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Health NZ leaders told the Health Minister tight controls on hiring staff were crucial to delivering its budget and that recruitment of any frontline worker was only possible with the sign-off of senior executives.
In a briefing to Simeon Brown last March, then-Health Commissioner Professor Lester Levy and interim chief executive Dr Dale Bramley said strict recruitment rules had been in place throughout 2024/25, and frontline hiring decisions required the sign-off of the regional deputy chief executive.
"This has been coupled with regular close monitoring of recruitment pipelines and the establishment of the HR oversight group," Levy and Bramley wrote. "The expectation is for these controls to remain in place throughout 2025/26."
The documents were released under the Official Information Act to the Public Service Association (PSA), which says Health NZ intentionally delayed recruitment, leaving patients and health workers suffering as a result.
In the same briefing, Levy and Bramley said there would be control over clinical safety, so there were no compromises made to services.
PSA national secretary Fleur Fitzsimons said that was "pure fantasy", saying that roles weren't advertised or filled for months at a time, leading to chemotherapy services being shut down and stroke patients not getting the regular care they deserved.
"These documents expose that the health minister was aware that our health system was not filling hospital vacancies as part of a deliberate savings plan and that patient care has suffered as a result. It's scandalous."
The health minister's office said he told the agency late last year to eliminate bureaucracy in hiring. Health NZ says it no longer uses regional panels for budgeted staff.
'Complex, bureaucratic approval system'
An internal document in June 2024 from then-chief executive Margie Apa showed four regional recruitment forums were set up to approve all hospital and specialist service roles.
An organisation-wide hiring freeze was put in place for all non-frontline roles. This applied to all hospital roles that did not deal directly with patients and all public health jobs that did not deal directly with the community.
The forums included regional directors, medical, nursing, allied health, rural decision-makers, as well as finance and P&C enablers, and were required to regularly sign off hiring decisions.
Fitzsimons said the approval systems were complex and bureaucratic, taking the hiring decisions away from the hospital and service level.
"The approval would take months. In one case, we had a payroll officer, needing to be approved by the chief executive, before the vacancy was advertised.
"Health New Zealand set up a complex, bureaucratic approval system in order to slow down recruitment and save money, and the minister knew about it."
The entire Health NZ northern region, which has more than 20,000 employees, was limited to hiring 40 full time roles a fortnight, claimed a union report, called Vacant by Design.
The report quoted workers who described the process as involving "multiple layers of internal and national approvals".
The union said the requirement for regional deputy directors to also sign off frontline staff meant local decisions were made too far away from where the vacancy was.
"The decision about whether to replace an emergency department administrator in Gisborne was made in Hamilton, while the decision about whether to approve a mental health worker in Kaitaia was made in Auckland," the report said.
Six months to fill three neonatal nurse roles
Fitzsimons said the slow recruitment process led to "harrowing examples" of health services being understaffed, with some vacancies not even advertised for months.
"It took six months to replace three neonatal intensive care nurses in Wellington, a Northland radiologist vacancy sat unapproved for 12 weeks, we saw a regional sonologist vacancy - 28 weeks before it was approved to be filled.
"We are seeing a deliberate strategy, driven by Simeon Brown, where hospital vacancies are not being filled, because they want to save money."
Other examples included an intensive care nurse in the Wellington region not approved after 19 weeks, an emergency department nurse in the southern region not approved for five weeks, a midwife in Counties Manukau not approved after seven weeks and a cardiology service administration clerk not approved 10 weeks later, the report said.
A survey of 1800 PSA members said 76% of their team waited more than a month for approval to fill vacancies, and 85% said unfilled roles drove colleagues to stress and burnout.
Fitzsimons said the delayed hiring process led to stroke patients suffering.
Stroke patients should be seen every day, but were commonly only being seen three times a week, impacting their ability to make meaningful progress, the union report said.
In July, Brown announced hospitals could recruit and deploy staff without central sign-off, reducing response times when demand rises, but Fitzsimons said the policy was far from over.
"There is an approval system for new roles in our hospitals that means vacancies are taking too long to be filled and it needs to stop."
Health minister, Health NZ respond
A spokesperson from Brown's office referred to a Letter of Expectations Brown sent to Health NZ in November 2025.
"The minister's position was clear that Health New Zealand 'must continue to remove unnecessary bureaucracy to ensure clinical appointments are delivered in a timely manner, particularly in geographic locations or services experiencing workforce shortages that are directly impacting on patient care'."
A Health NZ spokesperson said it had now changed its hiring processes and the four regional recruitment panels no longer existed.
Current recruitment processes for budgeted roles were now 'two-up', involving the hiring manager's manager, he said.
Management, admin or other roles that weren't budgeted for may need regional review from a forum or committee.
Health NZ introduced a devolved operating model earlier in 2026 to ensure decisions were clinically led and met local need, the spokesperson said.
"While planning and strategy remain a national function, healthcare decisions - including recruitment - are being made closer to care."
The spokesperson said Health NZ did not accept the suggestion recruitment decisions were deliberately leaving services understaffed or that they compromised patient safety.
"Recruitment decisions are made based on service need, workforce availability and patient safety."
The spokesperson said Health NZ recognised workforce shortages were pressurising some services and staff, but that vacancies were being recruited for across the country and a vacancy did not automatically mean a service couldn't meet demand.
