Policy and Advocacy in New Zealand

Q&A with Sarah Stevens-Gieseg, Chair of the ASA New Zealand Sonographer Advisory Group.

The ASA New Zealand Sonographer Advisory Group commenced in November 2022 and provides policy and advocacy advice to the ASA on issues of relevance to New Zealand.

Can you tell us about some of the major changes taking place in New Zealand’s health sector at the moment?

New Zealand’s health sector has gone through a lot of change over the past few years, with more to come.

In 2022, the nation’s health system was restructured and centralised with the creation of two new national entities: Health New Zealand (Te Whatu Ora) and the Māori Health Authority (Te Aka Whai Ora), instead of the previous model of 20 District Health Boards. These entities were given responsibility for planning, funding and the provision of publicly funded health services. This reform was a significant change from the previous model and was aimed at addressing ongoing inequitable health outcomes and access to services, particularly for Māori.

Significant work has taken place since 2022, but inconsistencies remain. Some refer to this as the ‘postcode lottery’ as cost, wait times, access to services, and quality of care can differ quite significantly depending on where you live.

Following the elections of late 2023, and the formation of a new coalition government, a further change occurred with the Māori Health Authority being disestablished, with staff and functions being absorbed into the Ministry of Health and Te Whatu Ora/Health NZ.

Subsequently, the government have replaced the Board of Health NZ with a Commissioner, Dr Lester Levy, and four deputy commissioners. Dr Levy has indicated he intends to overhaul the health system, including changing the size and structure of Health NZ.

In 2024, we have experienced significant cost-of-living pressure for households and a tight fiscal agenda for the government and employers. The focus of the government prioritises fiscal control. This year has seen redundancies of support staff and the cancellation of several hospital infrastructure projects. Health service providers (particularly those in the public sector) are working with tight budgets and limited resources.

What are the main challenges sonographers in New Zealand currently face?

In a post-COVID environment, sonographers are under pressure. Demand for ultrasound services continues to increase, however, delivering these services can be difficult due to significant workforce shortages combined with limited funding and resources. For example, the government payment for obstetric scans has risen just 3% in 16 years. Demand for public sector services is often oversubscribed, causing delays or forcing patients to pay what can be high surcharges in private clinics. Due to the low government subsidy for obstetric scans, for example, many private clinics no longer offer this service.

Despite its comparatively small population, New Zealanders are quite geographically dispersed. Outside the major metropolitan centres, there are many areas of the country where it can be particularly challenging to support patients, including those in regional and remote communities. Māori and Pacific Island communities, elderly patients, or those who find it difficult to travel to larger centres, as well as those needing specialist care, can all be at risk of poor access to timely and affordable services.

In addition, there is currently only one education provider – the University of Auckland – delivering accredited sonographer qualifications. This means there is a limit to the number of domestically trained sonographers available, making us highly reliant on overseas-trained sonographers, with around twothirds of new sonographers each year coming from overseas. These sonographers typically need to undergo a period of supervision to become familiar with the health system and culture. On the positive side, the University of Auckland has recently commenced a cardiac ultrasound post-graduate qualification, meaning sonography students seeking to become cardiac sonographers now have an avenue to study domestically.

Are there any significant differences for sonographers between New Zealand and Australia?

While there are many similarities, there are also notable differences for sonographers in New Zealand.

In New Zealand, all sonographers are regulated under the MRTB. Some sonographers can report their ultrasound examinations in line with workplace titles, protocols, and employment contracts. In addition, while domestic training opportunities are limited, students benefit from having more structure around student placements and many also receive financial support from employers during their training.

While both countries face a shortage of sonographers, New Zealand’s shortage is likely more acute, and the country is highly reliant on overseastrained sonographers. We also face competition for our sonographers from overseas.

New Zealand’s health sector has gone through a lot of change over the past few years, with more to come

New Zealand has a simpler political structure than Australia, and changes can happen quite quickly. This can be both an opportunity and a challenge. Culturally, I think we recognise the importance of diversity and representation so that we can better care for all our patients.

Finally, I think New Zealanders are naturally quite innovative and collaborative and sonographers and radiologists often work together to develop creative local solutions – many of these have potential for wider application.

What is the ASA doing to support sonographers in New Zealand?

The ASA continues to grow its membership base in New Zealand and look for ways to better support sonographers. In late 2022, it formed the New Zealand Sonographer Advisory Group (NZSAG), which regularly provides policy and advocacy advice and support to the ASA to ensure the voices of New Zealand sonographers are understood and represented to government, regulators and key stakeholders. The NZSAG is a dedicated group representing a wide range of sonographers. Important current issues include identifying and addressing workforce challenges, improving the cost and access to ultrasound exams, and responding to issues raised by the regulating authority.

The ASA has and continues to liaise with the relevant government stakeholders and the Chief Allied Health Officer. It was involved in the government’s Sonographer Reference Group, providing input into the national allied health workforce report Hauora Haumi Allied Health Report 2024, released earlier this year. This report highlights the contribution, barriers and opportunities for each allied health profession, including sonography.

Looking forward, what do you see as the main opportunities for the ASA to support sonographers in New Zealand?

I see several opportunities, including:

• continued engagement with key government and regulator stakeholders to ensure the voice of sonographers is heard

• increased collaboration with other health sector stakeholders to address some of the major challenges facing sonographers and patients

• continuing to represent New Zealand sonographers in everything they do, including consultations, professional development opportunities, professional guidelines and standards, research projects and surveys, etc.