Pay gap eroding essential community health care

Fiona Kingsford, chief executive, Whānau Āwhina Plunket says, "Collectively we represent services that support New Zealanders from cradle to grave. We’ve come together for the first time because we fear communities are missing out on critical health care."

While the group wholeheartedly endorse the recent historic pay equity settlement for Te Whatu Ora nurses and healthcare workers, it has created a stark pay gap with those working in primary, community, and telehealth care, estimated at between 15 and 35 per cent.

Mrs Kingsford says, "The impact that the pay gap has on recruitment and retention, and subsequently the delivery of essential health services, has reached crisis point and can no longer be ignored.

We fear we will no longer be there to meet our combined mission of assisting New Zealanders to start well, live well, and die well."

The primary, community, and telehealth care workforce complete the same education, undertake additional training and skills development as Te Whatu Ora staff, and provide vital care and support to thousands of people every day. There is no justification for them not being remunerated equally.

The combined picture is bleak, with workforce shortages eroding service delivery.

Whānau Āwhina Plunket has 35 nurse vacancies, potentially impacting 140 Well Child Tamariki Ora core contacts to pēpi and tamariki every day; in an unprecedented situation, Family Planning had 64 days of closures across its clinics during August due to a lack of nursing staff; more than 1,000 aged care beds have closed permanently; and a number of hospices have reduced their inpatient beds.

A rapid data collection run in September attracted responses from 246 general practices, with 43 per cent of respondents reporting they had closed or restricted services due to a nursing workforce shortage. This is impacting things such as immunisations, cervical screening, diabetic annual reviews, cardiovascular risk assessments and opening hours. While only a snapshot, the survey results correlate strongly with research carried out by GenPro in August which showed 54 per cent of responding member practices had reduced services in the last six months. GenPro results also showed 43 per cent had nursing vacancies with an average of two nurses per practice having quit in the last six months.

Dr Samantha Murton, president of The Royal New Zealand College of General Practitioners, says, “Our community, primary care, and telehealth nurses and health workers care for and treat millions of New Zealanders, including our most vulnerable elderly, hapū māmā, pēpi and tamariki, and those who are dying.

When our services begin to crumple, these people are forced into an already overrun hospital system that is also at its breaking point.”

The significant pay gap and resulting recruitment and retention issues are forcing hospices to make some tough decisions.

Hospice chief executive, Wayne Naylor, says, “The options are reducing services to fit with available staff or use their finite reserves to increase salaries to match Te Whatu Ora, which is unsustainable even in the short term.

Hospice care cannot keep relying on the generosity of communities through charitable giving and selling second-hand goods to pay for essential health care staff and services.”

Family Planning chief executive Jackie Edmond explains that young people are particularly impacted by closures across its network of clinics, “About 1 in 6 of the young people (16 to 19 years old) we see don’t have another regular health provider and 1 in 5 of them don’t know where else to go to get contraception. When we are forced to close clinics because we don’t have staff to open them, it is these young people that are at most risk of unintended pregnancy or sexually transmitted infection.”

National and international research has long since proven that primary and community care is essential to a well-functioning health system. The implications of the loss of care, early intervention, and prevention delivered in the community is catastrophic.

The group wrote to political parties, seeking a position and timeframe for action on closing the pay gap. Disappointingly, just one political party had responded by the 20 September deadline.

Mrs Kingsford emphasises that, "The incoming government must address nurse pay parity urgently. We require 100 per cent pay parity with Te Whatu Ora employed nurses and healthcare workers if we are to keep providing essential services in our communities. We cannot afford to pay more, and it is putting services at risk."

Despite the challenges, the group reiterate that care is still available, although it may be provided differently as organisations design ways to navigate their staffing shortages.

Dr Murton says, "We know we’ve painted a sombre picture, but we urge people never to delay seeking care. If you or someone close to you needs medical assistance, please contact your provider as you would usually or call Healthline on 0800 611 116."