At each visit, the Minister is accompanied by Ministry of Health and regional Health New Zealand staff, who are able to answer questions about local initiatives and programmes that are being implemented in that community, and to also hear what the community thinks are the ‘ticks’ and ‘crosses’ of current health delivery.  The Minister is running these Roadshows in his dual portfolios of Associate Minister of Health – Rural and Minister of Mental Health. Minister Patterson, as Minister of Rural Communities, is also attending as many as possible. This is a significant investment in time and commitment by the Ministers and agency staff. It is a great reminder to all attending about the distance and difficulty getting to some of these places, and therefore why close-to-home healthcare is so important to local whānau in terms of cost and time.

The most recent roadshow was held in Kaitāia. For those who have not been to the far north recently, Kaitāia is the last major town before the road heads off to Cape Reinga, near the southern end of Ninety Mile Beach (Te Oneroa-a-Tōhē). It is about 164km from Whangārei, but because of its twisty roads, the drivetime equates to around 2.5hours. Kaitāia itself has a population of just 6,140 people, but services a wider population of approximately 30,000. The name Kaitāia translates from te reo Māori as ‘abundance of food’, reflecting the region's rich natural resources, including birdlife, fish, forests, and fertile land suitable for agriculture, which historically provided an abundance of food for people living there. This explains why the area was originally populated by Māori. The population is still 53% Māori, with 83% of the population in a social deprivation category of 5 (the worst off!). Only 13% of the population earn over $70k per annum.

Kaitāia is lucky enough to have an HNZ-operated rural hospital with a 43-bed capacity. It has one of the highest admission rates in the country. Kaitāia also has four general practices: Te Hiku Hauora, Broadway Health and Top Health, along with the recently opened all-Māori nurse-led clinic Te Whare Oranga, which focuses on the massive unenrolled population in the far north.

What a great place for the Ministers and officials to visit.

To get there, I flew from Wellington to Auckland and then transferred to a small connector plane to Kerikeri. From Kerikeri, I drove an hour and a half along the scenic route to Kaitāia. Along the way, there were small areas near beaches such as Coopers Beach and Taipa with some flash houses, but predominantly the land was rural with many people living in old, poorly-maintained weatherboard shacks. I had been invited to stop and have a chat with the owner of the Kāeo pharmacy. The settlement has a population of 260, but services a wider region of 1390 people. Its largest business was a Fishery Factory that closed in 2011. Driving in from the South, you first encounter the rural school, police station, petrol station, Four Square grocery, church, museum, and library.

It quickly became apparent to me that, as a rural pharmacist, Viv faced the same fundamental issues that rural GPs faced in servicing small and distanced communities. She identified:

• Volume-based funding models (Govt paying a fee per prescription) are not financially viable for operations such as hers.
• Big Box Pharmacies offering free prescriptions via online ordering in the big cities, making things worse.
• Getting locums to provide holiday relief is almost impossible. If she can get someone to allow her a break, the cost is prohibitive.
• Training up locals over a number of years to become pharmacy assistants, only to have these people leave for higher wages in the big cities once trained.
• Needing to try to close the financial gap by selling a range of retail goods from her shop.
• The lack of a peer support network locally to help share the burden.

During this discussion, she effortlessly dealt with a steady flow of locals, dropping into her shop for health advice, prescription pick-ups where she would check in with the person about their state of health and use of the medicines, and going online to fix errors in patient records and prescription eligibility on behalf of the person. She also received a call from the locum GP who was rostered to come into the nearby small, nurse-led clinic, about the care of certain patients. It was obvious that she had the trust and respect from her community, and her services were invaluable. Without her, whānau would have to travel large distances to the nearest alternative pharmacy at significant cost. It was clear to me that many would not, or could not afford to, and their health would inevitably suffer.

She shared with me a message she had received from Fritz, where he shared that it was only by getting away on this trip that he now realised the personal costs that his family and relationships had suffered due to devoting so much of his time to his community – and cautioned her to be careful not to do the same.

I have been involved recently in discussions around the reweighting of capitation funding for general practices. Clear evidence that HealthNZ had gathered showed that practices operating in rural areas, those dealing with high socially deprived populations, and those treating patients with co-morbidities incurred higher patient visit burdens and therefore needed to receive more funding. I am also part of a separate working group looking to allocate a pool of ‘rural funding’ money that is designed to help cover the proven increased business costs of operating a practice at a distance from metropolitan areas, including getting locum and replacement staffing.  Through these talks with Viv, it has become obvious that similar funding solutions need to be found for rural pharmacy - and I am sure those same issues apply to other allied health professions struggling to serve rural and remote communities.

If providers like Viv’s close, those communities will be so much worse off, and their health issues will not be resolved by courier and tele-health by themselves.

So, as MC of the Ministerial Roadshow, I opened with my reflections to those gathered on my visit to Kāeo Chemist, and thanks to Viv and Mel. This was echoed by calls of ‘Kia Ora Viv’ from many members of the audience.

We went on to hear about the issues that locals were experiencing in getting GP appointments, the real lack of dental treatment for whānau, the cost of getting diagnostics and specialist treatments, and much more.  One person called out, “Minister, if you want to find out what the problems are with rural health in New Zealand you have come to the right place. We are the lowest of the low here in Northland.”

The messages were certainly heard by those present, and many problems echoed similar communities in different parts of New Zealand. We all have to keep working hard to make change and get a better deal for our rural communities and the kaimahi working there.  I am personally committed to having these messages heard, and all of us at Hauora Taiwhenua are committed to holding those in decision-making positions to account for our entrenched ‘postcode’ health system. We are making a difference, but I am always concerned that it is not enough and not fast enough.

I am left reflecting on my latest text exchange with Viv, thanking her for the time she and Mel gave me on my visit up north. Her final message was, “… we need people to hear we are valued and can’t continue without things changing. I am crunched to the max.”

Thank you for all you do, Viv, and others like you around the country. Know that your efforts are valued.

Mauri ora

Grant