The Minister of Health has a serious challenge on his hands.
The health system urgently needs to find ways to meet demand and reduce inequalities, the Ministry of Health has warned Minister David Clark in its Briefing to the Incoming Minister (BIM).
There's a particularly worrying warning, too: the primary health system is completely missing some of the most vulnerable people.
Primary health care - services accessed in the community, such as GPs - is linked to better health and lower rate of early death, the report says.
But those services are not reaching Māori, Pacific people, youth and people with disabilities as well as they should. Costs and opening hours remain a barrier to access for those groups.
"Services do not always work well for some of the most vulnerable people, and sometimes miss them entirely," the report says.
For people with disabilities, services aren't working either. Many are "one size fits all" and are not tailored to the needs of individuals.
It says new ways of providing consistent care are urgently needed.
"We urgently need new, more cost-effective, ways of delivering care that will meet demand and provide consistent experiences for people using services."
The picture is also stark for children in care. They are more likely to have received mental health services than children who are not in care, but that support gets patchy once they leave the care system.
"Once they are no longer in care their rates of self-harm or suicide are much higher than those for the rest of the population. This raises questions of the effectiveness of the health system's ongoing support," the report says.
Things are dire for the elderly too. While we are living to an older age, we are not adding quality of life to those additional years.
"We have been more successful in adding years to life than in adding life to years," the report says.
"There is a growing gap between health expectancy and life expectancy... One significant challenge we face is to find ways to maximise the time people spend in good health. To do this, we will need to address long-term conditions and their precursors," it says.
The health briefing also singles out inequality in housing quality as a driver of health problems.
"Cold, damp and overcrowded homes directly contribute to poor health outcomes. Six percent of New Zealanders live in homes with major damp or mould problems and 10 percent live in crowded conditions.
"Housing crowding is linked to a number of health conditions, including rheumatic fever, meningococcal disease, respiratory infections and skin conditions"
Alongside clear problems in inequality of access, the report says it's increasingly difficult to put a cap on spending.
Combined DHB deficits exceeded $100 million in 2016/17 - double the loss forecast in October 2016. Dr Clark told Stuff on Thursday the deficit has now reached $154 million, but he wouldn't release the documents.
That level of debt shows "efficiency gains in the $2.4 billion of health services purchased by the Ministry are becoming more difficult, and demand and cost pressures bear on those frontline services too," the report says.
It suggests looking to alternative governance arrangements for savings.
The briefing was released as part of a document drop on Thursday. 170 such briefings were released. They can be read here.