Rural Health Forum 2010

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About

In January 2010, the National Health Committee laid out the challenges we as a nation face in delivering consistent and comprehensive healthcare to rural communities. The report served as a reminder that more focus needs to be given to servicing the 22% of the population living in diverse rural communities.

The 2010 Rural Health Forum aims to keep the momentum and debate going by showcasing new rural health initiatives and discussing how we may overcome some of the barriers faced daily by rural health practitioners.

Join your peers from DHBs, PHOs, rural hospitals, GP clinics, health trusts and associated rural health providers at the Forum to learn from and network with people directly involved in meeting the challenges of delivering healthcare in rural communities.

Keynote Addresses by:
Brian Rousseau, CEO, Southern DHB
Dougal McKechnie, CEO, NZ Health IT Cluster

Chaired by Dr Richard Macharg, CEO, Queenstown Medical Centre & Dr Carol Horgan, General Manager, Dunstan Hospital

Over the two days, we will ask the key questions and address the many challenges
•   What healthcare services can we realistically expect to be able to deliver to rural communities in the future?
•   What needs to be measured through the national rural health indicators?
•   How will the IFHCs fit into the rural healthcare mix as the sector moves to devolve and integrate services to primary healthcare providers?
•   What is being done to ensure broadband access and connectivity in rural areas? – And how will the new National Health IT Plan assist in this?
•   Are mobile health services the way forward for rural health delivery?
•   What will the future hold for rural PHOs?
•   How do we improve access to healthcare for rural Maori and the elderly?
•   How do we ensure community engagement and involvement in rural healthcare delivery?
•   How can we extend the scope of services by rural paramedics and nurse practitioners?
•   Why does clinical governance need to be made a priority in rural hospitals?
•   How do we deal with the increased incidence of depression and suicide in our rural communities?

With presenters directly engaged in meeting the challenges for healthcare delivery in rural
communities – from:
Health Waikato | NZ Institute of Rural Health | Mobile Surgical Services Project | Otago DHB | Southern DHB Wairarapa DHB | Te Tai Tokerau PHO | Dunstan Hospital | Otago University | Waikato Clinical School
New Zealand Health IT Cluster | New Zealand Medical Association | Health Workforce NZ  | St John | Waikato DHB

Take advantage of our special 2 FOR 1 DEAL and pay just $995 per person with our Early Bird Saver.

Agenda

Agenda: Day 1

8.30

Registration and coffee

9.00

Opening remarks from the Chair

Dr Carol Horgan, General Manager, Dunstan Hospital

9.15

Keynote: The cost of providing healthcare to rural communities (Keynote)

• What healthcare services can we realistically expect to be able to deliver to rural communities in the future?
• Restructuring services and preparing for community integrated healthcare delivery
• Aligning funding for rural healthcare with new priorities and strategies
• Specific challenges for DHBs servicing rural areas
• What can be done to keep services available within budget (e.g. to avoid the use of expensive locums)

Brian Rousseau, CEO, Southern DHB

10.00

Developing a set of national rural health status indicators: Part 1

In February 2010, NZIRH embarked on a major research project to develop a National Collection of Rural Health Indicators. Nearly a quarter (22%) of the population lives in diverse rural communities. For all the assumptions made about the status of peoples living in rural areas, we have no specific models for measuring Health Status or Outcomes, Health Determinants and/or Health System Performance in these regions.
• Lessons from the literature on development of Rural Health Indicators
• Application of the Urban/Rural Profile data base from Statistics NZ in the NZ health environment
• Contextualising international rural health indicators to the NZ Health environment
• Our ‘myth busting’ findings about rural communities from the information and data analysis achieved to date

Robin Steed, Chief Executive
Jan Cooper, Health Planner and Researcher
NZ Institute of Rural Health

10.30

Morning tea

11.00

Developing a set of national rural health status indicators: Part 2: Panel debate

The NHC report found that more information is needed around rural health status and the effectiveness of rural health services in order to better align strategies with community needs. This will involve DHBs conducting regular rural health needs assessments and a closer engagement with communities to understand their local priorities. There’s talk of developing national rural health status indicators to ensure consistency across district and regional boundaries, but with rural communities being so diverse and the need for a diversity of healthcare models; is it even possible to set national standards?

Robin Steed, Chief Executive, NZ Institute of Rural Health
Jan Cooper, Health Planner and Researcher, NZ Institute of Rural Health
Dr Pete Foley, Chair, NZ Medical Association
Dr Carol Horgan, General Manager, Dunstan Hospital
Jocelyn Tracey, Chair of the PHO Performance Programme Advisory Group, DHBNZ

11.50

Adapting rural hospitals to the call for more integrated health services

With the current focus on devolving some services located in hospitals to primary healthcare settings and establishing Integrated Family Health Centres, how will rural hospital services be configured in the future? Better, sooner, more convenient healthcare will require close liaison between primary care and community services. Further discussion between primary and secondary service providers is required to identify how new models of care will ensure community needs and ministry expectations are met.
The hospital services required in rural areas depends on demographics as well as geographical factors. Good inpatient services require good clinical linkages with base hospitals, and good ambulance transfer services. Rural hospitals must have good communication with base hospitals to best utilise the rural hospital capability.
Workforce issues impact on clinical capability for rural hospitals. Clinical staff at Dunstan Hospital played a significant role in the establishment of rural hospital medicine as a vocationally registered scope of practice. Here we discuss how this will help rural hospitals maintain a key role in rural healthcare delivery under the new models of care.

Dr Carol Horgan, General Manager, Dunstan Hospital

12.40

Lunch

1.40

Primary Healthcare Nursing Pilot Project: “Joined Up” Services to Improve Patient Outcomes – Challenges and Lessons Learned

The purpose of this project is to trial different approaches for District Nursing, Public Health Nursing and Practice Nursing to develop a collaborative and integrated community nursing workforce in rural settings. The key focus is the development of a connected network of health practitioners and the desired outcome is to improve the experience for the patient through co-ordinated care, seamless referral, improved information sharing and collaborative decision making. This presentation explores the journey of moving a rural nurse workforce to integration, the potential gains and the lessons learned along the way.

Bernadette Doube, Project Manager, Primary Healthcare Nursing Pilot Project

Unfortunately due to personal circumstances, Jill Dibble is no longer able to present at the conference.

2.25

Case Study: Developing an integrated health infrastructure in rural communities

An Integrated Family Health Network is currently being set up in Eastern Bay of Plenty by an alliance group including Eastern BOP PHOs, the Bay of Plenty DHB, local iwi, the National Maori PHO Coalition and Healthcare of New Zealand. In this case study, Dr Wellingham will discuss the Eastern BOP concept; learnings so far from establishing an integrated rural community care model in Kawerau, as well as findings from a successful telehealth pilot in the Turangi/Taupo area.

Dr John Wellingham, Board Director, Healthcare of New Zealand Ltd
John is a general practitioner at a large multidisciplinary health centre in North Shore City, and health sector advisor who is recognised in the industry for his work to improve the quality and coordination of patient services in the community setting. He is the immediate past Chair of the Royal New Zealand College of General Practitioners’ Board of Quality. His previous roles have included the development and implementation of chronic care programmes with a focus on improving the delivery of services to people with higher than average clinical risks such as Maori and Pacific people.

Material is not currently available. Please check back soon.


3.10

Afternoon tea

3.30

The expanding role of the nurse practitioner

Rural practice requires broader scope of practice, with responsibilities spread among fewer health workers. Many communities now have nurse-led clinics, nursing outreach teams, or other ways of intensively using the skills of nurses. Increasing the involvement of nurses in primary health care can improve the health of the population in a cost-effective way. In this session, we discuss ways to encourage the development of nurse-led clinics and support extended scopes of practice for rural nurses.
• Feedback from the Rural Nursing Workforce Strategy Group
• What support do rural nurses need to take on the extra responsibilities?

Helen Pocknall, Director of Nursing, Wairarapa DHB and Board Member

4.15

Extending the scope of services by rural paramedics

A desperate shortage of experienced health professionals in rural areas could result in greater reliance on rural paramedics, but before any such move, we need to establish how much it would cost, impact on workload, and the support infrastructure needed.
Making better use of pre-hospital services to avoid bottlenecks in EDs
• Where is the greatest need and which services would paramedics be able to undertake?
• Drawing on experience gained in the UK and Australia
• Feedback from pilot projects in the Waikato region

Grant O’Brien, Change Manager Development and Support Unit, Waikato DHB
Brent Nielsen, Operations Manager Midland, St John

5.00

End of day one & networking drinks

Agenda: Day 2

9.00

Opening remarks from the Chair

Dr Richard Macharg (FRNZCGP), Chief Executive
Queenstown Medical Centre

9.10

Work currently underway to improve broadband access and connectivity in rural areas – and the expected impact of the new National Health IT Plan

In this presentation, we discuss the new priorities for regional and national health IT investment as identified in the National Health IT Plan. How much of the spending is targeted at rural areas? How will the proposed investments improve the efficiency of healthcare delivery for rural patients? What actual work is currently underway to improve broadband uptake, access and connectivity for rural healthcare providers? Dougal will provide insights on these crucial issues and look at the real impact of the Rural Broadband Initiative and the Connected Health initiative.

Dougal McKechnie, Chief Executive, New Zealand Health IT Cluster

10.00

Are mobile health services the way forward for rural health delivery?

A working model of the primary and secondary interface in rural areas is evident in such activities as the surgical bus and specialist outreach services. With the trend towards specialisation of doctors, should the focus be on offering more visiting specialists and mobile health services instead of trying to retain doctors in rural areas?
• The impact of increasing specialisation in central locations on the access to services for rural communities
• When a visiting specialist is not the answer
• Aligning visits of mobile unit with the rural “life cycle”

Dr Stuart Gowland, Urologist and Director, Mobile Surgical Services Project

Please check back soon for presentation

10.45

Morning tea

11.05

Ensuring continuity of care for rural patients

One of the main ongoing issues in rural healthcare is attracting and retaining appropriately qualified doctors, nurses and allied health staff. This has a direct and negative impact on the continuity of care of patients and on job satisfaction of existing overworked rural healthcare professionals. We look at the impact of such initiatives as voluntary bonding, ROMPE and the Rural Medical Immersion Programme and discuss what else can be done long-term to maintain health service delivery in rural towns.

Dr Branko Sijnja, GP, Balclutha
Director, Rural Medical Immersion Programme, University of Otago
Board member, Otago DHB

11.50

Why clinical governance needs to be made a priority in rural hospitals

A 2009 survey found that a significant proportion of hospitals have no recognised medical leadership or formal clinical governance structures. Good clinical governance is essential to ensuring quality of care, especially in an environment of high staff turnover or critical staff shortage. In some cases where clinical governance is in place it is led by the DHB, while other rural hospitals are in the early stages of developing their own clinical governance structures. With this presentation, we provide examples of both scenarios and discuss benefits and challenges.

Ross Lawrenson, Professor of Primary Care and Head of, Waikato Clinical School

12.40

Lunch

1.40

Improving access, availability and acceptability of mental health services in rural communities

There are a number of factors preventing rural patients seeking help with mental health issues; the risk of exposure in the local community; lack of transport to access further afield services; and the strong rural culture of self-reliance. But anecdotal evidence suggests that there’s an increased incidence of depression and suicide in our rural communities which needs to be addressed.
• Latest initiatives addressing rural mental health needs
• The impact of external factors; the economy; unemployment; isolation
• Establishing community based networks and promoting openness around mental health

Barry Taylor, Suicide Prevention Officer, Wairarapa DHB

2.25

Improving access to healthcare for rural Maori

There is a direct correlation between rural areas with high levels of deprivation and the proportion of Maori in the community, so it is important to address the underlying socio-economic factors making it harder for rural Maori to access healthcare services. Many rural doctors report lower levels of rapport with Maori patients, but new initiatives such as Whanau Ora and the increasing use of Kaiawhina provides an opportunity to reach Maori communities in a culturally appropriate and effective way.
• Health issues particularly prevalent in our Maori population
• The importance of Whanau Ora approaches for meeting the health and disability needs of rural Maori.

Rose Lightfoot, Chief Executive Officer, Te Tai Tokerau PHO

3.10

Afternoon tea

3.30

Ageing in Place: Specific challenges for rural communities and aged care health professionals

Fewer disability and aged care support services tend to be available in rural locations than in urban areas. Challenges for provision include finding appropriate support staff, the cost of delivering services across long distances, and the lack of economies of scale.
• Travelling to and accessing services for older people
• Reviewing and improving the quality of aged care services as part of the Positive Ageing Strategy
• How do we improve the availability of health and community support services for older people?
• Ensuring that older people who cannot live alone can continue to be close to their community

Dr Stephen Chalcroft, Clinical Leader Older Persons Health, Southern DHB

Please check back soon for presentation

4.15

Closing remarks from the Chair and end of conference

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