The rapid upscale of outsourcing

Kia ora colleagues,

Earlier this month, the NZSA met with the new Health Minister, Hon Simeon Brown, to hear directly about his government’s direction for our health system, particularly the renewed focus on elective surgery and the increased reliance on outsourcing to the private sector. We appreciated the opportunity to engage with the Minister and raise key issues facing anaesthetists across the country. In the coming weeks, we will also meet with Te Whatu Ora – Health New Zealand leadership to continue this dialogue and seek clarity on the implications of these initiatives for our members, public and private hospitals, the patients we care for, and the sustainability of our profession.

We are aware of the complexity and concern that outsourcing raises for many of you. To support our members, NZSA has engaged legal experts to provide advice tailored to assist anaesthetists working in private practice to navigate this space within the parameters of the Commerce Act. This resource will be made available to members only and is intended to empower you to make informed decisions in an increasingly uncertain environment. We look forward to sharing more information on this in the coming weeks.

Whilst outsourcing is not new to the health landscape, it is clear that the government’s plan to outsource thousands of elective procedures in a rapid upscale may not be the fix our health system needs. Without intentional, collaborative and considered planning and patient selection across the motu, this approach risks exacerbating workforce shortages, increasing public hospital complexity, and entrenching inequity. The evidence suggests that outsourcing can lead to ‘cream-skimming,’ where private providers preferentially take on less complex, lower-risk patients. This leaves the public sector with the more resource-intensive cases – often without adequate staffing or funding – making it appear less ‘productive’ and further burdening anaesthetists and multidisciplinary teams alike.

We are also deeply concerned about the knock-on effects for training, staffing, and workforce sustainability. Although many anaesthetists already contribute to both the public and private sectors, the vast majority are operating at or near the limits of their capacity, regardless of their workplace. Diverting more work to private providers risks drawing even more staff out of the public system, increasing the clinical load on those who remain and reducing opportunities for registrars and junior SMOs to gain sufficient exposure to a range of cases. Similarly, solutions to introduce trainees into private hospitals could disrupt established workflows and reduce the efficiency and throughput of private operating lists. Without robust investment in our public hospitals, including workforce planning and infrastructure renewal, the long-term cost to the profession – and to patients – could be immense.

In light of these challenges, we urge our members to actively engage with NZSA. Your input and feedback are crucial as we represent the profession in these policy discussions. Whether you’re working primarily in the public or private system, your voice matters. Please take the time to share your perspectives with us – this is a pivotal moment in shaping the future of anaesthesia practice in Aotearoa. Together, we can ensure our Society remains a strong, informed, and relevant advocate for our profession and our patients.

Ngā mihi nui,
Dr Morgan Edwards
New Zealand Society of Anaesthetists, Ngā Ringa Tauwhiro o Aotearoa.