Kanohi ki te kanohi: The buzz of personal connections and charting new territory

It is now one year since I started my role as chief executive of the Rural General Practice Network. The country was in lockdown and the health system appeared under threat from a global pandemic surging across the borders.

Thankfully, we have not had to deal with the issues assailing countries such as India, Brazil and Mexico. The fact the Government listened and acted pragmatically on key scientific information and advice has been this country’s blessing.

So I find myself able to write this having just attended a face-to-face, kanohi ki te kanohi, rural health conference.

The big financial and reputational risk for our board in hosting this event was mitigated to some extent by holding it in a regional town, some distance from any managed isolation or quarantine facility or border.

Imagine if it had become a super-spreader event. Four hundred rural health specialists from around the country, taken out of action in one hit. The impact on rural communities is not worth contemplating.

No such nightmare ensued and, in contrast, this conference acted as a welcome stress relief for many.

It was the first time in 18 months that rural health professionals had been able to get away from their practices and communities, share stories and experienc­es, network, learn from one another, and let down their hair and relax.

The timing was perfect. Ten days after health minister Andrew Little’s announcements on the health reforms (no mention of rural), we were able to hear directly from Mr Little and associate minister Peeni Henare about the reforms and what focus there was for increased equity on rural health outcomes. So, what did we learn? Unfortu­nately, not a lot that was new.

There was the reiteration that primary and community care was the focus of the reforms. Diagnosing and treating people in their communities, thereby preventing unnecessary and expensive hospital admissions, is described as the key to a better health system.

We heard an acknowledgement that rural health outcomes are unacceptable, as are the rural workforce shortages, funding of rural general practice and the slow rollout of rural broadband, which would help unlock the potential of telehealth solutions.

We heard again about the promise to remove the “postcode lottery” of health outcomes in New Zealand.

Many in the audience wanted to be assured that this didn’t just relate to the different outcomes across the 20 DHBs, but the difference between RD addresses and urban street addresses.

Mr Little finished with the point that the opportunities for rural communities lie in the upcoming consultation over how the detail of the reforms will be shaped and implemented by the Transition Unit. Our challenge is get­ting our rural voices into those key discussions.

I listened with the hope that he might reward the group with a pre-Budget announcement to do with funding a rural health education initiative.

After all, predecessor David Clark had promised at our last conference two years ago, that rural education hubs would be set up. We had also been working for some time with the Health Workforce unit, through sector involve­ment with working groups and a steering group, to formalise a recommendation to the minister on a programme of interprofessional rural training: for rural, by rural, in rural.

It is common practice nowadays to have pre-Budget announcements of specific initiatives, but no announce­ment was made, which probably indicates no interven­tion is budgeted. I would welcome being proven wrong.

Mr Henare gave a little more detail on the commitment to the Māori Health Authority. He says this does not signal a separatist health system, rather, the support of services that could improve the health outcomes of Māori, wherever these may lie.

The detail of how the authority will work and operate could not be given because it must be designed by Māori, rather than be a predesigned system imposed on Māori, as has been done in the past. Mr Henare made sure all knew how to say and spell mana motuhake.

During the conference, the network held an annual general meeting where the provocative proposal put to members was to create a new organisation, Hauora Taiwhenua Rural Health Network.

This would be a collective structure, open to all rural health and wellbeing interest groups, coming together to provide a common voice to government and officials over key strategic rural health messages.

All those attending – the AGM had the biggest turnout in years – voted with enthusiasm for this change. It will give the new collective organisation a clear mandate to speak on behalf of rural communities and their health and wellbeing workforce. The timing is perfect for influencing the health reforms that are being introduced.

A key event for the network was the signing of a kawenata with Te Rōpū Ārahi, our Māori Treaty partner. This signing lays a solid platform for working together to help work towards better health outcomes for rural Māori, which we know will lead to better health outcomes for all rural communities.

The Transition Unit is now busy planning the implemen­tation steps and processes to “fill in the missing detail” of the reforms.

We are pressing to ensure that work includes a Rural Health Plan as part of the greater NZ Health Plan that is indicated in the Cabinet papers. And this, driven by a steering group convened and inclusive of rural health experts: rural mana motuhake!

During my first year I made a big effort to get out and about in the rural heartland, talking to communities and practices on the cutting edge of ensuring rural services, to lead to vibrant rural people and communities.

Over the next few weeks I am taking the opportunity to research the New Zealand hospital system: I am going to have a full knee-replacement operation. I will let you know what I find out. Many of my network colleagues have been wishing me luck; I hope I don’t need it! I look forward to re-engaging when I come out the other side, walking straighter again.

Grant Davidson is chief executive of the New Zealand Rural General Practice Network

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