Health New Zealand leaders told Health Minister Simeon Brown that tight controls on hiring were needed to deliver the agency’s budget, according to documents released under the Official Information Act and reported by RNZ on Wednesday. The union that obtained the papers says the controls left hospital roles vacant for months and that patients suffered. The minister says he never accepted the policy.
In a briefing to Brown in March last year, then health commissioner Professor Lester Levy and interim chief executive Dr Dale Bramley said strict recruitment rules had run through 2024/25, and that hiring a frontline worker required sign-off from the regional deputy chief executive. “This has been coupled with regular close monitoring of recruitment pipelines and the establishment of the HR oversight group,” the pair wrote. “The expectation is for these controls to remain in place throughout 2025/26.”
An internal document from June 2024, written by then chief executive Margie Apa, showed four regional recruitment forums had been set up to approve all hospital and specialist service roles. The forums included regional directors and medical, nursing, allied health and rural decision-makers, alongside finance staff. A separate hiring freeze applied to roles that did not deal directly with patients or with the public.
The Public Service Association, which received the documents, has published a report on them called Vacant by design. It says the entire northern region of Health New Zealand, which employs more than 20,000 people, was limited to hiring 40 full time roles a fortnight. The report argues the sign-off requirements pushed decisions too far from the wards where the vacancies sat. “The decision about whether to replace an emergency department administrator in Gisborne was made in Hamilton, while the decision about whether to approve a mental health worker in Kaitaia was made in Auckland,” it says.
PSA national secretary Fleur Fitzsimons said approvals routinely took months before a job could even be advertised. She said it took six months to replace three neonatal intensive care nurses in Wellington, a Northland radiologist vacancy sat unapproved for 12 weeks, and a sonologist vacancy in the southern region took 28 weeks to approve. Other examples listed in the report include an intensive care nurse role in the Wellington region unapproved after 19 weeks, a midwife role in Counties Manukau unapproved after seven weeks, and an emergency department nurse role in the southern region unapproved after five weeks.
The report also draws on the union’s annual survey of its health members, which drew 1800 responses. It found 76 percent said their team had waited more than a month for approval to fill a vacancy, and 85 percent said unfilled roles were driving colleagues to stress and burnout.
Health workers quoted anonymously in the report described the effect on services. “We had to shut down a service to provide chemotherapy in an area as there were not enough nurses to provide treatment,” one oncology worker said. A physiotherapy worker said stroke patients who should be seen at least Monday to Friday were commonly being seen three times a week, which affected their ability to make meaningful gains.
Fitzsimons said the papers showed the minister knew what was happening. “These documents expose that the health minister was aware that our health system was not filling hospital vacancies as part of a deliberate savings plan and that patient care has suffered as a result. It’s scandalous,” she said. In the union’s accompanying media release she said Brown could have ordered every vacancy advertised and filled straight away and did not.
Brown rejected that on Wednesday and questioned the union’s timing. “It doesn’t surprise me that the PSA union, which is literally campaigning for a change of government, is pulling up a document from the beginning of last year when I first became the minister of health,” he told RNZ. He said a great deal had changed since the briefing landed on his desk.
“Since then, we’ve got a new board, a new CE. We’ve put in place devolution, which is devolving decision-making back down to regions and districts so that these local decisions are made closer to home so that recruitment can be sped up,” he said. He also pointed to a letter of expectations he sent the agency in November last year, which his office said made clear Health New Zealand “must continue to remove unnecessary bureaucracy to ensure clinical appointments are delivered in a timely manner, particularly in geographic locations or services experiencing workforce shortages that are directly impacting on patient care”.
Asked whether the agency had kept the policy going after his own public comments last March, and whether the changes had come fast enough, Brown said he wanted Health New Zealand to move faster to speed up recruitment. Asked about the patients described in the union report, he did not say directly whether anyone had been harmed by hiring delays, saying instead that he was intent on fixing what he called a big bureaucracy set up by the previous government during a pandemic.
Health New Zealand said its hiring process had already changed and the four regional recruitment panels no longer existed. Approvals for budgeted roles are now made two levels up, involving the hiring manager’s manager, and a devolved operating model was introduced earlier this year. “While planning and strategy remain a national function, healthcare decisions, including recruitment, are being made closer to care,” a spokesperson said. The agency did not accept that recruitment decisions had deliberately left services understaffed or that patient safety had been compromised, saying decisions were made on service need, workforce availability and patient safety, and that a vacancy did not automatically mean a service could not meet demand.
Opposition parties seized on the documents. Green Party co-leader Marama Davidson said the union had provided “damning evidence that the minister of health has knowingly weaponised the bureaucracy to slow the recruitment of health workers as a cost saving measure”. She said it was appalling that more than three quarters of staff had waited more than a month for approval to fill a vacancy.
Labour leader Chris Hipkins said the pattern was clear. “The hiring freeze they’ve had across the country, stopping vacancies being filled is causing real harm to New Zealanders. It’s meaning that Kiwis are not getting the health care that they are entitled to under our health system,” he said.
The argument is unlikely to settle before voters have their say. Health funding and hospital staffing have been among the sharpest points of difference between the parties this term, and the general election is set for 7 November. If you want to see where each party stands on health and other issues before you vote, our voting tool lets you compare their positions side by side.
What is your experience of waiting for care, or of working in a short-staffed team? Tell us in the comments below.
This article was written by AI, briefed to report the facts, hopefully without some of the bias people bring to the job 🙂
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