Damian O'Connor Speech: Local Government New Zealand Rural Sector Workshop

Good morning ladies and gentlemen it's a pleasure to welcome you all to Wellington, and to this workshop.

I proposed this event following the success of a rural health forum I hosted in Wellington in February. The forum brought together a range of people and groups to discuss issues facing primary health care in rural communities.

It was a very productive day, characterised by a real sense of collaboration. It put a diverse range of people together in a room, all of whom were committed to finding solutions to some very difficult issues.

One thing was and is clear; we face some key challenges ahead in the area of rural health. Today is an opportunity for health and local government to get together and share ideas and seek solutions. We all have something to contribute to creating healthier communities. It's good to see so many of you here.

Government support for rural health

Let me give you a broad view of the Government’s support for rural health.

You may or may not be aware that almost 80 per cent of the $9.5 billion that the Government spends on health each year is devolved to the country's 21 DHBs.

It's distributed according to a population-based funding formula and it is then the responsibility of the DHBs to ensure their populations have access to health care services.

On top of this funding, Government applies a “rural adjuster”. The adjuster, worth $80 million in 2004/05, goes to DHBs with rural populations. It acknowledges that many rural DHBs face specific challenges, particularly in the more isolated areas.

The additional money goes some way to compensating these DHBs for the additional costs associated with maintaining small hospitals and community services that would otherwise not be viable. The survival of these services means the survival of our rural economy.

The Government is also making a major new investment in primary health care.

$2.2 billion of new money is going into the Primary Health Care Strategy over the next seven years. This is aimed at making general practice visits cheaper and more accessible. But the Strategy is about much more than that.

It’s about making health care more accessible in every respect. That is, improving transport, making practices “user friendly” and taking services to people who can't get to them themselves.

It’s about recognising the wider influences on health and tackling these - housing for instance. Simple things tend to be forgotten or overlooked, such as the fact that damp houses cause ill health. So we must make sure that houses are insulated and not damp.

A good example is the Lake Taupo PHO and Taupo District Councils, which have initiated joint ventures with the Energy and Efficiency Conservation Authority and Housing New Zealand to retrofit houses in Mangakino.

Primary health care is about keeping people well and not waiting until they get sick to take action. This means investing considerably more in health promotion - things like the “Healthy Eating Healthy Action” programme.

We need to focus on preventative action, such as the Meningoccocal campaign. Despite the last two weeks debate over the vaccine, one thing is clear –vaccination is vital if we're to protect our children and slow this epidemic.

Primary health care is about involving the wider community and as many people as possible in finding a solution to our major health issues.

To sum it up, it’s about a much wider vision of health and health care than some of us have had traditionally. And it involves working preventatively rather than remedially.

Support for rural communities

On top of this new funding for primary health care, rural primary health care services receive a further $10.9 million annually.

I'm aware of some concern lately that this funding is being discontinued. Let me take this opportunity to assure you that it's not. In 2002 we announced funding of $32 million over three years and last year, I announced its continuation, with $10.9 million per annum allocated from 2005/2006. We stand by this commitment.

So where does the funding go? Part of it supports “reasonable roster” arrangements, which assist rural doctors and nurses with onerous on-call rosters. Part of it helps fund rural nurse scholarships. It also goes towards retention, and a significant proportion is available to be used flexibly by DHBs or PHOs to create the kind of working environment that will attract and retain rural health workers.

The Workforce Retention Funding that's also part of the $10.9m has traditionally been targeted at doctors. One important new message that the Primary Health Care Strategy is trying to get across is the importance of the primary health care team.

Doctors are important, but so too are the nurses, community health workers, and the pharmacists who work with them. Creating an environment in which all of these professionals want to work is probably not going to be solved by money alone.

We are currently reviewing the rural payment scheme. The scheme dates back a while now. GP practices qualify for a payment if they score sufficiently highly on a “rural ranking” scale. This is based largely on distance from their main hospital and their on-call responsibilities.

Currently 417 general practices receive annual rural payments ranging from $3,000 to $25,000.

As rural demographics change, and the Primary Health Care Strategy brings about a shift in the way primary health care is delivered, some anomalies in the “rurality” ranking are beginning to appear. That's why we're moving to make some adjustments.

Recruiting new health professionals into rural medicine

I spoke recently to a group of students at the Rural Health GP Network Conference. The good news is that there's a waiting list of applicants for the rural GP training component. It seems the lure of the provinces is having an impact! The bad news is there aren't enough training places available.

In my West Coast electorate, Otago University's rural medical training centre is demonstrating the success of rural training. As Professor Jim Reid, head of the medical school's general practice department said when officially opening the centre, the first intake of students on the Coast hadn't had a good experience, they'd had "an absolutely superb one".

Rural training is essential if we're to attract and retain people to rural areas. Boosting centre numbers, or rural training capability is also something we're looking at seriously.

Rural emergency services

While we're putting resources into improving health, there'll always be people who get very sick or have accidents. I recognise that the availability of effective, responsive emergency services is highly valued by rural communities, who may be some distance away from a major hospital.

Ambulance services are a vital part of that emergency response; they're also a service to which individual communities have traditionally contributed a lot through voluntary time or financial support.

In the last three years considerable additional funding has been allocated to allow ambulance providers to employ more staff and improve response times, including in rural areas.

We also continue to develop the primary response in medical emergencies, or “PRIME” system, which supports rural GPs and nurses to co-respond with the ambulance. This allows the provision of a higher level of skill for serious emergencies in rural areas.

I'm aware that there has been some inconsistency in the development of PRIME and that it hasn't been implemented smoothly in all parts of the country.

These issues are now being addressed. The Ministry of Health and ACC have agreed to fund a national schedule of PRIME training, which will ensure all rural GPs and nurses in New Zealand have access to training in emergency care.

The Ministry is intending to lead work looking at funding incentives for rural primary health care practitioners to participate in the PRIME scheme. This will occur during the next six months and will involve representatives from the Ministry, ACC, DHBs, ambulance services and the rural primary health care sector.

The objective of this work is to figure out ways to sustain and improve involvement in rural emergency response throughout New Zealand.

The Government aims to continue supporting and strengthening rural emergency response services in accordance with the vision of “Roadside to Bedside” – that patients receive the “right care in the right place in the right time from the right person”.

Travel and accommodation assistance

It's imperative that all New Zealanders have access to timely, quality healthcare, no matter where they live. Under the current “Travel and Accommodation Assistance Schemes”, many rural New Zealanders have missed out on assistance in accessing specialist services.

At the Rural GP Network Conference in Auckland earlier this year I announced $36 million of funding annually to help people access publicly funded specialist services outside their area, when referred by a publicly funded specialist.

This will go a long way to addressing these anomalies and providing greater access. About 30,000 people nationwide get assistance under the current travel and accommodation policy and that figure is set to exceed 100,000 under the new scheme. Many of these people will be from rural areas.

The new policy, which standardises assistance across the country and provides greater consistency, will take effect on January first. Health PAC will administer all claims, which means that claimants will have one point of contact and will be reimbursed within a few days.

It's a really exciting policy, and it was one I was very proud to oversee and announce. Let's hope the uptake is good and it has the impact we want.

After-Hours Care

New Zealanders have relatively good access to after-hours primary health care. But it's very clear that one model of after-hours service delivery does not suit all.

Some rural providers serve communities that are located close enough to larger centres for them to participate in large co-operative rosters or contribute to other after-hours service models.

But other providers serve communities too far from larger towns for this to happen.

Workforce teams in rural communities are usually smaller in size and after-hours responsibilities can become onerous. This can impact on workforce recruitment and retention. Reasonable roster and workforce retention funding was designed to respond to these issues and as I said, a review of this funding is underway to ensure it's getting where it's needed most.

Changes in after-hours service delivery to enable more effective services have in many cases resulted in rural people needing to travel further to access services. This can be a problem for some rural people without ready access to private transport. Where this problem arises, some PHOs are using “Services to Improve Access”, or SIA funding to solve transport problems and improve access to after-hours services.

Local government /Health sector co-operation

The final points I want to make this morning are about the potential for local authorities, councils and health providers to work more closely for the benefit of their communities.

Councils have always played a major role in health. Water quality, sewage disposal, rubbish collection, housing regulations, town planning, food and hygiene inspection - all of these activities contribute significantly to the health of communities. In fact, they're more significant contributors at the population level than health services themselves.

As local authority representatives, you have a uniquely informed perspective on these broader health determinants. I’d like to see you working closer together with the new Primary Health Organisations. It’s that wider perspective that we in Health need to encourage.

I want to acknowledge all of you who've already made those links with local PHOs. In my experience, rural communities have an advantage, in that they have to work together in order to survive.

There are inspiring examples of local communities working together - campaigns to save local hospitals spring to mind.

Thank you again for coming today and for the chance to talk. I look forward to the rest of the morning. I'll now hand over to Dr Jim Primrose, the Ministry of Health's Chief Advisor General Practice to give you more detail about what's happening with PHOs.

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