The 107-page report from consultants Cranleigh Health, released yesterday, is the first in a review of Otago and Southland hospital services looking at the best way to provide future care.
While the report does not make recommendations about changes, it emphasises the need for change and greater integration of services.
The consultants said their finding about bed numbers was based on existing use and a predicted 30% reduction in hospital admissions involving patients with medical conditions which could be treated in the community.
Otago and Southland District Health Boards chief executive Brian Rousseau said interested parties would have two weeks to provide feedback on the report before it was finalised.
The report said the rural population was generally healthy, or around the national average, with Queenstown Lakes having the healthiest and least deprived population in Otago and Southland, and Gore the most deprived.
The main growth area for health care would be treating the elderly, requiring increased access to outpatient services.
There had been significant inconsistency in what was funded, which led to the fragmentation of services.
This supported the need to review the existing models and funding.
The cumulative cost of rural services, for example Queenstown District Hospital's 17% increase in the past five years, could not be sustained.
"In the rural community, the issue of affordability is accentuated, as economies of scale are not possible and workforce issues make delivery of healthcare in remote areas difficult and often tenuous."
In many rural settings, it could be argued there was no reason why there was any separation between community and hospital care, including pharmacy provision.
A consistent and fair package of core rural services was needed, along with a system where best practice was shared between rural hospital providers.
There were many good models and innovative concepts in the rural hospitals, but these were not shared and adopted across the region as well as they should be, the report said.
The report drew attention to the high attendances at the emergency departments of hospitals providing them. (Historically, Balclutha and Dunstan have not done so.)Large numbers of people with conditions which were not emergencies were among those arriving at the emergency departments.
This was forcing rural hospitals into running high-cost/high-volume medical models.
Region-wide decisions were pending about after-hours care and the implications of these would need to be evaluated in relation to each hospital, the report stated.
Rural communities would always need to rely upon Dunedin and Invercargill hospitals and there might be a need for realignment between what they delivered and which rural areas they served.
Each of the rural hospitals had specialist outpatient clinics, but it seemed the service provided depended less on patient needs and more on other factors including the willingness of the consultant to travel, the day of the week of the clinic, proximity of holiday homes and historical links to the area.
"There will be a growing demand for these services as the population ages and services need to be targeted to meet identified health needs."
A wide range of outpatient services were offered, but with the exception of Oamaru, these provided a low volume of service.
Occupancy of inpatient beds was generally low, apart from Dunstan, although its 80% occupancy rate was low compared with urban hospitals.
Increased community visiting by district nurses could shorten or eliminate hospital stays.
In this area there was much variation in the level of services provided, with Queenstown offering a low level of service and Oamaru and Gore high levels.
• The next stage of the review will look at what gaps there are in services to 2026, followed by research into how to fill any gaps identified.
A report will then be prepared, with recommendations on changes.
