There is general agreement among political candidates about the problems facing rural health, but their solutions differ.
The five party health spokespeople who took part in a political debate organised by the Rural Health Network (Hauora Taiwhenua) in September were in agreement that the workforce needs to grow and funding for general practitioners needs to be overhauled.
Agreement was less forthcoming on the merits of the government’s new health reforms and the National Party’s plans for a third medical school.
The perilous state of New Zealand health services was highlighted this week with data from the Royal Australasian College of Physicians that revealed NZ has 71 physicians for every 100,000 people compared to 99 per 100,000 in Australia.
Just 0.6% of NZ physicians work in rural areas.
The debate attracted Labour’s Dr Ayesha Verrall, Dr Shane Reti from National, Todd Stephenson from ACT, Ricardo Menendez March from the Greens and Dr Nina Su from TOP.
The word “crisis” was used regularly to describe the state of rural health services, with research showing rural people die sooner than those in urban areas and burnout is a growing issue due to a shortage of health professionals.
Verrall said newly introduced health reforms include for the first time a dedicated strategy, which Reti said was only added at the last minute after lobbying from National and ACT.
Verrall said increasing funding and allocating it for three years instead of one will provide certainty.
The workforce shortage will be addressed through immigration and initiatives with medical schools to get more trainees into rural areas and remunerating them better.
In the last quarter NZ attracted 3000 new nurses.
“We need to do more and we are focused on rural services and primary care,” she said.
Reti said he would change the funding model but said any rural initiative is pointless without first addressing the workforce shortage.
He said in the short term that can be addressed by attracting migrants and retaining existing staff through better wages, salaries and employment conditions.
In the medium term he proposed a bonding system that rewards nurses and midwives for staying while also creating a process to allow oversea-trained doctors who are driving taxis and Ubers to qualify for registration.
A long-term solution is the proposed new graduate entry medical school at Waikato University that will focus on supplying health professionals for rural communities.
Reti described the health reforms as another case of “the government and Wellington knows best” and said he wants to devolve as much decision-making as possible to communities.
Menendez March said the Greens want a holistic approach to health that includes addressing social issues such as income and the quality of housing.
Su said the issue is ensuring spending is in the right place.
The practising doctor did not think a third medical school was a solution given its cost and said a better option was virtual learning.
A solution to the workforce shortage was addressing inadequate capitation payments and for Health NZ to run GP clinics in areas that have populations too small to make GP services viable.
ACT’s Stephenson said GP funding needs to increase and the pathways for migrants doctors and nurses must be eased.
The Royal Australasian College of Physicians report also found NZ has fewer physician graduates than Australia –10.4 graduates per 100,000 compared to 14 – and it labelled parts of the South Island “specialist deserts”.
The West Coast has only one physician, and no paediatricians, which means a 100km trek for people needing those services.
Outside of Canterbury and Otago, the South Island has only 102 physicians for 342,000 people, or fewer than 30 physicians per 100,000 people.
The college is calling for the next government to commit to a comprehensive, integrated pipeline to recruit students into medical and healthcare career pathways.