This year’s Budget contains plenty of good news for health.

• There has been a substantial and much-needed upward lift in operational funding.
   
• This should make a positive difference to DHB balance sheets and most importantly help to better support timely patient care.
   
• There is a welcome injection of money to support post-Covid catch-ups.

But...

• We already have a massive tail of unmet need and we know that catch-ups take a very, very long time. 
   
• There will be ongoing acute demand which was causing bed block and 100% bed occupancy levels in many hospitals well before the Covid crisis.
   
• We need to be alert to pressure on staff as hospitals balance ongoing acute demand with the backlog of planned care, first specialist appointments, and follow ups.
   
• We still have significant workforce shortages and even with more funding these cannot be addressed immediately. Bringing senior doctors and dentists into New Zealand will be as difficult as ever, and it still takes the same amount of time to train junior doctors.
   
• We don’t yet know what impact post-Covid border and travel restrictions will have on medical training and recruitment, but it’s a fair bet that this has become more difficult, not less.

As to capital investment in health, we will have more to say about this in next month’s Specialist, but it would be fair to say it falls well short of Treasury’s 2018 estimated capital investment needs over 10 years. Current planned builds, and those in progress are typically less than fit-for-purpose and sadly, are unlikely to be informed by best medical advice. We are also concerned about capacity and capability in the construction industry. In short, don’t expect building issues to be resolved any time soon.

As Richard Hamblin and Carl Shuker noted in their excellent Spinoff article, “our system is not a linear production line where treatments are applied to relatively predictable demand.” Our system is messy and overloaded; and workload for senior doctors and dentists is an ongoing cause for concern.

While money is part of the picture, so is wellbeing. Safe, sustainable work with access to appropriate admin support, non-clinical time, leave, and decent workspaces are even more important. Fatigue and burnout are the enemies of catch up, and hospital occupancy needs to be managed with an eye on staff safety as well as on patients.

We are continuing to work through the finer Budget detail, but we have included below a table showing the main pieces of expenditure and any corresponding rises or falls in funding levels.