics and AI. The Ministry is also engaged in the al -of government approach to AI led
by Hon Col ins and being coordinated by the Ministry of Business, Innovation and Employment. This
work wil  highlight the potential opportunities that AI provides for the health system, including
preparing a joint agency overview from the Ministry and Health NZ on the current state of AI in
health.
We wil  provide you with advice on precision health in the coming weeks and look forward to
discussing this work with you.
Improving mental health and addiction services and action in suicide
prevention
This Government established a new Mental Health Ministerial portfolio in 2023, reflecting the need
for a dedicated focus on improving mental health and addiction services and to strengthen actions
to prevent suicide within the health system and across government.
The Minister for Mental Health is responsible for strategic and policy matters within the health
system relating to mental health, alcohol and other drug use, preventing and minimising gambling

3 ‘Precision health’ is a term for the use of technology and information to develop more precise, personalised, and efficient
ways of diagnosing, managing, and treating people.
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harm, addiction, and suicide prevention and postvention. This includes policy and prioritisation
decisions about mental health and addiction funding within Vote Health, including the mental health
and addiction funding ringfence and the problem gambling and alcohol levies.
The Minister for Mental Health has set targets to increase access to and timeliness of service
responses in mental health and addiction. These targets are supplemented by a focus on growing
the mental health and addiction workforce and a shift in resources towards services that act to
intervene earlier or are more preventative.
There is a significant programme of work underway across the Ministry of Health and Health NZ to
deliver on the Mental Health targets. There is also significant legislative reform underway to repeal
and replace mental health statutory settings.
There is an interface between the Health and Mental Health portfolios on health system matters that
have impacts for mental health, addiction and suicide prevention, such as accountability settings and
key enablers including workforce and infrastructure. We can support you in discussions with the
Minister for Mental Health to facilitate this interface and information sharing to provide you with an
understanding of relevant work within the Mental Health portfolio.
Opportunities for change
There are a range of tangible and ambitious opportunities to improve access, timeliness, and quality
for patients, building on work already underway. These opportunities are particularly around
workforce, primary and community care, medicines, better leveraging private funding as wel as
some wider system changes.
We have outlined current work and potential opportunities below and can provide further advice on
proposals that you would like to progress or consider further.
s 9(2)(f)(iv)

s 9(2)(f)(iv)
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s 9(2)(f)(iv)
Medicines
There are opportunities to improve access and innovation in medicines. Work is underway on several
important reforms to the regulation of medicines and medical devices. Elements of this work are
being led by different associate Ministers but there are opportunities for you to influence and shape
these reforms. s 9(2)(f)(iv)

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Workforce
A significant amount of work is underway on workforce settings to grow the health workforce, and to
ensure that the workforce is able to be utilised most effectively by expanding the scope of practice
for some roles including nurse practitioners. There are also opportunities within the Primary Care
Tactical Action Plan to strengthen the primary care workforce. There are additional opportunities to
support the sustainability of workforce costs.
There is a workforce action plan currently in place that aims to relieve immediate pressures and
strengthen the health workforce. This includes actions to support the Governments priorities around
national health targets, modifiable risk factors, long-term conditions, and mental health and
addictions targets.
In addition, work on the Primary Care Tactical Action Plan includes opportunities to grow the number
of primary care doctors and nurses in primary settings, increasing incentives for nurses to undertake
nurse-practitioner training, and increasing the medicines training cap and initiatives to increase
international trained workforce to work in primary care settings. Work on nurse-training pathways is
also underway that could expand the role of nurses in primary care.
s 9(2)(f)(iv)

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