On 4 & 5 May 2016 RHĀNZ member organisations came together in Wellington to workshop the key issues we collectively feel are significant for the health and wellbeing of rural communities.

We then took the five top “common ground” issues and potential solutions into parliamentarians.

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RURALFEST 2016 POLICY PRIORITIES

Yesterday, Wednesday 4th May, Rural Health Alliance Aotearoa New Zealand member organisations came together in Wellington to workshop the key issues that we collectively feel are significant for the health and wellbeing of rural communities. This document represents the outcome of that workshop. We acknowledge that these statements do not represent fully worked up policy advice but rather indicate a direction of travel that we hope politicians will consider.

CONNECTIVITY

Issue
Unequal standards of connectivity between rural and urban New Zealand impacts negatively on the viability of rural communities. Poor access reduces the ability to deliver good quality health outcomes through innovative technology . Poor access reduces the ability to drive economic productivity as it affects the extent to which areas and can attract human capability and utilise technological advances.

Why is it an issue?
Improved connectivity enables centralised health services to reach into rural communities and develop and deliver more innovative health solutions with greater efficiency. Extending health services to widely dispersed populations is expensive and being able to reduce the cost by the use of technology will lead to better service delivery.
Mobile black spots, especially along state highways, in rural NZ create unacceptable risks to the safety of tourists, residents and workers who are often required to work in isolation and on their own in remote areas.
Prospective staff members in both health services and other industries are often reluctant to move to rural areas where connectivity standards are substandard. This has impacts on the recruitment and retention of rural health providers into the regions.

Solutions
All rural medical facilities (GPs, hospitals) to be connected by fibre-like speeds by 2019.
All State Highways to have multiple carrier mobile coverage by 2019.
Government’s target to provide 99% of the population with more than 50MBs to be achieved by 2020.

RESEARCH & POLICY

Issue
There are significant gaps in knowledge of rural health status in New Zealand and we need more robust data to inform better, evidenced based policy making.

Why it is an issue?
We know that data is collected at every point of contact with health and social services and can be linked to where people live. Routine reporting of health outcome data does not compare rural to urban communities. A contributing factor for this is that there is a lack of consistency in the definition of rurality.
We don’t have sufficient information to provide evidenced-based interventions to most effectively create better health outcomes.
We do know that people with prostate cancer and breast cancer present at a later stage in their disease; we know that rural Maori have worse outcomes than urban Maori across a wide spectrum of health issues. This suggests that rural people in New Zealand are disadvantaged in the same way that they are in other countries but the breadth and scope of our knowledge is limited by the lack of significant research in rural communities.

Solutions
Government works with RHAANZ to develop an agreed definition of rurality, as it pertains to health. We would recommend that this is put in terms of consistent criteria that recognise the context in which the definition will be used for health.
Government invest in building a stronger understanding of rural health data to inform its decisions.
That Government form a rural desk across all Ministries and agencies to enable the use of this data to inform the development of evidence based funding, policy and service development and delivery. Baseline data will create a robust platform upon which research and associated policy development can occur.

RURAL WELLBEING

Issue
The changing nature of rural communities due to an increase in compliance, a decreased accessed to assistance and a reduction in social networks such as churches, schools, pubs and sports clubs has caused exacerbated feelings of isolation and increased incidences of high stress, anxiety, depression and suicide.
Recent short term funding boosts for rural mental health initiatives is a step in the right direction but needs to be sustained and increased to address the unmet need.

Why is it an issue?
High levels of suicide in rural communities are unacceptable.
Social cohesion supports healthy vibrant communities that are better able to deal with the stresses of isolation, adverse events and personal problems.
Engaged business owners and workers will be better able to deliver productivity gains through increased wellness.

Solutions
The current short term initiatives need community led government support to be further resourced and expanded.
Research on community cohesion and research on leadership shows that these two issues are linked. Focussed solutions that respond to local drivers can create innovative programmes that improve outcomes for rural communities. These will work best if community owned.
It has been proposed that we pilot three community driven leadership hubs. These will identify and fund a community leader and their local support network with the goal of leveraging off local organisations to address the specific needs of the community. It is important for these pilot programmes to be evaluated with the outcome measured to inform future investment and replicate in other communities.

RURAL HEALTH FACILITIES INCLUDING HOSPITALS

Issue
Rural hospitals provide an essential focus and service to their local communities.
The downgrading and closure of rural hospitals has left a gap in rural health and emergency services in communities across New Zealand.

Why is it an issue?
Effects across the country are variable but the increased separation between patients and vital services is creating a barrier to access to health services.
Maintaining primary/maternity services are key resources for rural communities and a recruitment and retention strategy for all clinical staff such as nurses, midwives doctors and allied health staff.
Volunteer ambulance and fire services are being put under increased pressure as they are filling gaps left behind by 24 hour emergency services that have been centralised.
New Zealand evidence shows that providing services even those such as CT scanning and exercise ECG in rural hospitals improves access to these diagnostic services in a cost effective way.

Solutions
Maintain and strengthen rural hospitals which are vital in the life of the rural community and its wellbeing.
District Health Boards are accountable for consistent and adequate funding for rural hospital services to preserve and upgrade existing sites and consider establishing and sustaining new services where needs are identified.
Support provision of services close to home and the timely availability of skilled emergency transfer resources.
Ensure that the necessary infrastructure upgrades within the facilities are made in order to make use of available ultra-fast broadband.

WORKFORCE

Issue
There are not enough health and social service professionals to adequately support rural communities.

Why is it an issue?
There is already is a shortfall of rural health and social services professionals in New Zealand and there is currently a bulge among those employed nearing retirement with average age of rural GPs 57 years and the majority of nurses and midwives are aged 48 to 54 years and nurses are retiring from work between the ages of 45 and 65 years.
A more stable and sufficient workforce will enable rural people to access rural services closer to home and will help overcome barriers to seeking healthcare, both acute and preventative. Depending on the source of information between 14 and 22% of the population are living rurally but only 1% of nurses in NZ are working in rural areas.
25% of rural General Practices are currently seeking a full time GP and over a third of pharmacies are having difficulty with recruitment.

Solutions
Government adopt the concept of a pipeline approach to rural health workforce training keeping rurally focussed students in rural areas throughout their training and in their early post graduate years. There is strong international evidence that this has positive outcomes on retaining and recruiting health professionals in rural areas.
Government fund a multi-disciplinary rural health school based on successful models in Canada and Australia.
Create an attractive working environment by investment in working conditions, technology and education for all health and social services professionals in rural communities.

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