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Kapiti Health Advisory Group Oral Submission on Te Pae Ora (Healthy Futures) Bill

Thank you for hearing from us. We are an Advocacy Group for Kapiti Residents and Advisors to the Mayor of Kapiti. We will not read from our submission but would like to make the following points:

  • Kapiti has a history of major concern over the provision of heath services closer to home with the Kapiti Health Trust in early 2000s, the hospital petition 2018/19 which was signed by over half of Kapiti residents and continuing concern to date. There is great anxiety over the provision of urgent care with 7,250 presentations to Wellington Emergency for 5,050 residents. 64% of those were discharged the same day. It takes nearly 2 hours to travel there and back. There is also poor coverage for urgent primary care with some at Team Medical at Coastlands and some at Kenepuru.

  • Despite public policy intentions over the past decades with the aim of decentralizing health services to give more emphasis on home and community care, this has not been realized. We are therefore very interested to support the concept of localities to see whether services can be provided closer to home where clinically appropriate.

  • The current provision of services by GPs has not achieved this and there has to be a better integrated system. A good example is that of Canterbury DHB. Whilst the Kapiti Coast Health Network consisting of GPs, CCDHB officials and Te Atiawa ki Whakorongatai has achieved some improvements it is not necessarily meeting the priorities of our residents. It is imperative that community representation is an input to localities, otherwise poor access of services will continue for Kapiti residents.

  • The concept of localities which is provided for in the Bill is a promising but we need to see more detail to ensure its effectiveness. How are localities to be determined, how are they to be managed and funded, how are they to assessed?

  • The Act needs to reference the importance of community participation in decision making.

  • Practical examples of services that could be decentralized are ophthalmology, orthopaedics, cardiac, respiratory and of course urgent care.

  • The resources required to implement localities approach needs to be considered such as increasing role of nurse practitioners, equipment, accommodation, and transport.

  • For more than two years KHAG undertook extensive consultation with Kāpiti stakeholders to identify the health services considered most important and needed by the community. Recognising that a hospital per se was unlikely in the short to moderate term, five priority needs were identified:

  • Access to Services

  • Urgent Care

  • Mental Health

  • Care for Disabled People

  • Care for Older Persons.

Thank you for hearing from us, we believe localities need input and monitoring from community organisation such as KHAG if our communities are to get access to the health services they deserve. I now hand you over to my colleague Sandra Daly after which I hope there is some time for your questions.

Thank you. Members of Kapiti Health Advisory Group contend our group provides an example of the way communities can work with health providers and others to identify needs, assess options and select the best services for their areas.

Like all communities, Kapiti has a number of distinct features. We have one of the highest ratios of elderly people in the country - although this is changing and over the next decade we expect to grow by more than 30,000 people as the opening of Transmission Gully and changes to building legislation make our community more accessible and young families move into the area. But - our nearest emergency facility, hospital and outpatient provider is at least an

hour’s drive away in Wellington. A daunting fact for the elderly and young families alike and creating distinct challenges that we have been working on collaboratively with a wide range of local organisations.

From 2017 Kapiti Health Advisory Group brought together local groups with an interest in the health and wellbeing of Kapiti people. As Colin outlined, through this process we identified the health priorities for our community and have worked closely with DHBs, our Kapiti Coast District Council, PHO, local providers, ASK shuttle service, Wellington Free Ambulance and others to

determine how improvements can be made. A number have been implemented and CCDHB has adopted our priorities for their Kapiti locality plan. These provide examples of what such collaboration can achieve.

We are pleased to see that it is envisaged that the future system proposed under this Bill will make it easier for “consumers, communities and whanau to contribute to our health system – from feeding into the design of their local services through to contributing to national strategies and plans”. This approach, if implemented as proposed, parallels the approach KHAG has taken

and will provide opportunities for communities to determine what is needed, where and when. And for groups like KHAG to be truly involved in the development of health services. We applaud this.

The concept of "localities" is a promising start and the importance of community participation in decision making must be emphasised. It will always need to be recognised there are constraints but having the opportunity to be involved in making choices for the available resources is the best way to gain support for decisions. These decisions affect the whole community and should not be determined solely by health professionals and managers.

KHAG has had a number of successes that provide evidence of what communities can achieve working closely with providers. Achieving the best outcomes for communities throughout New Zealand will require input from consumers, local Government, public and private health providers and other groups. The Bill must be structured to ensure these community members and groups like KHAG are enabled to work productively to achieve this.

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