Oamaru ED woes

New Zealand’s doctor shortage has hit home to people served by Oamaru Hospital where the emergency department has had to close three times in the last six weeks.

As the hospital’s chief executive Keith Marshall says, there is an ED in Oamaru for a reason and that is that the service sees about 9000 people a year, though it is only funded for 4000 presentations.

The hospital provides services to about 23,800 people in an area extending roughly 8990 square kilometres.

Its coffers received a considerable funding boost in its contract with Te Whatu Ora Health New Zealand earlier this year, but more money does not necessarily act as a magic wand to attract doctors to the places they may be most needed.

This situation illustrates, again, the fragile nature of our health services. It highlights the lack of cohesion there has been in the provision of health services nationally and our slowness to properly recognise we need to do much more to train and keep our health professionals here.

Mr Marshall said the doctor shortage affecting the ED has been more than a decade in the making.

Waitaki District Health Services is one of several independent health providers in rural Otago and Southland which receive government funding for their services.

They have been dogged by funding woes for years and concerns have been raised about how fairly government funding has been allocated.

Under the health reforms, rural communities were eventually included as a priority group, and last month the first rural health strategy was released.

In the public consultations on the strategy, people expressed concerns about access to care, particularly options restricted by workforce gaps and limited availability of services such as maternity, urgent and emergency care, and mental health services.

The strategy acknowledged urgent and emergency care had "settings that create gaps or risks for rural communities".

Oamaru Hospital. PHOTO: ODT FILES
Oamaru Hospital. PHOTO: ODT FILES
It said health agencies, the Accident Compensation Corporation and the sector need to re-assess options and approaches that could be sustainable and still meet community needs.

Published at around the same time as the release of the strategy was University of Otago research, led by rural health academic Prof Garry Nixon, looking at more than 160,000 deaths between 2014 and 2018. It found mortality rates in rural areas were higher than those for urban areas in all groups under 60 years old.

For under-30-year-olds they were almost double that of their urban counterparts.

The largest urban-rural disparities were seen for injury deaths, and most evident in the younger age groups. In those aged under 60, injury-related death rates were significantly and consistently higher for those in all rural areas than in the most urban areas.

The other area where disparities were most pronounced was for amenable deaths, those potentially avoidable if effective and timely healthcare is provided.

The research contradicted earlier studies which concluded mortality rates were similar in urban and rural settings, but the recent research used a purpose-built urban-rural classification system developed with health in mind and also used age stratification.

Those who have been arguing for years that rural health services have been the poor relation in our health system will be hoping this research will reinforce the need for improvement.

The rural health strategy recognises a one-size-fits-all approach is not what is required, with different options being effective for different communities.

With an emphasis in the strategy on prevention, the need for maintaining and improving (if necessary) emergency and urgent services must not be lost sight of.

This is particularly pertinent when the country is increasingly affected by severe weather events. As the strategy points out, rural communities are disproportionately affected by climate change, and more prone to being cut off from vital support networks in the aftermath of such events.

One of the five priorities in the strategy is a valued and flexible rural health workforce — growing and supporting it and expanding its capabilities to deliver the care needed by the community closer to home.

That cannot come soon enough for those affected by situations such as the Oamaru Hospital ED closures.