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.

New Zealand is recognised for early adoption and recognition of urgent care as a distinct medical specialty. Urgent care in NZ has been formally recognized since the early 1990s, making us one of the first countries to do so. The Royal New Zealand College of Urgent Care (RNZCUC), established in 1992, played a key role in this development. The RNZCUC set standards for urgent care clinics and practitioners, providing training, accreditation, and ongoing education for urgent care professionals

According to the 2022 Sapere report, the core issue is that funding does not align with patient need. This means that services that have a higher than average proportion of people with high health needs are not funded adequately to deliver care to their patients. This is a serious deficiency in a core part of New Zealand’s health system, which needs to be addressed if the sector is to sustain and flourish.

New Zealand is not alone in trying to encourage more innovation in the delivery of primary care. Industrialised countries throughout the world are increasingly interested in how to support their primary care systems to address the prevalence of chronic disease and improve health outcomes, particularly among underserved groups. As more resources are devoted to specialised care, countries are grappling with how to structure their delivery systems to support primary care and prevention.

Digital health readiness is the foundation from which data can be leveraged for primary and secondary uses to improve well-being, health outcomes, and resilience. It is a measure of the ability to make use of analytics, data, and technology for beneficial individual, community, and public health outcomes. Hence, “readiness” is a composite of abilities and structures across analytics, data, and technology. In addition, readiness requires human factors outlined above for capacity, co-operation, and oversight.

Having obesity puts children at greater risk of developing asthma, type 2 diabetes, digestive problems and joint pain, as well as depression and anxiety. Recent evidence indicates that childhood obesity-risk depends on the complex interaction of biological, developmental and socio-environmental factors, an exclusive focus on diet and exercise will do little to help.

"It takes a community to raise a GP". Over the course of the past 60 years, we have seen a major shift in medical school education across much of the world, wherein it moved the teaching and training of new doctors from communities into universities, where they learned basic sciences; and hospitals, where they got hands-on experience in patient care and research.

The New Zealand health system is a socialised, universal health care system, with maternity care free to all New Zealand resident women, from primary to tertiary level, unless a woman chooses to pay for a private obstetrician. A key point of difference of the New Zealand maternity service from many other countries is that the majority of women are cared for by autonomous, self-employed midwives who are contracted to the state.

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There is potential to make significant inroads into addressing workforce shortages by designing and implementing effective retention measures, taking into account the specific needs of different sections of the workforce. It takes time to train new people, to improve retention, and to recruit from overseas. There is no single mechanism which will ensure we have the health workforce we need, so this plan anticipates using all of these levers.