Straggle Muster 164 - 29/7/2005
Charlie Pedersen - newly elected President of Federated Farmers
Rural Health: Where Does The Rural Sector Stand?
There are no prizes for guessing what is at the top of the list of priorities for farmers and rural communities - the vast majority would answer health and education.
But given that I serve on a National Animal Welfare Advisory Committee (NAWAC), I would have to say these priorities should come after the care of farm animals!
I am proud to have this week been elected the president of Federated Farmers, an organisation with a long history of representing rural communities many live in, serve in, and work very hard to grow.
This rural health presentation aims to throw some ideas around, highlight the good and not so good, and talk about overcoming the tyranny of distance. But most of all it will relate my experience of what I know and love best, and who I represent - rural communities, the people in them and the businesses that they run.
I see that a line in the programme states or quotes the rural sector as "the backbone of the nation", but then qualifies this with the Tui and common kiwi catchphrase - yeah right
Many people have no idea of just how "yeah right" we are as a sector.
Think about these figures just for a moment in the context of how important rural health care is to New Zealand
- Agriculture and first stage processing accounts for 17 percent of New Zealand's GDP;- Primary industry produces 60 percent of New Zealand's exports;
- Primary industry provides for one in every ten jobs;
- One in four New Zealanders lives in what as classed as a rural area or small town;
- Fonterra Co-operative Group is the largest exporter of dairy products in the world.
It is not surprising then that in order to sustain and grow agriculture's valuable contribution to the domestic economy, we need to provide for the health needs of the communities that deliver these impressive outcomes for our country.
It is not my intention to use this as an attempt to highlight what the government has or has not yet achieved, for delivering on its promise of affordable accessible and timely health care to rural communities
Much time could be spent discussing and debating what defines accessible health care, how affordable it is and who's definition of timely we are abiding by.
Certainly we need to acknowledge there has been and continues to be great progress in supporting the delivery of health care in rural areas.
Recruitment and retention funding, rostering arrangements, locum support, nurse practitioners and dedicated rural health units are fantastic initiatives proving significant. We have a very good base on which to build health services that are tailored to specific rural needs.
To achieve a collective vision of healthy rural communities and to build on what we have now it is imperative to listen to local people.
In fact we need to do more than just talk with them, we need to truly engage them.
Sustaining healthy rural communities should go beyond talking about and providing what services they might need. We must encourage and support them to build on their own initiatives, but most of all trust them to determine and assist in the implementation of the answers to the health problems of their own communities. We must involve them in the decision making about the type and mechanisms of health service delivery that best meet their local needs and priorities
Primary health organisations have gone some way to making sure this happens.
But their thinking and decision making must not be captured by health professionals who think they know best, just as they must not be captured by lawyers and accountants.
In an ideal world they will be enabled to deliver what the community wants and help you to respond to the changing needs of their community. There are some outstanding examples of communities working collectively to make this happen and they need to be congratulated. Much of that work is a result of some amazing people.
We need to encourage and support more people to apply their energy and skills to spread around the country these examples of best practice. A patchy result is not acceptable.
Health is our collective responsibility. It is not something that happens just in doctors surgeries or small rural hospitals, or around the table of the district health board. It is something that happens everywhere in a community, and in the home.
This collective responsibility is amplified in a rural community.
As an employer, my business relies on attracting and retaining good people to come and work for me, but not only me. They also participate in the community in which my business operates. In my case emergency services also rely on my business, as three of my employees are volunteer firemen offering emergency medical assistance as required.
This leads me to the reliance on volunteers. A good part of the rural community is built on volunteer work. The question is, can we sustain this.
The rural community, like the rest of New Zealand, is suffering from a decreasing pool of volunteers. The same people serve on boards of trustees, committees and sports organisations. They run community support services like mental health, and offer support for new mums through plunket and play centre. They help rescue services pulling tourist vehicles out of ditches. They lend a sticking plaster or a drink of water to a lost mountain biker. They spend many hours doing fund raising. This all takes energy, training, commitment, time away from the family. And remember this is squeezed in between running, in many cases, multi-million dollar businesses called farms.
I think we need to be a bit smarter in placing the burden on volunteers. We need to think about some incentives for employers to accommodate people away from their work, make training easier, bring the training to the community not the community to the training, and maybe provide a flying group of professionals to empower and encourage these volunteers to ensure they receive the support they need.
To recognise this collective health responsibility, policy and funding initiatives have to be flexible to respond to community drivers and support community initiatives. Kiwis are innovators. They have to be. We need to support that innovation, not stifle or over burden it with unnecessary regulation.
There needs to be distinctions between what is rural and what is an isolated community, and recognise the needs of each.
Some hard calls will have to be made by health providers and government about what really is rural health provision, and compare that with the barriers to accessing health services for truly isolated communities. The challenges faced by isolated communities must be recognised and funded distinctly.
As the pressure on delivering health services for isolated communities grows, it is no longer acceptable to rely on simple funding formulae that claim to calculate how isolated a community is.
We need to look at the real factors influencing health outcomes in each community. What are the consequences of waiting a week before you actually decide to seek some professional health advice. The delay stems from not wanting time away from your business, or waiting for the day when you normally go into town. This is real in rural New Zealand. How can we overcome this?
There is a limited budget. There are limited specialty services - we need to make sure that real needs are identified and that rural specific funding truly does ensure fair access for all.
I presume I won't be telling you anything you don't know when I say that phone coverage is unreliable in many rural areas. This includes both land lines and cell phones. For many the internet is virtually unusable on a dial up connection. Some of us are lucky enough to get our roads graded once a year. Improving this infrastructure is vital to achieving healthy rural communities.
I ask: is it realistic to expect you to deliver a first class health service with third world infrastructure?
Wouldn't it be great if an on-call health professional could leave their home with the confidence that their cell phone would not lose coverage around the corner
Wouldn't it be great if a farmer could have the confidence that when he comes across an accident down the road he could contact emergency services immediately? What's more, wouldn't it be good if he could then press a button on his phone and provide to the emergency services an instant GPS location, and know that the details of the emergency call would immediately be sent to a local response emergency team.
Wouldn't it be great if we could have simple follow up consultations using internet video technology or have those facilities available for sole charge GPs to call on a group of dedicated rural service experts around the country!
You will no doubt hear from our next speaker the incredible communications technology that is now available and as a farmer and as an organisation we applaud the advances that have been made, but if we are going to be smart about how we use technology to achieve better health outcomes we need to get the basics right - Right Now!
Rescue Helicopters
I cannot underestimate the importance of the rescue helicopter service in delivering and providing access to emergency medicine for the rural community. It also provides an extremely effective transfer service between outlying regions and main centre health care.
I want to use this as an opportunity to stress that these services need to be retained and strengthened but most importantly provided with the funding that they need to operate efficiently.
Our organisation supports partnerships between private and public organisations and congratulates the commercial organisations and trusts for the support they provide to maintain this vital link.
But if there is any service that this Government should be providing greater financial assurance to it is the rescue helicopter service.
Perhaps we should be thinking about the expansion of this link. Think of the time saved in servicing large geographical areas, accessing specialist services and providing peer support for health care professionals. Is it false economy to ignore these possibilities or at least not trial the idea?
Endless hours have been spent highlighting and discussing our ageing population. The average age of farmers in New Zealand is now 52. The rural community is feeling the effects of creeping time and changing demographics.
Do we have the support for our ageing population in rural areas? Excluding outside family support, the answer to that question is no. What we do know is that rural rest homes are under threat, with many closed or closing.
It may surprise some planners that not everyone wants to live out the remainder of their lives in Winston Peters' sunny electorate.
The rural community is not unique in facing the challenges of caring for or being elderly. The constant commitment required from family members, the constraints of non-existent public transport when you can no longer drive, accessing home help, heating your home or affording spiralling rates bills, but again these challenges are amplified over and over by the tyranny of distance.
I do not have any immediate solutions, and I suspect many of you share my view that it's not all about funding.
What it is about is supporting the carers and the support networks that a community calls on when a family can no longer realistically provide care.
We need to support those carers and recognise the extra costs associated with travelling the long distances involved.
There is something 'New Zealand' about supporting somebody to stay in their home and the community that have dedicated the best part of their lives to. We need to think about smart ways of encouraging community and private providers to deliver elderly care in our small rural towns.
Being healthy and having access to appropriate health services is a fundamental right of all New Zealanders. Urban and rural.
I have only touched on a few of the challenges. I congratulate the organisers of this forum on your initiative of bringing together not only the leaders, providers and funders of rural health care but also those who are the receivers of that service. That most important voice is essential in the equation.
To conclude, Id like to leave you with a quote or even a slightly misquote from those well known New Zealand health experts Tim and Neil Finn.
The tyranny of distance didn't stop the cavalier
So why should it stop me
We will conquer and .
be healthy!
Charlie Pedersen was this week confirmed as Federated Farmers' new National President.
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