Forum 2019 - Health workforce

A strategic approach to planning and development of our workforce is key to ensuring Aotearoa New Zealand’s health and disability system can deliver safe, effective and accessible services now and into the future.

This workshop:

  • introduced the newly formed Health Workforce Advisory Board and outlined and invited input into its priorities
  • provided an update on work currently underway in the Ministry of Health’s ne Health Workforce Directorate
  • outline how the University of Otago has achieved proportionality with the population for Māori medical graduates.

Keynote speaker

Professor Judy McGregor, Auckland University of Technology, Chair of the Health Workforce Advisory Board

Video: Professor Judy McGregor - Forum 2019 - Health workforce

[Professor Judy McGregor presenting to an audience as part of the Health workforce session of Forum 2019]

Kia ora tatou, nau mai haere mai, talofa lava,

and warm Wellington greetings. But when I lived in Wellington, I never got to say "warm Wellington greetings" because it was usually a howling gale. But today, of course, it's a beautiful day.

So thank you very much indeed for coming this afternoon. It's heroic of you at 3 o'clock in the afternoon to be all present and correct. Today, I wanted to do four things. I wanted to talk about who we are as the health workforce advisory board, what we are expected to do, how we hope to work, the benefits of our annual report to the minister, and then to ask for your help in an ongoing way.

So just to start, I would like to talk to you about what this new acronym "HWEB" means and what it's going to do. It's been established under Section 11 of the New Zealand Public Health and Disability Act to provide the minister of health with advice on health workforce matters, including strategic direction, emerging issues, and risks. It's also mandated to work with the Ministry of Health to provide strategic oversight and sector leadership for New Zealand's health workforce.

Its terms of reference are not limited to but encompass the following, planning for New Zealand's health and disability system workforce, enabling greater participation of Maori in the health workforce, and partnering with Maori to better understand the needs and aspirations of that workforce, enabling greater Pacific participation and representation in the health workforce, education training and development of the health workforce, recruitment, retention, and distribution of the workforce, health workforce well-being, and supporting quality improvement, innovation, and change ways of working.

This is what we aren't. We don't have any personal funding or budget management responsibilities, and we're not involved in health sector employment relations.

Now, following me, the deputy director general, Anna Clark, is going to talk to you about the ER and how the connection will be with employment relations in the health workforce advisory board. So we're a break from the past. And as a Section 11 committee, we have the following opportunity of an annual report to the minister.

Oh, sorry. I'll just do us as members. First of all is me. My background is in human rights. I was the commissioner for New Zealand, the first one, and undertook the inquiry into the age care sector that resulted in the Equal Pay Award. And I've always had an interest and research interests in equal employment opportunities.

Dr. Jo Baxter, who's going to talk to us this afternoon, is, I believe, an expert in Maori retention, recruitment, and health workforce issues. And her experiences at Otago are invaluable to the committee.

Sophie Oliff is an interesting young pharmacist who's already tackled us in our first meeting on Friday around intergenerational dynamics. And picking up some of the points from the plenary session today, it's quite clear that intergenerational ways of working will be different. And it's great to have Sophie on board.

Andrew Connolly will be known to many of you as a senior clinician. He is also deputy commissioner at Waikato and brings a wealth of experience to the new board.

Faumuina Associate Professor Tai Sopoaga is an expert in Pacific health workforce development from Otago University. You might notice a similarity between the minister of health's Dunedin electorate and the number of Otago University representatives on our board. But I think those of us from Auckland will hold our own.

Lorraine is one of those. She comes from the Bay of Plenty, so she's a North Islander. Lorraine will bring to us expertise, both in nursing, nursing representation, and in the community and public health space.

So in addition to Karl who is from Gore and proud to be a Southland man, Karl is an expert in rural and mental health issues and brings great expertise and a passion for e-learning in the mental health space.

And Helen Mason will be known to many of you because she was CEO at Bay of Plenty. But she's going to Australia. Australia's gain is our loss. But she will be replaced as the CEO by the CEO of the Auckland DHB, Ailsa Claire, who was here this morning.

So I think we have a diverse and representative participation on the new board. Our first meeting on Friday was stimulating. And I think we will challenge each other, as well as the ministry, in our thinking.

How we plan to work was a focus of discussion at our first board meeting on Friday. And these were some of the principles that we agreed to.

And I want to pay homage to Ray Lind who, as the former CEO of Careerforce, was in charge of the interim committee that looked at setting up their health workforce advisory board. And our principles were developed in terms of some legacy points that he produced around how a new health workforce advisory board should work.

I think all of us on the board are committed to collegial and continuing and collaborative arrangements within the sector. We want to know what the sector's issues are. We want to work closely with major stakeholders. We want to listen. And we want to develop evidence-led, research-led advice.

We also would like to be able to be in a position to present to the ministers imaginative options and some honest dealing, in terms of problem analysis. We do acknowledge, of course, the tension between short-term pragmatism and long-term aspirations.

There are, I think, some opportunities relating to the statutory mandate that we have to present an annual report to the minister. And that is that it does provide an opportunity to measure and promote the value of the health workforce to New Zealand's economy, the community, whānau and individual being.

I foolishly indicated to the board that I would present at the first meeting a sort of meta-analysis, a quick lit review of all of the material that I could find on health workforce development in New Zealand in the last five or six years-- so all of the research that had been written from a variety of aspects.

Now, that was a foolish promise because instead of a sort of day's intense reading, it became weeks and weeks of scurrying around trying to find material. But one thing that emerged out of that process was a sense, for me, that the actual value of the health workforce-- not only economically, but also socially and in terms of its community contribution-- had been under-theorized and under-conceptualized.

So if we were to take the 230,000 people that the Simpson report estimates is in the health workforce and you say, multiply that by $60,000 might be the average salary. You get into the billions and billions of dollars. That's before you look at the value of employment in communities.

So for example, in Waitemata and probably in all DHB areas, the DHB is, of course, the predominant employer, with 7,500 staff ranging from Kaipara down to the Harbour Bridge, where obviously a major impact on our communities.

And so I see an important first step for the health workforce advisory board is to do some work around the value of the health workforce in general, which I think would help with discussions more broadly about values. It would help with discussion politically, perhaps, with treasury. It would help in terms of career development and recruitment. It could be valuable generally.

So another, I think, important benefit of an annual report to the minister is that we can bring critical and strategic workforce issues not only to his attention, because he probably already knows of many of them, but also to the attention of parliament and to the public. We should be able to use that to engage more widely, in terms of media debate, about health workforce needs and strategic directions. And of course, hopefully, our annual report would help catalyze policy and perhaps legislative response.

I think we're very, very lucky to be starting at a propitious time, just simply because of the huge number of health sector reform reports that have been issued and promoted and read and widely distributed in the last year-- so the mental health inquiry reports.

There's Heather's report, the Health and Disability System Interim Report, which contains some directions for health workforce around skills development, around well-being, and around criticality issues. I also think there's been quite strong problem analysis undertaken around health workforce and suggested directions for strategic development.

And then comes the challenge I think for the health workforce advisory board and for the ministry, who we hope to work very closely with, and other sector players, including the education sector, of who, why, when, and resourcing and the identification of the best options moving forward. So we start from a platform, I think, of really good available information about the health sector.

But if there's one overarching observation that all of that material presents to us, I think, if you read it at one hit, which I tried to do over a couple of weeks, is that nationally, we have no really other alternative, other than to face the changes that are coming and to deal with them because globally, I think we're in a situation where the health workforce is under pressure in terms of retention, in terms of attraction, and in terms of New Zealand's identity. It is such a strong component of employment in New Zealand. We must face the challenges as they're emerging.

This is where we're asking for your help. We're very, very keen, as we get underway, to undertake stakeholder meetings. We're interested over the year to meet as many people who are engaged in health workforce issues as possible, to meet representatives of the various stakeholder groups in both the regulated and unregulated health workforces.

We would also like to gather up as much research-led evidence and policy material as we can. So we're keen to ensure that anything that's been written or thought about, that we know about it.

It's quite hard, I think, when you do try and do a sort of meta-review to know whether someone has written about specific needs in midwifery or specific needs about sonography or whether there is something about predictive modeling. So all of that material, we need to know about. So if you're in a research environment in any way, shape, or form, we'd be very keen to know of your work.

And the third thing that we'd like to do as we move forward-- and these are not exclusive ways in which we want to engage with you, but they're some ways-- is that we are very, very keen to gather up best-practice examples so that as we develop what we think is a strategic overview, we take advantage of the dozens and hundreds of things that are happening out there in DHB land, in the community, and primary sectors in the unregulated health workforce that are examples of very good health workforce development practice.

So that's me done and dusted. Thank you very much indeed. I'm in the very lucky position of being too new to answer any really critical questions, other than to say I am optimistic about the future.

We don't carry a legacy of the past. And we hope that you will engage with us in the same spirit of optimism. So thank you very much indeed.

[APPLAUSE]

Presenters

Professor Sue Pullon, Professor of Primary Health Care and Director of the Otago Interprofessional Education Centre, the University of Otago

Video: Professor Sue Pullon - Forum 2019 - Health workforce

[Professor Sue Pullon presenting to an audience as part of the Health workforce session of Forum 2019]

[Professor Sue Pullon's mihi]

Good afternoon, and welcome. It's really great to be able to talk to you all this afternoon. And I'm going to share with you a little bit about the Tairawhiti Interprofessional Education Programme, which I set up in 2012 and has been running ever since, with Health Workforce New Zealand funding, now the Ministry of Health. And you'll see from that slide that this is a real partnership initiative.

University of Otago in Wellington leads this program, but we by no means could run it without a lot of partnerships. I really want to acknowledge Hauora Tairawhiti and Hawkes Bay District Health Board, because they have been absolutely wonderful partners, along with EIT, Otago Poly, and a range of other tertiary education providers as the program has grown.

So many of you will know, of course, that Tairawhiti is up on the east coast of New Zealand. And it's a long way from the various campuses of the University of Otago. I'm based in Wellington. A lot of the students come from Dunedin, but students come also from our Eastern Institute of Technology in Taradale and also in Gisborne.

[SPEAKING TE REO]

"What is the most important thing in the world? It is the people, the people, the people." And I think that's been our mantra since the day we started for this program. And this lovely stained glass window that's in the Gisborne Public Library really epitomizes the journey we've been on, trying to paddle the waka in the same direction.

So in a nutshell, the Tairawhiti program invites students to join the program for five weeks at a time. We run this program five times a year in Tairawhiti. The students are all final-year students. So this is very much a transition to practice program. And the students come from a range of places around New Zealand.

They live together in shared accommodation that's provided respectively in Wairoa and in Gisborne hospital campuses. And you can see the range of students that we now have on the program. Not all students can attend every block. There are timetabling constraints. There are real juggles and challenges organizing when the students are able to come to Tairawhiti.

But when they're there, they spend quite a bit of their time based in clinical work. So they're on clinical placements, as most of you will be familiar that final-year students need work experience. And they're working with health professionals in their own discipline. But in this program, we also get them to be working in pairs and in threes, working with students, learning with, from, and about each other in different settings.

So in a community pharmacy, we might have a pharmacy student for whom that's their normal sort of clinical home. But they will be joined by a nursing student one day, an occupational therapist student the next day, and it's their job to teach the other student what it is that they do. So the students get a really good idea of their own roles, but also the roles and responsibilities of the other health professionals that they work with.

There's also an integrated program that's run by our staff up there. We've always been very keen that this program gives something back to the community in the short term. So the students engage in doing community projects which are requested by different health providers in different parts of the community in Tairawhiti.

Our current team is Natasha Ashworth, who's a nurse by background, Marty Kennedy, who's a pharmacist, Rose Schwass, who's our program coordinator and administrator extraordinaire, and Janie Thomas, who's a midwife. Those four people really help to coordinate the integrated program for the students over the five weeks that they are there.

The range of objectives that the students are expected to meet are quite complex. And as you can see there, that ranges from Hauora Maori objectives to interdisciplinary objectives, rural health objectives, and looking at chronic condition management, as well. So these all in their own right are important things for all health professional students to learn about. But by bringing them together in an integrated program, this is a very different way of learning for most of them.

These are really important objectives in a place like Tairawhiti. Half the population is Maori, so we couldn't do this without deep engagement with Hauora Maori and Tikanga Maori. All the students go on a Noho Maore when they first arrive, and they're expected to give back to the community and engage with the community, as well.

So all of these objectives, we've been able to show that the students have engaged with and learned from. So they learn in many different places. They learn in community pharmacies. They learn in consultation rooms in general practices.

They learn in the hospital. They learn out on home visits. They learn when they are driving around the region, going out to visit some of the much smaller places than Gisborne and Wairoa themselves.

So since 2013, when the program expanded to Wairoa, we've been able to cater for somewhere between 75 and 80 students a year in total, spread across 11 disciplines at various times. And that's been quite a challenge. And I think we can pretty accurately say now that that's about the capacity of this particular community, because remember, the health workforce is only quite small in a place or places where the population is quite small.

So we've had over 500 students through the program now by the end of this year. And we're really proud of that number of students who have engaged with the program. But just to put it in perspective, there's a long way to go if we want every health professional student to engage in this kind of activity.

At Otago alone, there are somewhere between 3,600 and 4,000 health science students enrolled at any one time. And if you expand that to think about EIT, SIT, Otago Polytech, AUT, et cetera, et cetera, et cetera, the country has at any one time many, many thousands of health professional students.

And all of them get trained in clinical placements. It's an enormous ask on our health providers and health professionals to undertake that training. So supporting those people to do that training is really key to expansion.

We make no apology for sharing with you a little bit about our research in the space. The words "evidence-based" and the words "theory" and "conceptualization" have come up with the earlier speakers. So we've undertaken research and published about a lot of different aspects of this particular program and really keen to be able to say to you, yes, we're pretty confident that in the short-term outcomes, we can show that the program really makes a difference to many students.

But it's not just all about numbers on sets. A lot of this is deeper and more complex learning than it appears on the surface. The social learning, the shared accommodation, seems to be an important feature of this particular program. I think those conversations that you have at the dinner table, et cetera, are pretty important.

We've also looked at some of the issues around professional identity that arise on this kind of program. Sometimes, people think that interprofessional education is all about producing generic health workers. Well, that is not the case. Interprofessional education is about understanding and articulating the various roles and the various skills that those roles bring to modern patient care, particularly for people with complex conditions.

So some work with the dental students-- we've also looked at the combination of perceptions about cultural immersion when students are on an interprofessional program, looking at talking about students who talk about nurses and nursing. Interestingly, in this piece of research, it wasn't just the nursing students who were able to more clearly articulate what it means to be a nurse. But many of the other students in other professions got a much better understanding of what nursing was all about.

The longitudinal interprofessional study is a study that we've looked at the cohort of students who went through the program in 2015 and also '16. But what we've done here is compared these students with their cohorts from which they were drawn. So for 500-odd students, we followed them now for five years. They literally, as we speak, are just finishing off answering their very last survey.

And we've been very excited to be able to say to you, yes, we've got an over 80% response rate over five years. And that's no mean feat for a program which follows people over time, especially mobile young health professionals.

Quite a lot of these respondents are now living and working overseas and hopefully coming back to us soon. So we've published the protocol, but we haven't got any results. And we'll have those sometime during next year.

One of the things that we very quickly realized with sending students to Tairawhiti was that expecting students to go in cold turkey, if you like, into a different way of learning and a way of learning with other health professional students for the first time as final-year students is simply not sufficient and not educationally sound to expect students to go into effectively a capstone project with no prior learning in the field.

So we're developing now at Otago a whole range of learning activities which more junior students can undertake on the main campus in Dunedin and which more senior students can undertake successively in various places where students are distributed. So we have a longitudinal curriculum development. We have a conceptual framework, in which the goals are far more than simply undertaking IP for its own sake.

They are very much around producing students who are collaborative-ready practitioners who are socially accountable, who are culturally competent, and who also understand the principles of leadership and followership. So those are all things which the Tairawhiti program has sparked.

Five years on, we recently went back to some of the very early students who were in our very first 2012 and 2013 cohorts and asked them about what it is they remember about coming to Tairawhiti and what effect it might have had subsequently. There's a whole range of responses.

I won't read all of these out. You can read them for yourselves. But just one that struck us very much was, "it hasn't influenced my career choice, although I haven't forgotten what I learned and the values the people of Tairawhiti hold."

So this is gold, in terms of educational change and students' appreciation of the privilege that it is to be a health professional and work alongside people, recognizing and acknowledging their values. And I think that's something that it's not quite an unintended consequence. But we've been very proud of what the students have gained and articulated.

Of course, this doesn't all happen without a big team of people behind the scenes. It's not just about the people on the ground delivering the teaching. It's not just about the students who are actually at Tairawhiti. There's a big team of people who work together across the disciplines, across the institutions, and from head office.

I think if you don't support these kinds of programs that are a long distance from main institutions, people can very quickly become disenfranchised, feel isolated and unsupported. So we regard that support as absolutely key to our success.

So I'm going to stop there, because I'm sure that you're all ready for a bit of a break.

[SPEAKING TE REO]

[APPLAUSE]

Associate Professor Joanne Baxter, Associate Dean for Māori Health, the University of Otago, and Director of the Māori Health Workforce Development Unit

Video: Associate Professor Joanne Baxter - Forum 2019 - Health workforce

[Associate Professor Joanne Baxter presents to an audience as part of the Health workforce session of Forum 2019]

[Dr Jo Baxter mihi]

Well kia ora everyone. I really want to thank people for inviting me to speak here today, and I suppose I don't hide my passion for Maori health or Maori health workforce development very well, so I will always take up an opportunity. And actually, I don't hide my passion for the fact that I'm actually from the west coast. I happen to be [INAUDIBLE] and Otago, but I am west coaster born and bred. So issues of rural health and Maori health are also very, very close to my heart, and it's great to be part of a group that's hopefully going to help us tackle some of the issues that we have in terms of workforce and land in a place that means that the diverse communities that we have are well served by the health workforce that we have.

I've also been really, I suppose, inspired already by many of the initiatives that are out there that I know many of you are already part of. And some of this is about joining those dots and bringing positive things together and working together to get to where we want to land. So I want to tell you a bit about my journey in supporting equity in terms of Maori health. And this has really been a 10-year journey with the University of Otago. So my background is in medicine. After leaving medical school, I trained in psychiatry and I worked in psychiatry for quite a long time. And then had an itch I wanted to scratch, which was around how can we make a difference at a really big picture level, and ended up coming back through public health medicine, and health workforce has been one of the areas where I think we can make a huge difference.

So I want to talk about why we're focusing on equity at Uni of Otago, some of what we've learned to date about what are some of the critical success factors that have supported our outcomes, and our next steps because we are only partway through the journey that we are on. If you look at the international literature about the importance of having a diverse workforce, you'll see things that look like this. And this comes out of nursing research, which really highlights and focuses on diversity, but the important role that diversity has in supporting access. And access leads to reduced disparities, and reduced disparities contributes to health equity.

Other models break that down in what are the mechanisms for why we have diversity contributing to health equity. And some of those come very much at the patient communication level, but it also talks about where people choose to work and the kind of roles they have. So increasing workforce that will support underserved communities. Growing trust between communities, patients, whānau, and health services. And then also having people in there that are advocates and champions. And I'd like to add another one here that we've certainly seen and observed within our health sector when we have seen the growth of Maori in the health workforce. And it's probably no surprise to people to start to see that we're getting pockets of growth in strategy, policy, commitment to things Maori happening in some really interesting places. Some of the colleges in medicine and some of the less well-known specialties.

And often, when you look at what's behind that, it will be because there's been often been Maori staff or Maori communities or Maori people who've actually come in and started to push. So we've got a desire for enabling policy, and it's wonderful to see the prioritization and policy that's supporting things Maori, but also having the people in there to actually give life to that intent as part of this.

And so research that we've done at our unit has really highlighted not just some of those formal roles and the recognized roles, when we've researched and looked at Maori graduates from our health professional programs, we've found people highlighted many, many things that they were doing behind the scenes, encouraging young Maori to think about careers in health, working with their own whānau in their communities, and very much that collegial providing support for their own colleagues and informal mentoring. And this was happening in all sorts of places and spaces. So the things that we don't often measure are out there, and so growing the workforce allows for those intangible and more organic impacts.

And I think very much, when we think about the context that we have, then we can think about the advantages of having a full and flourishing health workforce that is Maori out there across all parts of our sector. And we have a long ways to go. And some of this data is taken from very recent. Some of it's a bit older, but we know that around between 6% and 9% of nurses and midwives are Maori, and for the programs we run at Otago, only between 2% and 5% of the registered health workforce for these professions and a number of others is Maori. So we look like that tiny little sliver.

And so the question that I have is, so what have we missed out on, in terms of our capacity as a health workforce, to actually understand, to drive, to solve solutions, to actually meet the needs of Maori when we haven't been present in many places and in sufficient capacity to actually be contributing to that? And so often our focus on equity in terms of Maori as, we're here and we want to be there, and if we do, we'll get somewhere.

But I also think we ought to reflect on the dynamics of not being there in the first place. And what is the implication of that? And some of the struggles that we have, like we want a program and we're going to try and make that program be responsive to Maori after it's been developed, for instance. Maybe we wouldn't be in that situation of always trying to adapt if actually Maori were central and part of the program development to begin with.

So there's a whole range of impacts of this, and I'll just mention one of the ones that I think has come out very much. And I think that with underrepresentation of Maori, you have a small number of people who have multiple roles. So I also have a very personal vested interest in growing the Maori health workforce I counted up all the committees I'm on, and I was well into double figures and more. And I'd love to be able to share the love around, so another great reason to grow our workforce.

And then qualitatively, I just want to acknowledge the experience of some of the young people in the emerging health workforce that we have. And so this came from a reasonably new young doctor as part of research. I'm usually the only Maori and the team. I'm always the only Maori doctor. Everyone expects so much, but I'm still training. So it'd be great to be a world one day where our young trainees weren't having to be all things to all people.

So how many do we need? And we did a bit of modeling. This is back of the envelope modeling, but roughly if we were going to reach 20% of the workforce roughly, which is based on the proportion of Maori who are young people in our population, we'd need 13,000 more nurses, just over 2,000 more doctors, close to 400 dentists, and 300 and something midwives. If I had a magic wand, I might be able to do it. But otherwise, we've got to grow these. And you can do the sums about how long it's going to take and the commitment we're going to need to make a really meaningful dent on those numbers.

So I call this a tale of two inequities because our health workforce inequity is a pathway that comes from education, and there are huge ethnic differences in educational attainment. And of course, for many of the programs we have, we require people to come into tertiary education often with a background that requires some science, and they have to compete and get into some very heavy duty programs that are often quite intense.

So UE attainment, this is a decade of UE attainment. And what you can see for both Maori and Pacific as it's looking pretty grim, so around 25% And if we think that a small proportion of those are coming out with sciences as part of that mix, then you can see the challenge that we have.

So our path in Otago was to partner with the Ministry of Health a decade ago, and the goal was to grow the numbers of Maori in the health workforce. And this lined up with our policy that we have as a merit on society so that our graduate poll would also reflect New Zealand society through a whole range of programs within the Division of Health Sciences, and then also in the wider university spanning a range of things.

So prior to 2010, we had a fairly dismal track record as an educational provider for Maori in health sciences. So less than half of Maori students were getting through to second semester in our competitive health science first year. That's the pathway into the health professional programs. Many of those students came in with educational vulnerabilities, and although there was lots of support-- and there's always great pastoral support and some academic support-- we were dismally failing those students.

So we set up in partnership with the Ministry of Health the Maori Health Workforce Development Unit in 2010 to do something about this. We aspirationally had a goal that 20% of students across the Division of Health Sciences would be Maori by 2020. It's 2019. I'll tell you where we got to later, but we started out with 4.2%. And these were very standard approaches to growing things, but in particular Maori-led and directed, and a strong social justice agenda and a very clear direction in terms of program development. Some very important policies underpinning our direction, both from the University, from tertiary education and health.

And I just want to acknowledge here He Korowai Oranga. I think this is a great piece of policy that positions Maori participation and the health and disability sector right in the middle. And I see pathway 2 as a link to both pathway 1 and pathway 3. So I think if we can do something about the workforce, we will tackle some of the others as well. We have a range of health professional admissions, processes, and pathways at Otago. And just a new one we've got, there's a socioeconomic equity one as well starting this year, Maori, Pacific, rural.

So our approach was, rather than to come in and say what's wrong with Maori, we took it the other way. We saw there is a whole lot of people in the society that seems privileged in order to get their young people, to have young people into health professional programs. What is that privilege? What does it look like? Where does it come from? How does it work? And then how do we unpack it and repack what we're doing for the Maori students that are coming our way?

So over time, we've developed four programs underpinned by research and evaluation, and our tagline is "from inspiration to" graduation these are all evidence informed. They have strong student voice and co-creation, have theory of change, program logic, and Maori-centered in principles. So one of the programs as an outreach program where we work with years 9 and 10 on science engagement and years 12 and 13 on health science engagement and health professional pathway programs.

We have our flagship program, which is Tū Kahika. These are young people desperate for careers in health, but who have had significant educational disadvantage. We provide a scholarship program for them.

And then our health science first year, which we completely unpacked, repacked, and wrapped a whole lot of things around it. If this was an educational talk, I'd unpack all of it, but just to give you a bit of a thing, we work very much with peer tutors and supports. And we do a whole range of things with those students over the course of the year, which includes running all-weekend physics tutes on the weekend that the big Hyde Street Party's on. So we manage to cover hauora as well.

And then we work with our students all the way through to graduation, and we're now starting to do a lot more to prepare those Maori students for what it's like to enter the health workforce. Range of research and evaluation projects, including one that I want to acknowledge working with the South Island DHB Health Workforce Hub, where we're looking at how do we support really successful transition from our Maori graduates into the DHBs and how the DHBs can support them through best practice and recruitment and support for Maori entering the workforce.

So our outcomes have been exceptionally positive. We have a huge, high level of engagement for these young people. We have a high level of return from our outreach programs, and many of the students that we've seen in years 9, 10, 11, 12, 13 come back, and they're now out there in the workforce, many of them.

Our foundation program has been hugely successful. Many of these students didn't have UE when they started the foundation program. Almost all of them do by time they finish. Most go on to health sciences, and many of them talk qualitatively about the huge difference this has made in their lives.

These are just some of the graduates. We've had coming out of Tū Kahika, and some of you may recognize some of these. We've got dentists, surgeons, physiologists, physiotherapists, and a whole range of people here. So our numbers have skyrocketed, particularly more recently. And in terms of our health science first year, we had a 40% increase in just the last year, which has created logistics issues in terms of where do we get a room that will take 235 people. And that was on a average of between 50 and 65, 66 before we started the unit.

High levels of engagement, and this is what our year looks like when you have to stick them on the floor because we don't have anywhere else to put them. And again, qualitatively, students are talking about this being transformational for them in terms of educational experience.

In terms of health professionals, we now currently across all programs have 369 Maori students across our health professional programs. We have a whole pile more in health sciences and bachelor of health science. And this is the medical school. We have 264 Maori students currently in medical school across the years, averaging about 20% of the medical school class. So we've hit 20% in medicine and working-- they are in close in dentistry and on the way with physio. So watch this space.

So we really have two overarching critical success factors, and one is the foundations and committed leadership, policy leadership, and a real commitment to this. And then the other one has been around evidence informed, data-informed, highly effective programs with lots of quality improvement as we've gone. And it really fits into these two things-- having the intention and commitment, and then paying attention to what we're doing. And both things have been required. Sometimes people think you do one or the other, but I think you have to do both.

So our conclusion is that we can reflect society in our health professional programs. Success requires input and commitment at all levels, but that we get multiple benefits and both health and education. So it's like the bifecta, if there is such a thing. And really, if we want to tackle equity, if we take a our determinants, we work on health services and we get our health workforce right, I think we can really get to the goals that we want to.

So just overall, we haven't got to 20%, but we have got to 15%. So I think that's pretty good, of our students overall being Maori. And we have some new projects, and part of it is actually preparing Maori students for the diverse roles they'll have in the workforce. So [MAORI].

[APPLAUSE]

Anna Clark, Deputy Director-General Health Workforce, Ministry of Health

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