SDHB seeks dialogue on its healthcare vision

By Mike Houlahan

The Southern District Health Board is about to take its new primary and community care plan on the road for public consultation.

Health reporter Mike Houlahan asks two leading public health figures to cast an eye over the DHB’s vision of the future.

Peter Crampton. Photo: ODT files

It gets an A for ambition, but the final grade for the Southern District Health Board’s new primary and community care plan will depend on how it’s implemented, public health leaders say.

The DHB last week released the latest version of its plan, setting out a future in which a "health literate" population knows when to access health services.

When that time comes, people will do so via technology.

"Over time, this (consumer portal) will become a single point of virtual ‘contact’ for consumers with the Southern health system," the plan proposes.

Self-management in your "healthcare home" will be the aim.

If you need more than that, the healthcare system will be set up as a "hub and spokes" system, with a hospital at its centre and other services radiating out into the community.

"I can pick up that plan and have clarity about the direction of travel and feel quite confident that the DHB is heading in a positive direction," Peter Crampton, a public health expert and dean of Otago Medical School, said.

"The challenges will be in allocating resources to empower that plan to be implemented, and managing the processes of implementation."

Resources and processes are issues for Dr Tim Malloy, president of the Royal New Zealand College of General Practitioners, too.

GPs will be expected to deliver a large part of this plan, and whether they will be given the tools to do that effectively concerns him.

"The amount of times we have had electronic solutions which have overpromised and underdelivered in healthcare in this country is amazing, and leave one feeling slightly cynical about yet another plan which promises wonderful things," Dr Malloy said.

"But I don’t want to sound entirely cynical because where that works, when you have good information available between the secondary and primary sectors, it has true clinical value to the patient in front of you.

"If it is truly achievable, that will be great."

Ultimately, the plan will not succeed if it encounters patient resistance.

To gauge public opinion, SDHB management hits the road next week for a series of consultation meetings across Southland and Otago.

They will rack up plenty of kilometres — and therein lies one of the issues of designing a healthcare system for the region.

It is big, and there are many pockets where the new technology driving much of these proposals does not yet reach.

Another major issue is Southern has a greater proportion of elderly residents than most other regions.

Research shows the elderly are late adopters of new technology, raising questions of how fast uptake will be and whether the SDHB’s target of having one-third of the people to sign up quickly is achievable.

"The current generation of older people is nowhere near as IT literate as the next generation of older people will be," Prof Crampton said.

"That will necessarily impact on how IT use works with the current elderly, and that has to be worked through."

Dr Malloy echoed Prof Crampton’s concerns about how the elderly would adapt to the SDHB’s proposals and added that the poor might also struggle to join the well-informed health consumers of tomorrow.

"In my experience, health literacy is directly proportional to deprivation status," he said.

"If people are already literate, then you add little value in stating the obvious, but there is great value in encouraging patients in their own self-care — in my experience those people who are competent and capable in this area will continue to be so.

"The challenge is shifting those people who are less confident in the domain of self-care to a different place, and that’s a challenge for health systems across the world."

Telemedicine — a whole range of IT health tools ranging from telephone triage right up to artificial intelligence scanning and diagnosis of ailments from imagery — is a fast-growing field.

Dr Malloy said doctors were not averse to working with new tools, so long as tried and trusted methods were not entirely discarded.

"It really concerns me that the rhetoric around this is of a brave new world that is going to solve the problem of not having enough doctors or nurses out there in the field, which frankly is not correct.

"The reality is that the technology we are referencing adds a tool to the work that we do, they are not an alternative to standard, good quality primary care, specifically general practice.

"I continue to have fears around the aspirations that many people have to somehow solve problems which are seriously bigger than the potential solutions those technologies represent.

"They are an adjunct to our work, not an instead of."

There is also the issue of patient resistance to overcome. Many people want to talk to a doctor or nurse rather than rely on a machine, and want what doctors term relationship-based medicine.

Prof Crampton said the SDHB’s plan frames IT as an enabler, an approach which he strongly supported.

"Technology does not provide us with magic solutions ... This is a strategic plan, it gives us a sense of the long-term future we wish to travel towards, it would be completely remiss if the plan did not fully incorporate IT enablers."

The geography of Southern meant IT solutions were absolutely necessary, and some could be "game-changing" he said.

"Some of it is status quo elsewhere in the world, some of it we don’t know what it will look like yet ... there is work to do, but it is correct we are signalling that future."

mike.houlahan@odt.co.nz