New Zealand's journey towards integrated healthcare has seen significant milestones, driven by both policy initiatives and grassroots efforts among healthcare providers. The integration of digital health technologies and collaborative care models has enhanced the efficiency and effectiveness of the healthcare system. However, continued efforts are needed to address existing challenges and fully realise the potential of integrated care in improving health outcomes for all New Zealanders.

Te Whatu Ora's Data and Digital (D&D) division is pivotal in enabling the health system's reform agenda in New Zealand. The integration of 29 organisations into a coherent and efficient digital system represents the largest ICT programme ever undertaken in the country. However, this task is complicated by a legacy of underinvestment, leading to significant technical debt and a lack of clarity about the current state of digital services.

The increasing reliance on outsourced healthcare services reflects the growing demand and financial pressures on NZ's public health system. While the public-private healthcare partnership in NZ has been beneficial, several improvements can enhance efficiency and equity: developing integrated health information systems for seamless patient data transfer and better resource allocation; investing in preventive health measures to reduce the overall demand for surgical procedures, allowing healthcare facilities to focus on more complex cases; and implementing equity-focused policies to improve surgical outcomes for Māori and Pacific populations, including better access to care and culturally competent services.

The systemic disparities in health outcomes, socioeconomic status, and healthcare access for rural populations, particularly Māori, indicate a significant gap in addressing the unique needs of these communities. The higher mortality and preventable death rates among Māori in remote areas, coupled with increased socioeconomic deprivation and limited healthcare access, highlight the critical areas requiring attention. Fostering healthy, vibrant rural communities is essential for enhancing the overall wellbeing of these regions and ensuring equitable health outcomes across New Zealand.

The negative impact of the current food system on health is also alarming. There is an increasing prevalence of long-term conditions (LTCs) such as diabetes, cardiovascular diseases, and certain cancers, driven significantly by dietary factors. Notably, only 6.7% of adults and 4.9% of children in NZ meet the recommended fruit and vegetable intake. Obesity-related health issues alone cost the public health system an estimated $2 billion annually, with the total societal costs ranging from $4 to $9 billion.

What is the optimal path forward? Should we prioritise the training of more onshore GPs? Should we allocate resources to distribute the workload across a multidisciplinary team comprising nurse practitioners, physician associates, and prescribing pharmacists? Should we leverage technology to bridge the existing gaps? Or should we pursue a combination of all these strategies?

Understanding when medical students and doctors make career decisions is crucial for universities, postgraduate colleges, and the doctors themselves. Career choices are influenced by various factors, including background, personal preferences, and job nature.

The current policy challenge for New Zealand’s health workforce is to align governance with effective implementation. This requires fostering skills in collaboration, and local execution.

For telehealth utilisation to progress further, policymakers and health system leaders must understand which telehealth services and modalities are most frequently used by providers and patients.

Where does this leave telehealth in New Zealand?

Oral health in New Zealand encompasses a variety of conditions, including dental caries, periodontal disease, oral cancer, oro-facial trauma, and congenital anomalies like cleft lip and palate. According to the 2009 New Zealand Oral Health Survey, while 90% of adults have some or all of their natural teeth, one-third suffer from untreated tooth decay and a similar number show early signs of gum disease. Additionally, 40% of adults reported a history of dental trauma, and the 2008 Accident Compensation Corporation data recorded 32,110 oro-facial injuries. In 2020, the New Zealand Cancer Registry reported 547 cases of cancers affecting the lip, oral cavity, and pharynx. These chronic and cumulative conditions highlight the necessity for ongoing oral healthcare.

The aged care sector in New Zealand, encompassing aged residential care (ARC) services and home and community support services (HCSS), confronts well-documented challenges that include financial constraints, workforce shortages, and the assurance of equitable access to services. NZ currently hosts approximately 32,000 older individuals in 676 ARC facilities. The majority reside in rest homes (13,500) or in hospital-level care (13,200), while dementia and psychogeriatric units accommodate around 5,500 residents. In the fiscal year 2022/23, Te Whatu Ora allocated approximately $1,352 million to ARC, with residents contributing $1,010 million due to means testing.

At one end of the spectrum, personalisation is often equated with higher quality but at a greater cost, while standardisation is seen as cost-effective, offering fewer features and limited scope for customisation. Yet, in an era where meaningful, real-time analytics are increasingly accessible, healthcare providers can gather outcomes data from local, regional, national, and global sources to create personalised care plans that consider a variety of factors. Standardising care and measuring outcomes allows for the development of customised treatment plans that cater to individual patient needs.

A reimagined workforce would begin with sharing a clear and compelling change narrative that describes the rationale for change. Establishing benchmarking to understand the efficiency of processes and activities compared to international standards would be a subsequent step.

Achieving consensus and coordination will be essential to ensure that standards evolve to meet the needs of learning health systems. Standards are not static; they are dynamic, requiring ongoing input from user communities to define and refine their application in various contexts. New standards will continually be necessary, particularly in areas of innovation such as new devices, and patient-generated and patient-reported data.

Returning time to care is a concept which emphasises the critical need for healthcare providers to allocate more time to direct patient care amidst escalating administrative burdens. This reduction in hands-on care negatively affects patient satisfaction, outcomes, and can precipitate healthcare worker burnout. By embracing a holistic approach that incorporates technological integration, educational initiatives, and process optimisation, healthcare professionals are hoping to reclaim time for patient interactions and care, highlighting the concept's significance.

The adoption of value-based primary care models from international examples, such as Kaiser Permanente's drop-in consultations and Massachusetts' algorithm model for managing heart failure and hypertension, presents viable pathways for improving New Zealand's primary healthcare system. These models emphasise the importance of accountability, efficiency, and patient-centered care, offering a blueprint for the transformation required to overcome the current challenges faced by GPs and their patients in New Zealand.

The inevitable integration of AI in clinical settings is forthcoming, irrespective of the readiness of the medical profession. This will require a comprehensive understanding of our current landscape (encompassing legislation, policy, infrastructure, data, research, and workforce), along with a clear vision and cross-sectoral consensus on the future of healthcare.

The pandemic and other globally significant health and wellbeing challenges, such as climate change, conflict, and political and economic pressures, could be seen to have a silver lining in that they present an opportunity to explore, develop, and implement novel and transformative strategies. These strategies could not only address nursing shortages but also help to resolve numerous entrenched challenges within the healthcare system and society at large.

Recent analyses of St John's operations have not identified significant cost inefficiencies, suggesting that St John operates with a degree of cost-effectiveness comparable to international peers, benefiting from its community-based volunteer model. However, in the 2018/19 fiscal period, St John's operational expenses escalated by 6.7% from the previous year, culminating in an $11 million deficit against total revenues.

Over the past twenty years, the majority of high-income nations have seen a reduction in their hospital bed capacity. Decreases in bed numbers and shifts in related indicators such as length of stay or bed occupancy rates are often interpreted as evidence of more efficient resource allocation.

An Immunisation Taskforce was convened in 2022 after the rates for children five and under hit record lows. The report noted that NZ's haphazard immunisation system was failing children, especially in vulnerable communities.