By Chris Bullen.

Health Minister Dr Shane Reti recently said, “More resources will be directed to front-line health services” as part of Budget 2024. 

What did the Minister mean when he used the term ‘front line’? 

 I suspect he has in mind clinical staff – nurses, doctors and so on.  He’s right, in part. New Zealand does have a chronic clinical health worker staffing crisis. But I have three questions for Dr Reti. 

First, where do public health staff belong in his schema: are they ‘front line’ or ‘back line’? By public health, I mean public health nurses, public health physicians, epidemiologists and analysts, health protection officers, and all the others who are involved in disease prevention and health promotion.  I’d argue these people are also providing front-line health services. Take COVID. Without this highly skilled group of people investigating outbreaks, making decisions about protecting vulnerable people in rest homes or other care facilities, tracing contacts of cases, monitoring the patterns of disease spread, making sense of data, and communicating skilfully with the public – we would have been much worse off. 

 Does Dr Reti suggest that more investment in clinical services will mean less investment in public health services? That would be short-sighted. While public health services often do not involve one-on-one clinical encounters with patients, they provide a vital line of defence against the many environmental and biological hazards we face in our globalised world. Without investment in expertise in the often unseen and unheralded work of disease prevention and health promotion, our clinicians would be even more overwhelmed than they already are.

 Second, where do health systems support staff belong in Dr Reti’s vision? These people provide expert planning of services and facilities, financial management, contracting, booking, staff recruitment, etc. Without adequate numbers of suitably skilled people in these roles, our health services would be unable to function, and doctors and nurses would spend more time on administrative tasks and less doing what they were trained to do.

Thirdly, and critically, does the Minister mean that ‘more resources’ will be forthcoming overall, or does he have a ‘zero-sum’ view of health system funding, whereby “more resources directed to front-line services means fewer resources for public health or for systems support services?

Ideally, he will have made the case to his cabinet colleagues to grow the share of funding that goes to health. That would enable investment in training and recruiting more staff into front-line clinical and public health services roles and at least maintain the investment in our current essential support services. Budget 2024 will no doubt answer these questions and shed more light on Dr Reti’s vision of the future for health.