NZNO's Blog


Free healthcare for under 13s

budget_2Rosemary Minto is a nurse practitioner who works in a very low cost access clinic in Tauranga. She is passionate about the potential for primary health care to create a healthy Aotearoa.

I work in a primary health setting and the machinations of Government that affect my clinical practice, and the people I see are always of interest to me. So I was very interested in the Budget announcements about the $90 million for free healthcare and prescriptions for children under 13.

Working in a very low cost access clinic means I deal with deprivation and preventable illness every single day. The social determinants of health are not theoretical concepts for me; I can tell you exactly how a cold, damp house and not enough money and unemployment affects the health of children and adults alike. So, extending free healthcare is excellent news, and I congratulate the Government for this sensible and sustainable measure.

It is essential that the scheme be viable for general practice. Free health care for under 6s took several years to implement with the level of funding insufficient for many general practices to be interested in the programme. I hope this won’t happen again.

In the practice I work there is constant pressure between budgets and service provisions, and if the funding formula for under 13 visits isn’t sustainable we could end up in the position of cutting staff and services, an untenable option with current pressures on services and quality performance target pressures.

But if they get it right, fantastic. It will be an opportunity for nursing staff to work to the breadth and depth of their scope of practice.

There is more good news for low cost access funded practices in the budget. $1.5 million has been set aside next year for nurses in very low cost access (high need) practices. We’re not sure whether this is to fund more new graduate programmes or to employ experienced nurses, but it’s great that the Government has recognised the value nurses bring to low cost access practices. It demonstrates that nursing is being considered in the equation as planning, negotiation and implementation occurs.

Nursing voices are represented on Ministerial-level advisory panels on primary health and we fully expect to see the nursing workforce utilised well. Unfortunately, $1.5 million doesn’t go very far these days and it would be great to see the government commit more funding to ensuring nurses and nurse practitioners can be utilised to the fullest extent of their scopes of practice. Direct funding for nurse practitioners would have been a great step for this budget.

And whilst free healthcare for under 13s may mean that children are not showing up in ED departments with high acuity, it still means that the causes of their illnesses in the first place are not being addressed. Poverty and housing, unemployment are things that also need to be sorted before primary health can really do what it should. And that is create a healthy Aotearoa, where services are provided to people when and where they need them, with no barriers to access.

Unless the Government deals with the many social determinants of health, this funding will be yet just another drop in the bucket.



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Health services on the West Coast must meet the needs of its population

ImageThe 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.