It’s a rural delivery

DHBs, with a few exceptions, never quite got primary care, and nor did they want to

DHBs have passed. As of 1 July, Health New Zealand, along with the Māori Health Authority, now funds, commissions and provides public health services.

Any last doubts DHBs should have been spared, were likely laid to rest when Counties Manukau DHB recently called for local practices to stay open over the weekend to help alleviate pressure on Middlemore Hospital’s emergency department.

It wasn’t a totally unreasonable request but the timing was off. That call was made early on a Friday afternoon.

If evidence were needed of the failure of DHBs to act as “health” not “hospital” boards, it was this display of ignorance of general practice.

The idea that practices, with their staff exhausted, could pull together weekend clinics and after-hours shifts with half a day’s notice must have raised more than eyebrows when first mooted.

It certainly revealed a lack of understanding of the reality for general practice, not to mention the fact that some practices were already staffing weekend clinics.

Some media wove a narrative of general practices being paid up to $1400 an hour to see patients, as if the hospital’s crisis was a financial windfall rather than an unwelcome burden that practice teams would rather not bear.

But bear it they did. Several dozen practices were able to help over those weekends, but whether they can do so in future is far from clear.

If Counties Manukau had been doing its job as a health board, the management plan to engage primary care to help in the event of heightened seasonal pressure on the hospital would have been written and tested years ago.

But DHBs, with a few exceptions, never quite got primary care, and nor did they want to; it was the annoying bit of the system they didn’t absolutely control. Far easier to open a few more outpatient clinics than work with community and primary care providers.

Shortages of GPs and primary healthcare nurses were warned of a long time ago and are well and truly here. And the DHB leadership that failed to act on those warnings, because their glance often did not extend beyond the hospital gates, now hold key roles in Health NZ, charged with transformational change.

One needs to be optimistic because there is no plan B. And, as so often is the case, the search for optimism lands in the rural sector where 1 July saw another sector rebirth, the creation of Hauora Taiwhenua Rural Health Network.

Hauora Taiwhenua was launched last week at a function in Parliament’s Grand Hall.

As I mingled with guests from across the rural health and political spectrum, I recalled the last time I was in the hall. That was the launch of the Federation of Primary Health Care Aotearoa New Zealand in 2018.

At that time, I sensed many were present as a result of the sheer political willpower of former health minister Annette King, who had pulled the federation together. Others were there solely because everyone else was – they weren’t sure how the federation might work, or if it would.

Last week the vibe was completely different. Hauora Taiwhenua has had a long gestation. Its transformation into an advocacy group for all rural health professionals, consumers and communities was well under way before the current health reforms were conceived.

The hardy souls who sustained the Rural General Practice Network for many years voted unanimously last year to allow their network to fold and re-emerge as part of the new organisation. At the same time, the network signed a kawenata (agreement) with its kaumātua group, Te Rōpū Ārahi, with a view to working in partnership with Māori rather than kaumātua acting in an advisory role.

It’s early days for the new group but there’s a sense of shared vision and one win already under its belt.

Last month, after lobbying by the rural caucus, health minister Andrew Little added a Rural Health Strategy to the Pae Ora (Healthy Futures) Bill, something rejected by the pae ora legislation committee. Rural health leadership was thrilled at the turnaround.

In his inimitable fashion, Mr Little referred to Hauora Taiwhenua during Parliamentary debate on the bill, justifying his criticism of the business models of some rural providers.

“There’s a new organisation that’s going to be launched soon, and when you set yourself up to be a leader of a community, what goes with the claim to leadership is the need for responsibility and responsibility to those communities. Any claimed rural health leader who says that nothing needs to change is not a leader, and they would be an obstacle to leadership and to positive change for rural communities.”

I don’t think anyone in the Grand Hall would argue with that sentiment, least of all the leaders who will take the new rural health network forward.

Like Hauora Taiwhenua, the new central health agencies are inheriting huge challenges. Waimarie pai. Good luck to you all.