Doctors and hospitals in rural areas say they have been ignored by a government plan to upgrade many hospitals in preparation for Covid-19.
Rural General Practice Network and Rural Hospital Network say they are disappointed the $100 million funding announced yesterday focuses on provincial hospitals, while 30 of 33 rural hospitals will miss out.
Rural Hospital Network chair Ray Anton told Morning Report the investment would be timely as Covid-19 spreads into communities beyond Auckland.
"Rural communities, hospitals haven't been upgraded to provide adequate facilities to handle [Covid-19] patients.
"What we're talking about is a situation where we need a place where we can screen patients who are arriving with symptoms, that we can isolate them while we are testing them to make sure they are either negative or positive, and then to have a good system for transporting them to urban centres."
They are anticipating Covid-19 cases to arrive at rural hospitals as domestic travel increases amid eased restrictions coinciding with the summer holidays.
"Thousands of people are flying into Queenstown Airport and they'll be spending time holidaying in Queenstown," Anton said.
"Lakes District Hospital in Queenstown is a DHB-owned hospital and upgrades in that hospital haven't been made to accommodate for this kind of situation," he said.
"They need an improved ventilation, they need an isolation room to be created. It's the same situation in Dunstan Hospital, Balclutha Hospital, Oamaru Hospital, all those facilities in Southern [DHB] haven't received investment in order to upgrade their facilities."
Anton said while there was no intention for rural hospitals to keep Covid-19 patients long term, they still required enough resources to be able to handle the potential cases until they leave or are transported.
"The clinicians are concerned that if patients are presenting and they're not able to isolate them properly, that they may need to be transported them more quickly, delays may occur in transporting patients into the urban centres."
Southern DHB rural manager Debi Lawry said the lack of access to transport was a significant problem.
"Despite extensive planning and striving to ensure we are building resilience, none of the six rural hospitals in the Southern region are prepared for Covid."
Anton described it as a situation of "post code lottery", and said we need to be able to look at a rural-proofing approach.
"If we are going to introduce improved quality of ventilation and isolation in hospitals because we've recognised that we've underinvested in these areas, we need to think not just of the urban centres but also the rural areas.
"But that is variable. In other parts of the country, we have seen investments being made in rural facilities, so it's kind of depending on where you are, and we would like to see a more consistent approach."
Rural General Practice Network chief executive Grant Davidson said it "ignores basic human behaviour" to think that Covid-19 patients would only turn up at urban hospitals.
"We know that when people get sick or injured, they show up at the nearest facility they can find and quite reasonably, expect to be cared for there."
University of Otago rural health associate professor Gary Nixon was also disappointed by yesterday's funding announcement.
"I think rural health services in rural hospitals were largely, not totally, but largely left out."
Nixon, who also works as rural doctor in Central Otago, said rural health care services were not prepared for what summer could bring.
"Summer really stretches a lot of our local health services, most of us are really only resourced to manage with our relatively small resident populations."
He said potential Covid-19 cases would need to be separated from other patients, but rural areas only had small facilities which were not really designed or geared to do that.
"Everything's gonna be so much more complicated and difficult this summer."
Nixon said these issues highlight the need for a consistent and national approach to rural health, something he hoped the government's health reforms would achieve.
In a statement, Minister of Health Andrew Little said "I asked District Health Boards to come up with projects that could be put in place quickly and that would improve our capacity to treat people with Covid-19 or protect other patients against becoming infected.
"Not every hospital is expected to care for Covid patients who need hospital-level care. The smaller the hospital, the higher the risk to non-Covid patients, which is why our Care in the Community programme is based on hospitals organising as regions and sending patients to the hospital best equipped to safely provide the care they need.
"Nevertheless, most of the rural hospital projects put forward for the $644 million Regional Hospitals Improvement Programme were approved. The fact that a project doesn't get money from this funding round doesn't mean it won't be funded in future, by district health boards themselves or through the government's capital funding programme.
"Any rural hospital worried about its ability to safely care for patients should be urgently contacting its DHB."