Crisis in the Provinces: Is it Time for a NZ Rural Health Commissioner?

RHAANZ asks this important question as it heads towards it’s 4th RuralFest event, on the 6th and 7th November 2019.

Frustration over chronic workforce shortages, poorer health outcomes and unequal access to healthcare is mounting for the group representing around 30 of the country’s leading rural health, business and agricultural organisations.

The Rural
Health Alliance Aotearoa New Zealand (RHAANZ) meets in Wellington tomorrow for
the organisation’s 4th RuralFest, an annual day-long event to
discuss and formalise a formal policy ‘wish-list’ to take to parliament the
following day (Thursday) for a series of unique, high-access meetings with the
Health Minister and MP’s from other political parties.  

A fresh
call for New Zealand’s first ever stand-alone Rural Health Commissioner to
champion the needs of all non-urban New Zealanders, is likely to be one
pressing government ‘call to action’ from RHAANZ members.

 “It’s time the health of 600 thousand New
Zealanders, our country’s second largest city, was given far more equity” says
RHAANZ council member and GP Dr Chris Henry. “I’m looking forward to asking
RHAANZ members to take a sector-wide view of the need for a Rural Health Commissioner,
to advocate for the health rights of all rural New Zealanders”.

An alarming
inequity of access and outcomes, a growing burden of mental health need and a
system which continues to fail Maori – RHAANZ says it’s a situation even a
government-commissioned report of New Zealand’s health system calls “simply

Simpson’s interim Health and Disability System Review clearly states that rural
communities are currently forced to make do with an unacceptable level of
service accessibility” says Dr Henry. “Her report talks of a rural health
service near crisis, desperately in need of form, structure and a clear and
consistent strategy for delivering rural health services. A Rural Health
Commissioner would take leadership of all these urgent issues, push for policy
change, accountability and ensure policies are followed-through”.

Australia clearly recognised the importance of an over-arching health voice for
its rural population by establishing its own Rural Health Commissioner role two
years ago. He credits the Australian government with having the foresight to establish
the position and believes it is equally needed here, as both countries share
similar problems.

“It would
be a great solution for New Zealand” says Professor Worley. “What’s now been
realised in Australia is that a complete and comprehensive pathway is needed
for rural health. My role’s about brokering collaboration and articulating
where the gaps are in the system. I’m doing that by listening and reflecting on
what I hear, and it’s given people hope that finally, someone is listening, and
that workable solutions are going to have support”.

Worley says one major success so far has been agreement for a National Rural
Generalist Pathway for trainee doctors. Once established, existing Australian medical
schools will develop rural campuses where students spend their entire medical
training, a move, when linked seamlessly to rurally-based junior doctors and
registrar training, that’s  expected to
produce up to 350 extra fully qualified rural doctors for Australia each year,
with over 3500 students and doctors living and learning in rural Australia at
any one time.

member groups represent not just rural GP’s, hospitals, nursing and allied
health workers, but social services, district councils, farmers, forestry
workers and agribusiness.

 “Until now, many of our proposed solutions
have been discussed but not necessarily heard, with progress too slow,
especially in dealing with critical workforce shortages” says Dr Henry. “The
constant headlines tell the story, whether it be inequitable access to diagnostic
tests and surgery, closures of rural maternity services or alarming rates of
suicide and mental health sparked by isolation, fatigue, burn-out and stress. There’s
a sense that while government understands the issues, it hasn’t quite grasped
the urgency of the situation”.

closures of six rural primary maternity units nationwide over the past five
years; Justice Ministry provisional data showing 20 farmers lost their lives to
suicide last year alone; and news that the country’s Mobile Surgical Bus regularly
struggles to find enough nurses to support surgery at most of the 24 rural
locations it visits, are just a few examples of issues requiring urgent

it has however been heartened that many previous RuralFest priorities have been
actioned by government.

“Last year,
for the first time, the Health Minister’s Letter of Expectation to all twenty
of the country’s District Health Boards urged them to make the needs of their
rural patients a priority as part of the new Rural Proofing policy” says Dr
Henry. “Otago University researcher Dr Garry Nixon has also now been awarded a
Health Research Council grant to define a clear and consistent definition of
the term ‘rural’. This basic data is desperately needed to more accurately
target future funding and policy decisions. Health Minister David Clark has
also announced a scoping project to establish Rural Health Training Hubs.

“While this
shows the government is willing and prepared to listen, it’s frustrating to see
patients struggling to access equitable healthcare and suffering adverse health
outcomes just because they choose to live rurally” says Chris Henry. “My hope is
that RHAANZ members use this year’s RuralFest to discuss whether the time is
right to now take the Rural Health Commissioner issue to parliament, in an
effort to improve the health of all New Zealanders, whether town or country”.

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