Rural health trusts have been given a reprieve by the Southern District Health Board, which will allow them to partner with bigger agencies to provide services for older people.
An overhaul of home-based support services sparked fear among rural providers because the DHB wanted to contract those which could serve all of Otago and Southland. They were to be forbidden from subcontracting.
However, in a report responding to submissions, the DHB said "local flexibility" would be maintained through letting providers jointly tender.
The DHB received 63 submissions on a plan to end contracts with 17 providers, and introduce a "restorative" system with fewer providers. The "restorative" model tries to meet health and social needs, rather than just carrying out chores.
The DHB said yesterday it was going ahead with the plan, with a few changes. Existing contracts would end in June, rather than March, because of concerns the timeframe was too tight.
Respondents feared the new system would cost more, or was cost-cutting in disguise.
The DHB countered by saying the new model required a different use of funding, which was essential to provide for the ageing population.
Respondents were happy the new regime spelled the end of needs assessments conducted over the telephone, a method introduced controversially in 2010 during a cost-cutting drive.
When contacted yesterday, Milton Community Health Trust nurse manager Dale Wyber was pleased the rural trust still had a chance of serving its local community.
It had not seemed realistic for big agencies to have offices in small towns like Milton, and it made sense to use trusts already providing services, she said.
The feedback summary also said the DHB was rethinking whether to exclude enrolled nurses and social workers from the new agency-based role of "clinical co-ordinator", who were required to be health professionals.
Submitters were concerned there would be a lack of health professionals to fill the roles.
The feedback document reveals concern from submitters the DHB's use of the word "restorative" to describe its new system was confusing and misleading.
To some it suggested a return to normal functioning, which was not the case.
"One respondent stated that 'attempting to replace doing things for the elderly with teaching them to do it for themselves is in reality a cop-out and unrealistic'."
The DHB said it was working on new terminology to describe the service.
Because of a "significant response" from submitters, the DHB agreed to retain an Otago "individualised funding" scheme, which let the older person manage their care. The DHB would look to expand the scheme into Southland.
In a press release, finance and funding executive director Robert Mackway-Jones said most submitters were supportive of the changes.
"Under the proposal, home-based support will focus on maximising clients' independence and wellbeing, while providing better quality care. This model is more flexible, and can be better tailored to meet an individual's needs by focusing on what people individually need to stay healthy and independent.
"We also wanted to make a system that is equitable and transparent across the district, as well as being easier for older people to access and use. Under the new proposal, there will be clearer criteria for accessing services."
