Friday, July 1, 2022

Rural focus missed in health reform

Neal Wallace
Rural communities should be a priority health focus alongside women, Māori, Pacific and people with disabilities in the Government’s health reforms, according to a NZ Rural General Practice Network (NZRGPN) submission.

Rural Women New Zealand (RWNZ) president Gill Naylor is pleased the legislation has a focus on women’s health but is disappointed it doesn’t specify rural.

Rural communities should be a priority health focus alongside women, Māori, Pacific and people with disabilities in the Government’s health reforms, according to a NZ Rural General Practice Network (NZRGPN) submission.

The NZRGPN says the proposed legislation ignores the needs of 740,000 rural people and will mean the continuation of poorer health outcomes for those living in rural communities.

The Pae Ora (Healthy Futures) Bill, which amalgamates the country’s District Health Boards into a centralised body, will be reported back to Parliament later this month.

Despite the economic importance of rural-based industries, the network claims that unless “rural people” is added to the Bill as an identified priority population, then health inequities and the rural health staffing crisis will continue.

“Change can only occur if this group are identified, have a targeted health strategy and specific rural health outcome measures are established, monitored, and all parts of the new health system held accountable for ensuring this group achieves the equity it has been promised.”

The network has 1800 members across 90% of rural general practices and says Health Minister Andrew Little’s stated desire to end the post code lottery of health outcomes will not happen under these reforms.

“This lottery is no better exemplified than the contrast between the health outcomes of those living in areas of urban post codes compared to those living in rural delivery addresses.”

Little rejects that claim, saying in a statement that the reforms will address issues faced by rural communities.

“The reality is the system at the moment is not geared up to hearing from communities to know what it is that they need.”

He says a new initiative announced this week, the locality planning process, will give rural communities a say on what services they need.

The minister has established nine locality network pilots, or collectives, to provide advice to Health New Zealand and the Māori Health Authority on the health service needs identified by their communities.

“Iwi and the local community will determine their own geographic area that will become the ‘locality’, so the area it serves makes sense to the people that live and work there.” 

The area for each locality network will be by priority population groups, iwi and local government boundaries. 

A commissioner will then be appointed to talk to communities and providers in each locality about healthcare priorities.

Little says an objective of the reforms is to channel more funding into primary and community care.

“Putting more money into primary community care is a better way of making sure that those in rural communities get the health care they need in a more timely sort of way, and it is my expectation that we will see this,” Little says.

NZRGPN chair Fiona Bolden says locality planning will be toothless without legislation requiring the measurement of outcomes.

“The issue with the Pae Ora Bill is that without any focus on rural, there is no legislative requirement to measure outcomes as they have to do with Māori, Pacific, people with disabilities and women.”

She says rural health services have been in a state of crisis for at least a decade, with 40% of the 194 rural practices looking for staff and health outcomes for rural people poorer than those for urban.

“The reason it is in such a bad state is that for years policy makers and officials have looked at the needs of rural through an urban perspective and it hasn’t worked.”

The NZRGPN submission states that primary health care always lags behind funding for large base hospitals and it also needs legislative backing.

“We would like to see explicit mention of primary care and funding streams guaranteed to support this in a sustainable manner,” the network submits.

Rural Women New Zealand (RWNZ) is pleased the legislation has a focus on women’s health but is disappointed it doesn’t specify rural.

“We know from our work to support quality maternity services and in raising awareness of gynaecological cancers that this focus is sorely needed and well overdue,” national president Gill Naylor says.

She also fears the reforms will not addressed health inequalities for rural people.

“Addressing inequity based on where a person lives is vital to ensure better health outcomes for all New Zealanders,” Naylor says.

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