The Hokonui Localities Roopu signs its partnering charter: Hokonui Runanga kaitoko matauranga Jo Brand (left) and Southern Community Health Council representative Bronnie Grant sign on behalf of their organisations while waiting behind them to sign (are from left) Time for Change representative Mihaela Erdelyi, Southland Regional Public Services director Trinity McMahon, Gore Medical Centre director Andrew Ure, Gore Health business manager Rhonda Reid, Te Hau o te Ora manager Anna Gaitt, Hokonui Huanui lead Lisa McKenzie, Gore Medical Centre practice manager Susan Jones, Gore Health chief executive Karl Metzler, Gore Police senior sergeant Cynthia Fairley and Gore District Council acting chief executive Rex Capil. Photo: Sandy Eggleston
Health Localities have been touted as a key component of the Government’s health reforms but few details about what they are or how they are to work have been released. Following the launch of the South’s first locality last week, health reporter Mike Houlahan considers how it might work and what it might achieve.
Cynics might claim the Government has made up the details of its health reforms as it has gone along, and health localities are regarded by many as exhibit one in that submission.
Although touted as a crucial part of the reforms, and intended to link local communities to the national health framework, the legislation which set up the reforms was largely silent as to how localities were to be set up and how they were to work.
It is quite possible that was because the Government itself was not entirely sure about that — it set up nine locality prototypes (now expanded to 12) and essentially left them to sort it out themselves.
Last week, with little fanfare, the South joined the brave new world of locality prototypes with the signing of the Hokonui Locality Partnering Charter.
The very short agreement commits the Community Health Council, Community Networking Trust, Gore District Council, Gore Health, Gore Medical Centre, Hokonui Runanga, the regional public service, Te Hau o Te Ora Partnered Primary Care Services and Time For Change Te Hurihanga — collectively known as the Hokonui Localities Roopu — to work together to “improve the hauora (health and wellbeing) of the Hokonui Locality”.
Which is noble and all well and good, but how exactly that is meant to happen remains an open question.
The partnership has agreed to “develop a vision, strategic leadership and direction” for Hokonui, and to create an aspirational locality plan that will ensure health equity and community wellbeing, which is also “meaningful and achievable”.
The partners are also to, on behalf of the community, “hold Te Whatu Ora to account for delivering on the plan”, although the charter is silent on exactly how they are meant to do that.
When asked, a Te Whatu Ora Health New Zealand spokesman said it and Te Aka Whai Ora the Maori Health Authority must prepare an annual report assessing progress against the priority outcomes set out in the locality plan, which, again, is all well and good but very far from being specific, or in offering any tangible sanction against the national organisations should they be failing the good people of Hokonui.
There could be as many as 80 localities around New Zealand and a dozen across Otago and Southland.
They are meant to take over from the 20 health regions — the residual administration of the former district health boards — by July 2024, so time is running out to finalise the details.
The charter said Te Whatu Ora was responsible for identifying a “named locality commissioner”, and for working with “locality leads” and the community to co-design service delivery models — in plain language, ensure there are hospitals and doctors, nurses, GPs and other health professionals in Hokonui.
When asked what responsibilities a locality commissioner would have, who are they were employed by, to whom they reported, what their approximate remuneration would be, if they would have a staff or an office, and what budget allocation they would have, paid for by whom, the one-line response from Te Whatu Ora was that a national commissioning director (Abbe Anderson) had been appointed.
“One of her priorities is the development of the operating model for commissioning.”
So, watch this space and leap bravely into the unknown, Hokonui.
In the interim, the roopu has started an engagement process to find out what its community wants in its locality plan.
For all the mystery about how localities will operate, there is also excitement.
In the old health system structure Gore was part of the massive Southern District Health Board, the largest DHB geographically of the 20 across New Zealand.
Smaller centres often felt misunderstood at best and neglected at worst under the old system: no matter how hard board members and staff tried to take on board concerns in the regions, the issues in Dunedin and Invercargill tended to dominate discussion and funding.
Even if the Hokonui Localities Roopu is not entirely sure how, members believe there is a chance to create a health organisation for their region which will focus purely on achieving the best possible outcomes for Gore and its environs.
Gore Health chief executive Karl Metzler said his facility was the ambulance at the bottom of the hill, and that the locality model could allow health providers to work together to address factors which caused ill-health and poor wellbeing before people reached the point of leaving hospital care.
Documents drafted in the past for the SDHB had identified small pockets of health inequity, especially for Maori, in the Gore area, and Hokonui Runanga kaitoko matauranga Jo Brand said the locality model should ensure the voice of the community was heard.
“We need to make sure that all areas are servicing the need of those living there.” — additional reporting Sandy Eggleston