Christopher Luxon says his government has 'certainly strengthened healthcare' - has it really?

There's nothing like the worst flu outbreak in 10 years to test the mettle of the health system - and to test the prime minister's claim it's in better shape than three years ago.In August, when Christopher Luxon survived his second leadership coup attempt he delivered a one minute speech including a line that the government had "certainly strengthened healthcare".But as nurse after nurse after patient after doctor spoke out about overloaded emergency departments and general practices this winter, at the very least the "certainly" seemed like a stretch.Ministers and health officials repeatedly talked about the winter plan they had put in place.That included attempting to increase access to urgent care clinics, to encourage immunisation, and to get pharmacists to take on more care.Inside hospitals it included extra beds, and staff who could pivot to where they were needed most.But some nurses and doctors in overwhelmed EDs said they saw no sign of the plan in action as patients piled up in public corridors, some double parked, some even waiting outside the waiting rooms.They say what would have been most helpful was an end to Health NZ's hiring go-slow, well before flu season kicked in.In August, when Christopher Luxon survived his second leadership coup attempt he delivered a one minute speech including a line that the government had "certainly strengthened healthcare".SANELE CHADWICK / RNZED claims and what the stats sayNationally, the latest emergency department wait figures show 76.3 percent of patients were in and out of hospital emergency departments within the target of six hours.That is five percentage points more than the last figures under Labour's reign - in 2023. A win in the big picture.But there are two significant caveats - the figures are from March to June 2026 so do not reflect this winter's late flu outbreak; and a breakdown by region also shows huge variations, with about half of the country's hospitals going backwards year on year.Palmerston North's hospital has repeatedly hit the headlines for its overstretched emergency department.The statistics back that up, with just 55 percent of patients treated in the target time - a fall on the same period last year.The Capital and Coast health district, which includes the Wellington and Hutt Valley hospitals, was second worst on 63 percent, although had improved on the previous year.The West Coast fared the best, with 95 percent, and South Canterbury on 93 percent.However, complex cases from both areas would likely need to go to Christchurch Hospital for more advanced trauma care. Its six-hour clearance slipped from 80 percent to 74 in a year.Doctors and nurses there described having so many patients being treated in corridors this winter, they had to angle park beds for the first time.In corridors, patients did not have call buttons and often did not have monitors, making it difficult to alert staff if they needed help.It was bright, noisy and open, with no privacy and little chance to rest.Health Minister Simeon Brown says the improvement in the overall nationwide ED clearance rate is important because it meant more people overall were being seen on time - even if better progress was needed in some areas.The government's focus on the target of having 95 percent of people through ED in six hours was helping, he said"And it also highlights where further work and further investment is needed to make sure that we are seeing improvements across the country," he told RNZ.The July to September ED statistics won't be made public until well after the election.Health Minister Simeon Brown.RNZ / Samuel RillstoneThe load grows - and the GP connectionEmergency doctors and nurses have repeatedly said they are dealing with sicker patients, with more complex conditions.That contributed to more people turning up to EDs and could mean they had to be there longer, or were more likely to need to be admitted to a ward.The average number of people attending an emergency department each day has grown from 3156 to 3693 in the past nine years.There is a direct connection to general practice.Many patients say they struggle to get in to see a GP when they need to, which meant conditions could get worse, leading in some cases to the need to go to an emergency department.Others couldn't afford to see their local doctor but still needed care - and a hospital ED is free.Health NZ has had to walk the tricky line this winter of discouraging those who did not need urgent help to stay away from EDs, while making sure those who really needed it were not put off.Long time GP Rawiri McKree-Jansen said it has been a tough winter for general practice but access to family doctors appeared to be improving.It was very patchy though, he said."Clearly there are some clinics that are struggling to have appointments for patients in a timely way. So, we still hear patients who join this clinic who come from other clinics where they haven't been able to get an appointment for three or more weeks," he saidThe growing complexity of patients, including access to primary care, has also affected the outflow from emergency departments.Hospitals are often clogged with older, sicker patients, meaning ED patients may wait for a long time to get a bed in a ward.That in turn meant they were taking up space in the EDs while new patients kept coming in, and were often a big factor in overcrowding.It meant emergency nurses were having to care for patients who should be getting their care in a ward, as well as looking after all the new people coming into the ED.Long time GP Rawiri McKree-Jansen.Supplied / TendThe plan for general practiceAs part of the government's big push for health targets, it created a new one for primary care in June.It wants more than 80 percent of patients to be able to get an appointment with a GP within a week.Few patients would disagree, especially in areas where the wait could be several weeks.GPs generally want that too but some pointed out it was not that simple.GenPro, a group representing clinic owners, said long term relationships with family doctors and face-to-face appointments must be prioritised.Telehealth, which had grown in the past three years, was a good innovation but should complement community care, rather than be the main source, the group said.General practices are partially funded by the government - via Health NZ - and partly funded by the fees they charge patients.This year, after a long negotiation general practice got a $175 million funding boost.That meant an increase of at least 6.9 percent for most clinics, but that could be as high at 13.9 percent if they met new targets relating to immunisation, cervical screening, smoking and online booking systems.Some GPs warned it would be easier for some clinics to hit the targets, such as those with less complex patients, making the funding inequitable.But Brown said the funding rewards "progress" towards the targets meaning every clinic could benefit, no matter where it started from.Despite stories from desperate patients struggling to get appointments for weeks, Brown said over this government's term there were now fewer general practices with "closed books", meaning more were taking on patients.And online GP services were a good innovation, he said."It's not for everybody, but it is about saying that if you can't get in as quickly as you need, there is an alternative," Brown said.The College of GPs said the recent improvement to funding had helped the situation of general practice - but much more was needed.Ninety percent of medical issues were managed in in primary care, with 24m "patient contacts" a year compared with 1.4m ED visits.Strengthening GP level care would keep patients healthier and improve the whole health system, the college said.National's Christopher Luxon (L) and Simeon Brown at a health clinic in Auckland this week.RNZ / Tuwhenuaroa NatanahiraHealth and the electionVoters are getting more worried about the state of health care.September's Ipsos Issues Monitor, which asks New Zealanders what they think are the country's biggest issues, puts healthcare and hospitals at number two. It is trumped only by the cost of living.Forty-four percent of people listed hospitals/health as one of their top three concerns, up from 38 percent three months earlier.Despite Christopher Luxon's assertion that his government had "certainly strengthened healthcare", key parts of the system struggled this winter, with some emergency department staff saying it was the worst it had ever been.After the dire conditions at North Shore Hospital's emergency department were exposed in August, the Nurses Organisation held a community meeting.Those attending said health was very much on their mind when it came to deciding who to vote for.