How do we better support rural hospitals in the New Zealand healthcare system?
In New Zealand, though data are limited, indications are that people living rurally have poorer health outcomes than people living in urban areas, and this is accentuated for Māori. Around 19% of New Zealand’s population rely on rural health services, and around 15% rely on rural hospitals for their healthcare.
The health and wellbeing of rural communities is at risk of further deterioration if something is not done soon to resolve the issues facing people who live, work and play in rural New Zealand.
Rural hospitals in New Zealand are small and geographically distant from a base hospital; they have acute bed capacity and limited diagnostics; and they have a predominantly generalist medical workforce. However, NZs rural hospitals are not homogenous (variations include governance, funding models and integration with primary care), nor do they fit seamlessly into either of the two tiers of the health system (community–primary care or hospital services).
The Rural Hospital Medicine Training Programme (RHMTP) is NZ’s only rural-targeted vocational training programme. The professional body for RHM, the Division of Rural Hospital Medicine (DRHMNZ), sits as a chapter within the Royal New Zealand College of General Practitioners (RNZCGP).
Targeted rural postgraduate training pathways are recognised internationally as playing a critical role both in recruitment and retention of a rural medical workforce and in reducing inequity of care and opportunity for people living away from urban centres. In 2008, in response to serious rural hospital workforce shortages and the lack of any training pathway, rural hospital medicine (RHM) was recognised by the MCNZ as a vocational scope of practice. The intention was to provide recognised training standards for the medical workforce and to encourage the development of systems, such as clinical governance, in rural hospitals.
New Zealand's first-ever 70-page Rural Health Strategy was released 2 weeks ago by health minister Ayesha Verrall. The strategy document acknowledges the lack of data on rural health access and outcomes and points to the Geographic Classification for Health's (GCH) new rural categories R1, R2 and R3 as a way of gathering consistent data. Published last year, the GCH differs from the Stats NZ rural classifications by defining more small towns as rural and by no longer regarding the commuter belts around big cities as rural.
The priorities for this first Rural Health Strategy include making services available closer to home for rural communities, growing and supporting the rural health workforce, and shifting focus to prevention.
Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. It would be very remiss of the wider sector to undervalue the importance of the rural health system, its challenges and needs.