Postcode care killing rural New Zealanders, doctors say

Doctors working in rural communities say their patients are dying at higher rates from preventable causes just because of where they live.

Rural New Zealand produces 80 percent of New Zealand's export earnings - but when it comes to health, rural New Zealanders are getting short-changed.

Northland surgeon Vanessa Blair grew up an hour north of Dargaville, where her sister still runs the family farm.

Their mother started having chest pains one Saturday, and her husband drove her to Dargaville Hospital.

"My mother was seen at 10.30pm on a Saturday night, by a young doctor, just starting their career, who should have had tele-health support directly from Whangārei ED.

"Mum was misdiagnosed and sent home, and she died an hour and a half later of a massive heart-attack, at only 62."

The family's grief was made worse by the then-district health board's refusal to take any responsibility.

When raising this with the Chief Medical Officer at Whangārei Hospital, Blair was told 'although we own Dargaville Hospital and employ the nurses, because we outsource the after-hours care provided, to non-DHB doctors, we are not responsible for the care provided there'.

Last week RNZ revealed Dargaville Hospital no longer has any doctors rostered at night, but has had to resort to telehealth.

"I just can't believe that in 2024, 'tele-health from Timbuktu', is considered an acceptable alternative," Blair said.

"What I want to know is whether recent cuts to the payments made to the visiting locum rural health doctors, which have long been a necessary support our rural workforce, is the reason why Dargaville Hospital can suddenly no longer get doctors?

"Surely, if it has no doctors you need to stop calling it a 'hospital'!"

Problems "not new" - doctors

Blair - who is president of the New Zealand Association of General Surgeons - said one thing that had not changed in the 10 years since her mother's death was the "lack of accountability" from those at the highest level for the lack of care.

"It's like a form of gaslighting to the medical profession that these are new or sudden crises. These are problems that have been brewing for several decades in our regional workforce."

She has some patients ringing for appointments directly with her private clinic in Whangārei because they cannot get a GP appointment for six weeks.

When she spots unrelated potentially serious problems, like heart conditions, she recently has started to refer them directly to other specialists, if they can't get a timely appointment with their GPs.

"I'm just trying to help get people through the system."

Taupō Hospital is funded for ten full-time doctors but has the equivalent of just five.

Rural hospital medicine specialist Ralston D'Souza, who has worked there two years, said it covered a huge region, encompassing Tūrangi, Mangakino and Reporoa.

"Probably just to safely staff things, we actually need 11 to 13 FTE [full-time equivalent doctors], but the current funding is for 10."

He and his colleagues were very grateful to Rotorua Hospital doctors for making a two-hour round trip to help cover holes in the roster.

Then management tried to formalise the arrangement.

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"They're incredibly short-staffed, but they're still going out of the way to help us out. We're incredibly short-staffed and we're constantly picking up additional shifts where we can.

"But there comes a point at which we just have to protect ourselves."

One in five New Zealanders live in rural areas.

Research published by Hauora Taiwhenua Rural Health Health Network shows they have poorer health - but less access to healthcare.

It shows:

• Significantly higher mortality rates from preventable causes
• Alarmingly higher rates of suicide, particularly for males
• Twice as many people living in social and economic deprivation, particularly in more remote areas
• Far fewer families have access to mobile phones and internet in their homes
• Very low vaccination rates to prevent disease

The network's chairperson Dr Fiona Bolden said many of those statistics were worst for Māori living in the most remote areas.

"Māori living under 30 years old were twice as likely to die from a preventable disease as Māori the same age living in a city."

Non-Māori men aged 30 to 44 were 1.8 times more likely to die from preventable causes compared with their peers living in urban areas.

Preventable causes included suicide - "there's scant access to specialist mental health support in the regions" - as well as workplace accidents and road crashes.

Both primary care and hospital services in the regions needed a big injection of cash from central government, Bolden said.

"They're not going to have a rural health service without putting more money into it. And a 4 percent rise in capitation funding [to GPs] is not going to address any of the issues."

The sector was also anxiously awaiting the release of the Health Workforce Plan to deal with regional inequities, she said.

Improving rural health a government "priority"

Minister of Health Shane Reti said improving rural health was "an integral part of improving all health in New Zealand".

The government inherited "long-standing" problems with the health workforce, but was tackling them head-on through an additional 25 medical school places and working with Waikato University on its proposal for a third medical school, he said.

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"I'm also aware that in 2023/24 Health NZ progressed a specific number of workforce initiatives to help rural health providers with staffing."

Those included:

• A $9100 accommodation allowance for trainees on the General Practice Education Programme (GPEP1) who live within 30km of their rural GP practice
• Funding for locum GPs, nursing and rural hospital doctors to provide cover in rural general practices and NGO rural hospitals
• A Rural GP Relocation Fund to support recruitment into rural primary care providers
• Funding a National Rural Hospital Locum Coordination Service through the Rural Health Network initiatives to attract and grow a pool of New Zealand based and international locum doctors.

"Continuing to develop and support rural health services to respond to rural needs must be an ongoing priority for Health NZ," Reti said.