The health reform announcements on 20 April took many by surprise in terms of their ambitious nature and the pace of change. Christine Hall, Pinnacle Ventures chief executive, shares her thoughts on how we'll know things are different.
On a personal level I am supportive of the health reform changes and their intended outcomes. Having worked across primary, secondary and tertiary services, I see real opportunity in the new structure to reduce inefficiency and fragmentation, and minimise the silos that health services currently operate within. Every day I see the impact of these silos, and it is the same no matter which part of the system you operate in.
For the health workforce in general, it’s a constant balancing act to juggle demands on time, staffing shortages, massive caseloads, increasing complexity, the need to know your patients and supporting integrated healthcare across silos.
Add to this the very real shift in the need for health services to apply a social lens to the care that is delivered, knowing that both health and social circumstances are inextricably linked. The role and scope of the health service, and of general practice, is very much evolving.
With any change, once Government has been through the process of reorganising the deck chairs, I think it is important to understand how we will know that things are different.
For me, this is captured by a few simple measures.
We spend a lot of time referring and signposting people to services, and advocating for them to access a level of service that we would consider a basic human right.
Too often we see services develop criteria to manage their internal capacity issues and become focused on which patients can be excluded rather than included. Or we hear, "Sorry, that’s not us… you need to go to another service", and patients bounce around all over the place trying to find what they need.
For those with resources, finding and accessing services is not so difficult. But for those without resources, it becomes too hard, and they fall through the gaps.
In the new state, we should have confidence that the people who need support the most receive it, and we spend much less time battling the system on behalf of our patients.
We all have examples of working as part of a wider interagency team around the needs of whānau. When it's done well, it's a great outcome – not just because you know the whānau is getting what it needs, but also because you are working with others to manage risks and provide checks and balances.
Carrying risk alone – and I see this lots in the mental health space – is exhausting, causes sleepless nights and burnout. Every health professional needs a team around them, and whilst we have made great strides with the healthcare home model, I see this broadening outside of general practice and into more collaborative community initiatives.
We should be shifting towards social agencies having much more of a presence in general practice and vice versa – imagine what we could achieve with a social worker or navigator in each practice as part of the standard model of care delivery!
Some people like to come to the practice, but there are many who do not. If we are to improve outcomes for Māori and Pasifika we must be prepared to engage in a different way.
Again, this means strengthening our partnerships within communities, and being clear about who has trusted relationships and can facilitate our role and connection.
In my experience with homelessness, people do not access services because of cost and lack of trust. But if you were to turn up on the streets one night and offer free medical support, it would most definitely be accepted!
There is a real opportunity for general practice to leverage the people and agencies who are best connected with the community, to deliver creative healthcare and use enablers such as telehealth to make this happen.
A transitional leadership structure is the first step, then by 22 July the new structure should be in place so the pace is pretty quick!
I'm looking forward to seeing what the next steps of change bring and the opportunity for general practice to have a pivotal role in the integrated health service agenda.