The West Coast is a big place. It stretches pretty much the whole length of the South Island and its population is dispersed in small towns, from Haast in the south to Karamea in the north. It’s unique and so are its health needs.

The West Coast District Health Board is currently looking at different ways of providing services to the population. Some of its plans are controversial; with admissions there is the potential for harm and death to occur if some services are discontinued on the Coast.

NZNO thinks that’s not good enough. Every region deserves a sustainable healthcare service that meets the needs of its population and utilises its health workforce well. 

The employer has offered a meeting with all parties to discuss the issues but this has yet to occur, and certainly does not take the place of the formal consultation process under the MECA. 

We are concerned that although senior doctors have been consulted, nurses have only been minimally involved in the DHB proposal thus far. The obvious upshot of this omission is that the DHB’s business case is very “doctor-centric” and misses the great opportunity to implement a nurse practitioner model of care, which would work brilliantly in this environment. 

It is nurses who make up the bulk of health practitioners on the Coast and nurses who will have to bear the brunt of any changes to services. 

There is a proposal to move to a generalist nurse model in the acute care setting and the resulting reduction in beds will mean job losses. And if the region goes to an Integrated Family Health Centre (IFHC) model, it will mean that nurses will no longer be covered under the strong and effective partnership of the DHB MECA. The changes must not result in employers taking the opportunity to reduce wages and conditions for our members. 

NZNO is also concerned about the IFHC model as proposed. It’s a very “medical” model of delivering care, and if implemented would make integration between public health and health promotion, and inter-sector collaboration difficult. 

A major concern for us is that patient sourced funding in primary care increases substantially under the proposed new model. This will mean that the cost of providing healthcare will shift from the DHB to the patient, essentially privatising primary care in the region. 

The DHB business case suggests its new models of care will reduce presentations at ED, but our experience is that when communities are unable to access or afford healthcare when and where they need it, they end up at ED, sicker and needing more expensive acute care. 

We know that change needs to happen. Our members want a sustainable health service as much as anyone, but we see glaring issues that have not been addressed: 

1. the lack of inclusion of the NP model;
2. the lack of inclusion of inter-sectoral collaboration and broadening of the model to integrate this and public health and health promotion effectively into IFHCs;
3. no discussion of how issues for nursing will be managed
4. no consideration of how the community will be affected

It’s nurses who hold the whole thing together.  We look forward to engaging in a formal, constructive and productive consultation with the DHB. 

And we look forward to a West Coast health service that provides high quality health care to all Coast communities, when and where they need it.