You cannot divide, dictate, cut, restrict, ignore and instruct your way to a healthy health service – Rob Campbell

Gisborne nurses and midwives campaign for increased health spending and nurse-to-patient ratios during a nationwide tour by the nurses’ union.
THREE KEY NURSING FACTS:
Rob Campbell is a former Health NZ chair and the vice chancellor at AUT/Te Wananga Aronui o Tamaki Makaurau. He was a keynote speaker at yesterday’s College of Nurses Aotearoa Symposium in Christchurch. Below is his edited speech.
OPINION
In these times where the deficits in health equity, in the scope of and access to healthcare, and in the wider building of healthy communities are so clear we must have real clarity on who we are as promoters of health equity and what we must do to protect and promote it.
The deficits are real but they should not dominate our thinking. What should dominate our thinking is promotion of healthy futures and how we work together for those futures.
Whatever role we may have in that there is none more important than that of the nursing profession.
The university of which I am chancellor – AUT/Te Wananga Aronui o Tamaki Makaurau – is the largest provider of education to health professionals across a wide range of skills. Our work is fully committed to excellence and equity in that process.
I cannot help but reflect with sadness and concern on how far issues of equity have slipped down the leadership agenda at the minister’s offices, at Manatu Hauora and at Te Whatu Ora over the past year.
Trashing Te Aka Whai Ora was the symbol – a mindless piece of destruction in its own right but an even worse indicator of what is to come.
My wider governance experience also tells me something about what went wrong and what can best be done from here.
I did not stop being concerned about equity and excellence in our healthcare system when sacked by the previous government for warning of the dangers ahead, some already evident at the time. One day some of them might even accept that I was right.
You cannot divide, dictate, cut, restrict, ignore and instruct your way to a healthy health service.
Nurses are fundamental to any possible genuine pae ora/healthy futures. Such futures and the equity they require must have nurses, their interests and their capabilities actively at their core.
You are at the centre of this not just as objects of either deficit or change but as subjects, as drivers of solutions or solutions will not occur.
This is true also of the many kaimahi, paid and unpaid, in kaupapa Māori social and health services. They are not simply objects and costs but the subjects, drivers of and integral to solutions.
Any serious discussion on equity in health has to see nurses, not solely of course, but centrally as the key to solutions, as drivers of solutions.
The inequities are real. And they grow deeper as those with the ability to pay private services do access those services – meeting their needs while weakening service for others. If you are “wealthy and sorted” like the prime minister, the problems do not loom large or not at all. But for others they do, nurses included.
This idea that nurses are central to the answers to equity in health is not unique to Aotearoa.
You are aware that very core of “caring” is seen and often exploited as a weakness, and the expectation of managers becomes that of submissive service. But properly understood in unity and activism it is force far more powerful than government austerity and dictation and it carries the future of health with it.
I still believe that what I referred to on taking up the Te Whatu Ora role as “equity, excellence and efficiency” should still be the goals. These are complementary, not in conflict. The aim is the best, most equitable, services we can afford. This is something we can only achieve by those most involved working together for their patients and communities.
The behaviours which should underpin this were to be agreed in a charter to cover management, staff, contractors and funded service providers, later developed in the form of Te Mauri o Rongo, which is still officially in place.
The guiding pou of the charter are: wairuatanga/purpose and commitment; rangatiratanga/supporting people to lead; whanaunagtanga/working together; te korowai āhura/safety and support in work.
There are some grand words in this, some poetic expression. The basic principles are that we can only do this together, so we will.
There is no point in me reiterating problems for nurses – you know them better than me. We are a very long way short of where we need to be.
In summary, Te Whatu Ora became an organisation which was not seen as working for health service workers and its communities because it wasn’t.
All of these issues have been intensified under the new regime imposed during 2024.
The organisation appears to have the transparency; the breadth and depth of vision; and the flexibility and responsiveness of a concrete wall.
Those leading this are doing and saying what they are told rather than what they should. I do not believe for a second that Te Whatu Ora did not know how many nurses they were hiring, nor that they were having to pay such nurses.
I still think that, with all of its inadequacies, a good framework for building equity in health is provided in the Pae Ora legislation. But it would be naïve to think that there is any intention to head in that direction.
You may, in your work, have found differently but from my knowledge and experience there is simply no path to equity, excellence and efficiency in health services which does not have at its core a robust public health service.
Given this, there are two imperatives for those who wish to preserve what we can and to build understanding for a better future in our communities even while many aspects of equity in health are frayed.
There is a further danger which I think is not far off. Do not think that initiatives such as the new Ministry of Regulation intends to limit itself to “tape” of any colour impacting only businesses. I have no doubt at all that occupational regulation will be looked to as a target. Both unions and professional organisations will be posed as holding back efficiency.
It is very important not only to be prepared for this but to be ahead of the game where technology or other changes impact traditional qualifications or accreditations. I think it is important too to keep mounting campaigns for positive progress wherever we can. It can’t all just be about defending what we have when we don’t have enough.
So be assertive, be innovative, be positive, be open and active across all issues. Nurses are the centre of how we will create health equity.