GUEST BLOG: Ian Powell – Failing kidney patients symptomatic of health system crisis; health system needs its own mantra

Kidney patients being warned dialysis may be rationed is not a freak failure — it is what happens when New Zealand’s health system ignores prevention, sidelines clinicians and calls the wreckage “reform”.

These days, in fact for several years, when a major failing is revealed in Aotearoa New Zealand’s health system due to leadership (political and bureaucratic) decisions, as well as being significant in its own right, it is also symptomatic of the system wider crisis.

A recent striking example of this is a paywalled opinion piece published in the Press (23 March 2026) by kidney specialist Dr Curtis Walker: Costly ignoring of plan failed kidney patients.

Dr Curtis Walker is a specialist neph­ro­lo­gist (diagnosing and treating kidney disease) at Palmerston North Hospital and a board mem­ber of Kid­ney Health New Zealand.

He was also a former Chair of the Medical Council and member of the original board of Health New Zealand when it was established in July 2022. Back in the distant past, he was also national president of the Resident Doctors Association.

Preventable chronic kidney disease

Dr Walker begins his opinion piece by referring to kidney patients in Can­ter­bury being “…told that pres­sure on ser­vices could mean their lifesav­ing dia­lysis treat­ment may need to be rationed.”

While “fright­en­ing and shock­ing” for these dependent patients, it was no surprise to those respons­ible for plan­ning and fund­ing dia­lysis ser­vices.

On the one hand, for many years it was known that rates of kid­ney dis­ease were rising so sharply that they exceeded the rate of pop­u­la­tion growth; a sure sign of a tipping point.

But, on the other hand, despite being known, there was no proper planning to cope, including for prevention.

After years of work by health professionals, researchers and policy analysts, in 2015 the Min­istry of Health released a national con­sensus state­ment on man­aging chronic kid­ney dis­ease in primary care.

It included, with strong supporting evidence, a clear strategy to:

…identify kid­ney dis­ease earlier, slow its pro­gres­sion, reduce heart attacks and strokes, and reduce the need for dia­lysis and trans­plant­a­tion. But the plan was never fully imple­men­ted and a dec­ade later we are see­ing the con­sequences.

Dr Walker does not dig further into why the plan was not fully implemented. Certainly the Covid-19 pandemic would have been a contributing factor.

But the main likely explanation rests with the destructive and destabilising effects of the massive restructuring that the health system and those that work in it, including decision-makers, have had imposed from above.

This imposition was particularly since early 2021 when the then government announced its response to the Heather Simpson chaired review of the health and disability system.

The restructuring began with the political decision to disestablish district health boards (not recommended by the Simpson Review), restructure the Ministry of Health, and create a new national bureaucracy (Health New Zealand – Te Whatu Ora) to assume operational control of the health system.

This was followed by continuous internal restructuring within Health New Zealand, which still continues today.

The new bureaucracy has not known an organisational life without the prevalence of ongoing internal restructuring and is about to have its fourth board chair within its first four years.

When prevention is ignored, patients pay

However, Dr Walker does discuss the consequences of this failure to implement the above-mentioned plan to address chronic kid­ney dis­ease which now affects at least one in 10 New Zeal­anders.

While many people have mild kidney disease that can be man­age­able, when undiagnosed as is often the case, over time it can cause ser­i­ous harm to the point that dia­lysis and trans­plant­a­tion may be the only treat­ment options. It also contributes to increased heart and stroke risks.

The tragedy is that by the time many patients reach spe­cial­ist kidney ser­vices, they already have “…mul­tiple advanced con­di­tions that could have been man­aged much earlier.”

Dr Walker notes that:

As a res­ult, New Zea­l­and’s dia­lysis units are strug­gling to keep up with demand, run­ning seven-day sched­ules and push­ing treat­ments later into the even­ing in order to accom­mod­ate grow­ing patient num­bers.

He reminds readers that while dia­lysis is life-sus­tain­ing treat­ment, it is also demand­ing on patients and families. Most patients require treatment three times a week for sev­eral hours at a time. For many this also involves long dis­tances.

Leadership neglect and opportunity squandering

The problems of health system leadership neglect and the squandered opportunities for better patient outcomes (as well as being more fiscally responsible) are well-made by Dr Walker:

Kid­ney dis­ease must be detec­ted early and man­aged well in primary care to pre­vent the greatest cost and dis­rup­tion, which occur once patients require spe­cial­ist ser­vices.

Simple blood and urine tests can detect kid­ney dis­ease long before symp­toms appear. Since 2015, new med­ic­a­tions have also become avail­able that slow kid­ney dis­ease and pro­tect the heart.

Around 60 to 70% of the patients now requir­ing dia­lysis could have been identified much earlier and pre­vent­at­ive meas­ures taken.

Further:

Early detec­tion can make an enorm­ous dif­fer­ence. But test­ing alone is not enough. New Zea­l­and also needs a clear national strategy for kid­ney health – one that strengthens early detec­tion, sup­ports primary care and plans prop­erly for future demand.

Chronic kid­ney dis­ease needs to be on the Gov­ern­ment’s list of long-term conditions to allow for proper plan­ning.

We already know how to reduce the bur­den of kid­ney dis­ease in this coun­try.

The ques­tion now is whether we will finally act on that know­ledge.

Dr Walker forcefully makes the point that:

What we are see­ing today is not the res­ult of sud­den demand. It is the pre­dict­able out­come of a dec­ade in which New Zea­l­and failed to act on a clear plan to pre­vent advanced kid­ney dis­ease.

Kidney disease neglect symptomatic of health system

On the same day as Dr Curtis Walker’s opinion piece was published another paywalled article, this time by Stuff journalist Fiona Ellis, was also published by the Waikato Times.

She reported that less than half of cardiology patient referrals from general practitioners to Waikato Hospital were accepted last year.

GP representatives warned that the situation was getting worse. Patients were being left in “horrible” pain as they attempted to manage symptoms through primary care, or turning to private healthcare if they could afford it.

Two days later Ellis highlighted in another paywalled article how hospital workforce shortages affected this crisis.

The close proximity of the kidney disease neglect and declined cardiology hospital referrals, with a few tweaks here and there and allowing for some differences in context and circumstance, highlights something important.

That is, Dr Walker’s description of the failure to implement a clinically led and developed plan for kidney disease over a decade ago could be adapted to the wider health system.

His opinion piece highlights the value of using those with relevant clinical and related expertise to develop improvement plans and the potential benefits of proactively focussing on prevention.

After all it is those who work in the health system who generally know how best to improve it, especially where health service access, quality and delivery are concerned.

Dr Walker also highlights the failure of the leadership of the health system (both political and bureaucratic) to recognise this.

The health system needs a brutally simple mantra

Historically a mantra has been, among other things, a sacred utterance, syllable, word or group of words. It has an Indo-Iranian language origin and has been believed by practitioners to have religious, magical or spiritual powers.

It’s time for Aotearoa New Zealand’s health system has its own plain language secular mantra.

How about what makes good clinical sense also makes good financial sense.

I’m sure Dr Curtis Walker would concur; just saying!

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion.