Friday, December 1, 2023

Rural health frontline workers feel ‘misunderstood, frustrated’ 

Neal Wallace
Small rural hospitals, often the only source of healthcare for the 25% of New Zealanders who live in rural areas, are feeling neglected, misunderstood, frustrated and burnt out.
A study has shown it is difficult for rural hospitals to work within these structures and they are often left feeling invisible. Photo: Cedric Fauntleroy
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The quarter of New Zealand’s population who live in rural areas or small towns die at a younger age than their urban cousins.

That is one of the findings of a recent University of Otago study, which also found those in rural areas have more complex and poorer health outcomes than urban people – and the picture is even worse for Māori.

It also discovered a gap in knowledge about the place and contribution of rural hospitals in the health system, no description of rural hospital services in national policies, and little published research regarding their role or value.

This is despite around 19% of people in NZ relying on rural health services.

A small rural hospital will have less than 15 beds, which are integrated with a primary-care service.

Larger rural hospitals have more than 30 beds, providing secondary care services separate from primary care, along with advanced diagnostics and some surgical and anaesthetic services.

Those interviewed for the study spoke about a sense of community connection with their rural hospital.

“This connection meant an awareness of specific health needs and the ability to provide appropriate and relevant services,” the report authors say.

Feedback also reinforced that having a hospital facility open 24/7 provides a safety net, allowed people to stay closer to home for their care, and acts as a conduit between community-based care and base or tertiary hospital care.

The study details chronic staff shortages, managers constantly juggling rosters to accommodate leave, sickness and staff involved in patient transfers or training.

It also found that centralised bodies and institutions have a poor understanding of rural health, which translates into health policy, funding, and regulatory systems.

“It was, therefore, difficult for rural hospitals to work within these structures and they were often left feeling invisible.”

Funding is a major issue. With a lack of autonomy over how the money is spent, it was seen as fragmented and assumes an urban-centric model of separated primary and secondary services.

“Participants felt their rural hospitals were undervalued by the centralised urban-based organisations they were dependent on.

“This feeling was further exacerbated at an individual level by participants’ regular encounters of negative perceptions of rural hospital services from city-based colleagues.”

The report concludes by noting there is an urgent need for a national policy for New Zealand’s rural hospitals that adopts an approach with a specific rural context.

“The current NZ health reforms offer a unique opportunity to enact this.”