Kia ora tātoua
Rural Communities Deserve Better Safeguards
I have been following the media reports about the challenges facing primary care and rural hospital services in the Dannevirke, Pāhiatua and Levin areas with deep concern.
While I am not in a position to comment on the specific circumstances of any individual organisation, the situation raises important questions for the health and wellbeing of rural communities that extend well beyond one provider or one community. As primary care delivery models continue to evolve, it is important to consider whether current planning, funding, commissioning and accountability arrangements are delivering the level of local responsiveness and outcomes that rural communities expect and deserve.
What has been reported publicly is the resignation of significant numbers of clinical staff from a number of rural practices based on concerns about workload and workforce pressures. This has rightly led to growing anxiety within local communities about their ability to access timely healthcare. Community meetings have reportedly been held across the Tararua and Horowhenua districts, to seek assurances that appropriate services will remain available, while Health NZ, PHOs and providers work through the situation.
In this case the resignations relate to staff working in practices owned by one provider operating a number of practices, both urban and rural, across a wide geographical area of New Zealand. In each of those areas there are multiple PHOs, and practices are able to choose their PHO based on ‘perceived value’ offered. At HTRHN we are concerned that these factors are highlighting issues that are leading to detrimental outcomes for those people living in rural areas.
Regardless of the details of any particular case, the consequences of service disruption on this scale are far greater in rural New Zealand. Many people who access healthcare in Dannevirke and Pahiatua already travel an hour or more to reach those services – a reality that is shared by rural communities across the country. When local services become constrained or unstable, there is often no alternative provider within a reasonable distance. The result is longer travel times, higher costs, time away from work and family, and, for some, the difficult decision to delay seeking care or not seek it at all.
Our concern is first and foremost for the rural patients and whānau who depend on these services and have every right to expect timely access to quality healthcare close to home. We are equally concerned for the health professionals working on the frontline. No clinician should be expected to carry unsafe levels of workload or work within a system stretched beyond its limits. When experienced and committed health professionals feel compelled to leave because they can no longer provide the standard of care their patients deserve, it should be seen for what it is: a warning sign that the system is under significant strain and that rural communities are being placed at risk.
The events reported in recent weeks also prompt some uncomfortable but necessary questions:
These questions go to the heart of whether our health system has effective safeguards in place to protect rural communities when services come under strain.
Many of the measures traditionally used to assess performance focus on clinical and operational indicators. However, from a rural patient’s perspective, some of the most important measures are much simpler:
The recent introduction of Health NZ’s Primary Care Quality and Performance Framework (QPF) makes these questions even more pertinent. While the framework includes important measures, targets around immunisation levels, smoking cessation referrals and an online booking portal do not measure a patient-centric primary care service. The experience in Tararua highlights the need for stronger focus on what matters most to rural communities: access to care, workforce capacity, continuity of care and patient experience.
The ability of PHOs to monitor the quality of primary care delivery by their practices, hold practices to delivery standards and to put in place public health programmes across a region, are undermined if practices can easily change PHOs. Where is the accountability in the system for that regional population over multi PHOs?
The reality is that by the time communities are holding public meetings about access to healthcare, the warning signs have already been present for some time and opportunities for early intervention have been missed.
For the sake of rural communities across New Zealand, we urgently need clear policy settings and accountability measures. This should include:
We also need to ask a fundamental question:
Are current funding, commissioning and contracting arrangements delivering the local accountability that rural communities deserve? Decision-makers must remain connected to the communities affected by their decisions. Rural health services should be planned with communities, informed by communities, and responsive to local needs before pressures become crises.
An observation is that the further that decision-makers sit from the rural communities they are supposed to serve, practice-owners, PHO leads and HNZ staff, the quality and timeliness of important decisions deteriorates.
Ultimately, no accountability framework can overcome a workforce shortage. New Zealand needs a comprehensive rural workforce strategy and funding that properly reflects the realities and costs of delivering healthcare in rural and remote communities.
What the people of Tararua are asking for is not unreasonable. They are asking for what should be a fundamental right for all New Zealanders: safe, sustainable and accessible healthcare as close to home as possible.
As we approach the upcoming Pre-Election Political Panel, we look forward to hearing which parties are prepared to address these longstanding challenges and commit to strengthening the systems that rural communities depend upon.
Mauri ora
Grant
