Small-scale rural home-help providers are the losers in Southern District Health Board plans to seek Otago-Southland-wide providers of home-based support.
Under a proposal for change, the DHB would exit contracts with 17 providers next March and form contracts with fewer providers.
The proposal is advantageous for the big providers, for which a new bulk-funding system would enable better staff training and professional development.
This week, the DHB released its proposal for a "restorative" model of home help that would try to meet health and social needs, rather than just carrying out chores.
Provider staff would liaise with GPs and other health workers to co-ordinate care and carry out needs assessment for less complex cases. The DHB would continue to manage complex cases.
"To achieve this approach, Southern DHB will give preference in the proposed [tendering] process to organisations that can provide complete district-wide service coverage, without having to rely on sub-contracting arrangements, unless it will demonstrably support enhanced client care, for example a partnership with Maori health providers," the DHB said.
West Otago Health Ltd manager Michele Stainburn believed rural health trusts would be cut out as providers for the new service.
It would be impossible for the Tapanui trust to contract for all of Otago and Southland.
Ms Stainburn feared this would lead to local residents becoming "just a number" to a care manager in Dunedin or Invercargill.
The "seamless" care offered at present involving Tapanui GPs and other health workers could be compromised, she said.
This was an irony, since the DHB's stated aim was better integration between services.
"It's not broke. It works perfectly well as it is," Ms Stainburn said.
Milton Community Health Trust nurse manager Dale Wyber said she believed the trust already provided the type of service described by the DHB.
However, the trust would obviously not be able to tender for the whole Otago-Southland region.
She encouraged people to take part in the four-week consultation process.
New Zealand Home Health Association chief executive Julie Haggie said Southern DHB was following other areas in consolidating home-based support services, and in some places the transition had not been smooth.
The restorative model was good but it cost more. Detail was lacking in the DHB document, which alluded to economies of scale, but did not cost the new model, Ms Haggie said.
The desired outcomes placed a level of responsibility on to community agencies for which they might not be well enough resourced.
Ms Haggie pointed out that as well as older people, the new system covered those with chronic conditions and short-term home-support needs, in line with government requirements.
In a media release, DHB health of older people portfolio manager Leanne Illingworth said the new service would emphasise independence and wellbeing, and provide better-quality care.
"In the past, home-based support has typically included a limited list of personal care or housekeeping tasks. This model is more flexible and focuses on what people individually need to stay healthy and independent. It is about caring for people in a more holistic way."
Feedback on the proposal closes on July 18.
