21 Apr 2021

Experts optimistic but want assurances over health sector reform

2:47 pm on 21 April 2021

Health experts are hoping rural populations won't be ignored in a new shake-up with the health system.

Canterbury region farms

Health experts want to make sure rural communities are represented under the new health care system (file image). Photo: RNZ / Nate McKinnon

The government has announced all DHB's will be replaced with one new national body called Health NZ.

Minister of Health Andrew Little said the new entity would strive to make sure everyone, no matter where they lived, would have access to the same level of healthcare.

Rural General Practice Network chief executive Dr Grant Davidson said rural areas had been underfunded and ignored for too long.

While the announcement was encouraging, it didn't completely deliver, he said.

"Our biggest disappointment was the minister went through a whole list of priority populations and despite The Health and Disability System Review indicating rural populations were completely disadvantaged in the system - rural wasn't mentioned at all in his speech," Davidson said.

"So our concern is that the rural population throughout New Zealand will be forgotten again - the devil will be in the implementation detail."

Health care in rural areas was varied with many often being let down by the system, Davidson said.

"We have an understaffed workforce who are really stressed and at real risk of burnout or leaving, so there are some big problems which need to be solved."

There needed to be a rural representative when decisions were being made about the new entity, he said.

Many farmers and those that lived in remote areas put their health on the back burner with a "suck it up and she'll be right attitude", Davidson added.

"We need decision makers involved that's vital to keep rural needs at the forefront."

Dr Grant Davidson of Skills Active Aotearoa.

Dr Grant Davidson. Photo: Supplied

University of Otago's Rural Health department head Dr Carol Atmore said the planned localised systems were something many medical professionals had been discussing for years.

"The potential to have a focus on localities, where all of those primary and community care services are all meeting the needs of those communities, that could work extremely well," Atmore said.

However, she would like more clarity on how the new system would be put in place.

"I suppose the devil is in the details, so who describes what the community is that's covered by the locality? Who sits on the governance of that? How do community voices get heard? How do Māori voices get heard? I can see this as having enormous potential, if it's implemented well."

The government's focus of digitalisation could help to better connect remote communities with healthcare - if the right support came with it, she said.

"Most people actually do have a smartphone and I think the issue is the plans so you can solve that by offering data for health related issues and these are the sorts of things that I'm expecting that the digital part of the strategy would be looking at."

A major issue was still the primary health worker shortage in rural areas, Atmore said. She wanted to see funding used to attract people to work in more remote places.

Watch the health sector announcement:

Rural Women New Zealand president Gill Naylor agreed both more health workers and digital infrastructure was needed.

"We have instances of a two hour drive to breast cancer appointments, whether that be for screening, diagnosis, or treatment. Going into labour at midnight in a no cell coverage area, three hours drive from a hospital, and the rescue helicopter's on another rescue," Naylor said.

"Telehealth being offered where there's patchy coverage and little or no internet or broadband service."

Naylor was pleased Little said healthcare quality would not be based on location.

"We need to make sure rural postcodes aren't in the losing lottery."

Analysis on the rural and gender-related impacts of the reforms should be carried out to make sure some groups were not disadvantaged by it, Naylor said.

New medical school proposed for Waikato

Waikato University professor of rural health Roger Strasser said the announcement was a step in the right direction but hoped education would be on the agenda when change was implemented.

The university met with the health minister recently to pitch the idea of The New Zealand Graduate Entry Medical School (NZGEMS), he said.

The school would admit students who had a university degree and would be recruited from under represented, under served Māori, Pacific, remote and rural communities.

Students would be trained in the community with immersive clinical learning so they were prepared for a career caring for underserved vulnerable high needs populations across New Zealand, Strasser said.

Although the two existing medical schools produced high-quality doctors, only around 20 percent become general practitioners, 3 percent become psychiatrists, and almost none chose to serve high needs populations.

"If students study in their own communities it's more likely they will work there."

Get the RNZ app

for ad-free news and current affairs