Hope for a healthier small town
The announcement of a major restructure for the country’s healthcare system didn’t have them dancing in the streets of Taumarunui. But there was some hope that the reforms could mean greater access to services and more equitable resourcing.
News of a major governance restructure for the country’s healthcare system didn’t have people dancing in the streets of the rural King Country township of Taumarunui.
The town would be ground zero in any assessment of determinants that contribute to reduced health outcomes – isolated, low socioeconomic status, with a Maori/Pakeha population split of about 50/50.
But there was some hope amongst health professionals and providers that the reforms, broadly outlined by Health Minister Andrew Little on Wednesday, could mean greater access to services and more equitable resourcing.
Taumarunui, population around 5000, comes under the area administered by the Waikato District Health Board.
Resident, retired surgeon and member of the Waikato DHB’s Community and Public Health Advisory Committee, Paul Malpass, said while he was anticipating the changes, he still had concerns.
‘‘There was talk about reducing the number of DHBs and creating a Maori Health authority … and a lot of care nearer to home, community care and bringing care to the people.
‘‘I have to say we have been saying that for some time in Taumarunui. I am a bit concerned for the rural community in the sense Taumarunui township is 160km from Waikato (Hospital), so secondary services, tertiary services, are that far away and for some people even further … by and large it’s a poor community and access is a major issue for us.’’
The problems bedevilling isolated communities were not going to be fixed overnight by any structural change, Malpass felt.
Primary care in places such as Ohakune and Raetihi was stretched thin. ‘‘Secondary services say, ‘oh, we’ll work with the primary care people’ but there ain’t that much on the ground.
‘‘I have gone from hospital boards, to area health boards, to RHAs (Regional Health Authorities) and then we had the funder provider split with Crown Health Enterprises, all those sorts of things, and then we went to DHBs and I don’t think it’s made an awful lot of difference to people.
‘‘I think some of us old docs get a bit cynical.’’
Taumarunui GP Dr Harald Pfeffer echoed Malpass’ concerns about rural GP numbers – replacing retirees, succession planning and the general problem of an aging GP population.
The town currently has four GPs – while there is no definitive GP to patient ratio in New Zealand, the Royal NZ College of General Practitioners recommends between 1:1400 and 1:1600.
It was not a new issue, Pfeffer said, but one that, especially in the rural sector, needed to be addressed urgently. Overall though, without yet knowing the direct local impact, he supported the proposed changes.
Inequity of health care access and delivery on both regional and cultural/socioeconomic basis, had to be addressed – a point he said he had personally advocated in the past to the Waikato DHB as an advisor to its rural health committee.
Like members of the public spoke to in the town, Pfeffer also decried any further diminution of the hospital.
The constant machinations to close or downscale the hospital to a ‘one-stop health shop’ – in essence having a GP centre, a few beds and a rest home on site – would be a mistake, he said. ‘‘The hospital, as is, does meet community health needs. Perhaps a wider range or more frequent visiting specialists would be an idea worth pursuing.’’
This was a point the Ruapehu District Council also made in a statement from Mayor Don Cameron. ‘‘We want to see access to timely, affordable primary and secondary health services improved significantly and no reduction of hospital services in Taumarunui.’’
In fact the council wanted the Waikato DHB to speed up its commitment to improving services at the hospital. It welcomed the creation of a Ma¯ ori Health Authority which it hoped would ‘‘deliver significant improvements in Ma¯ ori health outcomes’’.
Already seeking these in the Taumarunui and wider area is Taumarunui Community Kokiri Trust, a major community health provider. Services the trust is
involved in include GP practices, mental health, child, and rangatahi services and social wellbeing support.
It is also involved with a pensioner home, plant nursery and gardens, and housing, having built a number of units in the town. These were originally in response to health issues, rather than homelessness, said Trust chief executive officer Christine Brears (Ngati Maniapoto).
‘‘Houses in Taumarunui weren’t healthy, they weren’t cozy and they weren’t happy homes and so as a result, this is what we have done. But it became two-fold, not only a health issue but also supporting your homeless issue.
‘‘Our view has always been a holistic view, we never looked at things from a silo perspective.’’
Like others in the town she was hopeful about the reforms, but, having been in action since 1996, experienced enough to remain wary.
‘‘We have been in the game since way back then, and we have managed to stick it out, managed to work within all the constraints that have been there until today and I must say it has been a hang of a struggle ... But we’ve been able to, I guess, strategically build the organisation to be able to deliver despite all of that.’’
Any Ma¯ori Health Authority would need to be conscious of both rural and urban populations, she said. ‘‘As a provider in our own right and one which is absolutely comprehensive, employing 134 kaimahi, 90 per cent of them Ma¯ ori, I mean that’s what we are talking about has been difficult to achieve – putting Ma¯ ori into the workforce, pathways of development, that’s one thing, the other side is then taking the barriers away that have inhibited Ma¯ ori from accessing quality healthcare.
‘‘Maybe this Authority is going to do that, take away the barriers, make it more culturally responsive for our people, but at the end of the day too, I also hope that the resources and the strategy is about uplifting rural providers and not being at arm’s length of urban Ma¯ ori providers.
‘‘Let us strengthen and develop, so our communities are being delivered a service that is equal to that of an urban centre.’’
For pharmacist Baraq AlTuhafi, owner of Unichem Taumarunui Pharmacy, any DHB amalgamation would mean little unless spending on bureaucracy was reduced.
In a town like Taumarunui central government policy on medicine charges could also have a big impact. ‘‘For us, we’d really want to see the $5 co-payment on prescriptions get waived. They are especially difficult for the lowwaged, the elderly and those with mental health issues to afford.’’
There would be fewer hospital presentations if people could afford their medication early, he said. This backed up a point made by Malpass: ‘‘people in a poor community have to make a decision about do I go and see the doctor because little Johnny is not well or do I put food on the table and that is actually quite real… [then] people might go and see the GP, but they can’t afford the medicines.’’
Pharmacies like his were often becoming the front line, and having to triage patients and liaise with doctors about prescriptions. ‘‘It’s not a problem, but it puts a lot of strain on the staff. We are a service-based low cost model.’’
Also talking models – and a hope that any health sector reforms would enhance rather than undermine the ones that were working – was Brears. ‘‘I believe we have a model that is really good for all people and that is where you have a plan of action and everyone who is required to fix up this whanau are all part of that plan, and they have a role to play, and it’s well coordinated. That’s us... But in regard to the great news, and it is, I think we just have to wait and see.’’