“It’s a strategy. And it has a name: ‘Starve the beast.’” — Fleur Fitzsimons

At our public meeting on World Health Day, Fleur Fitzsimons didn’t hold back.

She argues that what we’re seeing in public healthcare isn’t just strain or mismanagement, but a deliberate strategy to weaken the system.

Drawing on the PSA’s frontline experience, she sets out what’s been lost, what’s at risk, and why it matters.

We’re sharing her speech in full below. You can also watch the video here.

Speech delivered by Fleur Fitzsimons, PSA National Secretary, at Kaitiaki Hauora’s public meeting, Wellington — World Health Day 2026.

An important meeting in Wellington tonight organised by Kaitiaki Hauora and the NZ Fabian Society to discuss how we build a strong public health system in Aotearoa. A pleasure to be on a panel with Luca, Louisa and Malcolm, with excellent chairing from Kassie. 

The New Zealand public health system is in crisis.

That’s a phrase we hear a lot, and when language gets overused, it can start to dull the urgency. 

It can make failure feel inevitable.

But what we’re dealing with here isn’t just pressure or mismanagement.

It’s a strategy. And it has a name:

“Starve the beast.”

Its proponents use that phrase openly. 

The idea is simple: you deliberately underfund public services, you let performance deteriorate, and then you point to that deterioration as proof the public system doesn’t work.

What follows is predictable — people who can afford to leave, leave. Public confidence drains away. 

And the case for privatisation or insurance-based alternatives starts to sound reasonable.

We are now seeing versions of that playbook here.

The question we have to confront is this:

How can we build our public health system strongly enough — legally, constitutionally, institutionally — to withstand that kind of deliberate pressure?

This is an important point, it is not simply enough to have, fund and run a public health system, it needs institutional and legal pillars which protect it and ensure that Governments of all persuasions act in the best interests of patients.

I want to outline in some detail what my union has directly seen this Government do to our health system since they took office and what our fights and campaigns against this Government’s record in health tell us about what needs to change.

Firstly there have been more than 30 damaging restructures of Health NZ since the election.

These “restructures” are just a euphemism for cuts.

The cuts were imposed by Government and have resulted in at least 2,100 full time roles being removed from our public health system and an additional 640 health workers taking the opportunity to accept voluntary redundancy.  

Behind these numbers are real human beings, 2700 people who had more to give our public health system.

The toll on them and their families is one of lives turned upside down, of people forced to find work in other countries like Australia and in many cases people questioning their own self worth. 

The people who lost their jobs were all critical to a well-functioning public health system - they provided the oil that drives the whole system.

At a time of rising health needs from an ageing and growing population, we see evidence of a public health system under strain every day, the Government just ignored the evidence, ignore expertise, choose saving money over saving lives.

The job cuts and failure to fill vacancies fast enough have hit health workers across the health system hard.

The restructures were wide in scope and the cuts were deep.  We were getting sent change proposals each day for some time in early 2025.

In response, we wrote comprehensive submissions about what would be lost as a result of the proposed changes, these submissions had input from hundreds of health workers through their union to make the case against cuts.

They are actually now a compelling and important historical record of what has been lost. 

We asked the Privacy Commissioner to investigate proposed savage cuts to data and digital workforces at hospitals all over New Zealand. We knew that the changes would mean that privacy systems in hospitals would be undermined and so they were. 

The original proposal was for almost half the workforce of IT, data and digital specialists to go.  These are the people who understand the quirks of legacy IT systems in our hospitals and how to patch them fast. 

In response to the poorly though through wholesale changes and cuts, we filed legal proceedings in the Employment Relations Authority.

The litigation was aimed at stopping these rushed and damaging cuts, which we knew would endanger the lives of patients, and see thousands of dedicated health workers lose their jobs.

The legal proceedings were on the basis that the proposed changes are grossly substandard, contain basic inaccuracies and pay little regard to the health and safety implications of the proposals on workers and patients.

The proceedings ask the ERA to issue a compliance order stopping the dismissals based on breaches of:

- obligations under collective agreements,

- the Employment Relations Act,

- The code of good faith in public health (which places stronger obligations on employers to work with unions and focus on patient safety)

- the Healthy Workplaces Agreement and

- Te Mauri o Rongo The Health Charter which all set out how heath the health system must be run including how health workers are treated.

We argued that the combination of these legal protections on the health system created a protective web that mean that Health NZ could not dismiss people and make cuts in the poorly thought through way they were proposing. 

The litigation served a purpose, it resulted in a number of settlements including a settlement which saved 200 jobs and the National Public Health Service. 

Ultimately, when it was argued we lost our case in the Authority with an unusual decision that found that despite the clear provisions in the ERA and the Health Charter, Health New Zealand did not need to engage further with unions or health workers before making wholesale savage cuts to health services. 

Through the power of the Official Information Act, we now know that Health New Zealand themselves knew that the proposed cuts to data and digital staff would increase and I quote from a Health New Zealand document “the overall clinical and operational risks” and that they will “materially impact patient care.”

This remarkable admission was contained within a Health New Zealand document entitled “End user impact of digital change” before the cuts were proposed.

The document warns that cutting Digital Services staff who keep IT systems running will "hinder the ability to maintain such critical services effectively," and will have "a larger impact on the [the Government’s] health targets than initially suggested."

It states that cuts will hit rural and regional hospitals hardest. Smaller sites including Gisborne, New Plymouth, Whanganui, Masterton, Nelson, Greymouth and Rotorua were already identified as under-resourced and geographically vulnerable. "The impact would be felt more keenly owing to the multiple roles conducted by some staff. A combination of single points of failure and inadequate wrap-around support."

So we have a situation where Health NZ themselves knew that data and digital cuts would impact on actual outcomes for patients, but they went ahead and made the cuts anyway.

This is replicated throughout the health system.

IT outages are now ever present in our health system and the patches take longer to put in place. 

We saw this in January when clinicians across hospitals in Auckland and Northland were forced to use paper-based systems and whiteboards and again when Waikato Hospital staff were unpaid for 24 hours.  

We will keep seeing this.

Another restructure saw cuts of 23 roles at the Audit and Assurance Directorate at Health New Zealand.

They are a critical unit focused on ensuring for example that $12 billion of annual funding of the primary health care sector is paid out correctly and not subject to fraud.

The cuts amounted to a loss of 28% of the workforce.

At the time, we warned that millions of dollars of precious health funds will be lost if this proposal goes ahead so we wrote to the Auditor General asking him to investigate the proposal on the basis that fewer funded investigations and audits will be possible and that civil and criminal fraud and errors will occur as a result.

In fraud terms this is called creating more “opportunities” in the system.

Unfortunately the response was disappointing.

After outlining the power they do have to look at such matters, the Office of the Auditor General concluded that  they do not have “direct power to change what a public entity is doing and that they cannot intervene in decisions that have been made.” They did however agree to make their auditor of Health New Zealand aware of the points that we raised.

Alongside these cuts, we know that clinical vacancies are not being filled, we have official information act data showing that in some cases, it took up to 30 weeks for management to approve a hiring process for critical vacant frontline roles. These included medical imaging technologists who operate x-ray, CT and MRI equipment, roles vital for patient diagnosis and treatment. 

And its not just cuts at Health New Zealand.  

Late last year, two mental health workers conducted a routine visit on a patient.

The patient assaulted one of the workers both physically and both workers and members of the public verbally.

The worker made an assessment that the patient presented a risk to themselves and the public so rung the Police identifying themselves as mental health workers and explaining the situation.

They were told to fill in an online report.

The situation escalated. 

They rung 111 three times in total but no Police support was provided.

The patient then left their accommodation with their whereabouts unknown for two weeks until further assaults of members of the public allegedly took place.

This is a too common a story of New Zealand’s health system in 2026.

This patient deserved better care and support.

These mental health workers deserve Police support when concerned about their safety, the patients safety and the safety of members of the public.

The Police should be funded properly so they don’t need to make unconscionable decisions about not sending help to mental health workers.

But it goes further than that.

The PSA took a complaint about both the incident and the policy of Police withdrawal from providing support for mental health call outs to the Independent Police Conduct Authority.

We said Police have a crucial role in preventing violence in the community and that further instances will put Police and the public at risk. 

Their response to us was damning.

They said: 

“While we appreciate that the Police mental health response programme is a significant concern for mental health workers and the PSA, the Authority does not currently have the resources to conduct such an inquiry therefore, we will not be conducting a review as you have requested.

Anyone who had ever had anything to do with public agencies know that this is a highly principled cry for help. 

It is truly remarkable, an absolutely critical watchdog over the Police admits in a formal letter that it does not have the resources to investigate whether a decision of the New Zealand Police is made in the best interest of health workers.

It is remarkable but again, the IPCA is not funded properly and is part of the crumbling accountability on Government when they make conscious decisions to underfund health. 

We have resisted cuts, we have asked the Privacy Commissioner to investigate cuts to data and digital, we have sued in the Employment Relations Authority, we asked Auditor General to investigate cuts to fraud investigators, we asked IPCA to investigate the failure of Police to send help to mental health workers and so much more.

We have been on extensive strike action, some unions still are.

But if we’re honest about what we’ve seen over the past year or two, the pattern is clear.

This is how “starve the beast” works in practice.

You cut capability. You slow recruitment. You weaken oversight. You ignore warnings.

And when the system starts to struggle, you treat that as justification for doing less, not more.

What that exposes — very plainly — is that our public health system is not adequately protected against this kind of approach.

We have watchdogs without teeth or adequate funding.

We have institutions that can warn, but not intervene.

And we have no legal or constitutional guardrails that require governments to sustain the system at the level New Zealanders expect.

That’s the gap we have to close.

Because this isn’t about trusting one government or another.

It’s about recognising that the pressures on public health are now structural and ideological — and we need to build protections that are strong enough to withstand them.

That means putting real weight behind the system: legal obligations, institutional safeguards, and constitutional recognition that public health care is not optional — it is foundational.

If we do that, we take this out of the realm of political cycles and short-term trade-offs.

If we don’t, we leave the system vulnerable to being run down again — slowly, deliberately, and in plain sight.

And this is why tonight and Kaitiaki Hauora is so important in this General Election year.