Labour says resignations in top health roles is a result of the government's targets failing to solve the sector's problems.
Director-General of Health Diana Sarfati's resignation on Friday was the latest - coming within a week of Health NZ chief executive Margie Apa's, and Director of Public Health Nicholas Jones'.
Prime Minister Christopher Luxon and Health Minister Simeon Brown have both said the decisions were independent choices taken by those people.
However, it followed Brown telling RNZ that "there needed to be change across the leadership of health in New Zealand", and Health NZ commissioner Lester Levy telling The Post newspaper he wanted a chief executive who did things, rather than just writing about it.
It also followed new reports that ED wait times - one of two things Brown has highlighted as key in his approach to fixing up the sector - were suffering, particularly in Auckland.
Questions put to Brown about the pattern of resignations and the delays at EDs went unanswered on Monday.
Labour's Health spokesperson Ayesha Verrall said it was "clear there is a purge of health leadership going on" and it seemed to be coming straight from the top.
"It's beyond belief that this is a coincidence that people actually - many of them recently in their roles - would choose to resign," she said.
"That is a massive body count in terms of officials losing their roles ... it is absolutely guaranteed that will have consequences."
She said the government was betting the way to achieve its health targets was to replace the personnel.
"It's not as simple as they thought, and they've responded to that by firing the leadership in the health sector.
"They had lots of other options. They could have addressed funding. They could have changed the mechanisms in the health system for delivering on those targets, they instead decided that everyone needed to be moved on and I think that is probably a decision that will come back to haunt them."
She thought the pattern of resignations was unlikely to be the result of personality clashes.
"It is the job of public servants and politicians to get over personality problems in the interests of running the country ... it's unbelievable if that indeed is the case.
"A number of people who have had a long and important contribution to the health sector have been treated pretty shabbily. I don't think that's appropriate. I don't think it has a positive impact on the culture and the public service, and I think it's a shame for our country, really."
Labour health spokeswoman Dr Ayesha Verrall. Photo: RNZ
Verrall says government has 'no new ideas' on ED management
After taking the reins as Health Minister in late January, Brown highlighted improvements to ED wait times and primary care as key challenges he hoped to tackle.
Now, the NZ Herald has reported figures showing two thirds of patients showing up at EDs are not being seen within the recommended clinical timeframes based on the Australasia Triage Scale - a best-practice standard followed by New Zealand.
Auckland's Middlemore, North Shore and Auckland City hospital EDs were also among the five worst-performing for wait times, with Wairarapa and Palmerston North topping the list.
She said she had not seen any suggestion of the government taking a different approach to ED backlogs than what was already being done for the past 20 years.
"Flow management - which was part of what I had to do when I was a junior doctor in Wellington hospital in the early 2000s - that's still the basics of what's being done in emergency departments.
"The government's talked a big game about being able to fix this problem when they came in, but actually they've got no new ideas."
She said it was concerning Auckland EDs were now among the worst-performing.
"Traditionally, I've seen that as quite a well resourced place because on top of emergency departments and general practice, Auckland actually has a fair amount of urgent-care and after-hours clinics ... but in recent years the funding for that hasn't kept up.
"It's probably what was a really good system in the recent past starting to degrade and fall apart - and that's a shame for Aucklanders."
The problem was also likely worsened by a shortage of GPs and an ageing population.
She said the party was now hearing from some people that hospitals were no longer seeing people for some conditions which were previously routine, and Labour would continue to follow up to ensure the health targets were not being "gamed".
"We know last time they were in power, that's exactly what they did, is they just made it harder to see a specialist.
Call for more GP funding in Budget
Brown had pointed to his experience of the health system as a parent and patient informing his approach to fixing the health system - saying investment in primary care and access to GPs could help with prevention.
His predecessor, Dr Shane Reti, had committed to following up the work from the Sapere report which identified ways to make the primary care sector more sustainable.
Verrall said Brown's statements about the importance of primary care were encouraging, but it was clear the problems plaguing the sector came from poor resourcing. She said the Sapere report was a very good assessment of the level of funding needed.
"We know many people miss out on getting simple problems treated at the general practice, and it goes on to have consequences," she said.
"So 'if not that [Sapere approach], then what?' is my question to the minister, because we have a major problem with the sustainability of general practice."
She said that included a lack of GPs and the number of GPs approaching retirement age.
She would expect to see more funding for primary care in the Budget in May, she said - and was hopeful it would not be a repeat of the approach taken last year.
Health NZ in July confirmed a 4 percent increase in government funding for GPs - the 2024 Budget having signalled a $2.12b investment over four years into primary, community and public health - which compared with a 5.88 percent increase in costs.
As a result, Health NZ allowed GPs who relied more on government funding to increase their co-payment fees by a higher amount.
Verrall said that was simply passing the costs on to New Zealanders who needed to use the health system, putting it out of reach for those without the money to pay and disincetivising people from getting treatment early.
"It doesn't solve the problem ... it still blocks access to the people."
