The current COVID-19 pandemic risks further accentuating the rural-urban health inequities that exist in New Zealand, warn University of Otago health specialists.
A specialist team including Dunstan Hospital rural health specialist Garry Nixon and rural General Practitioner Dr Branko Sijnja, say “District Health Boards must consider and include their rural communities and health services at this time.”
In New Zealand, many rural towns represent many of the most vulnerable communities. Residents of these rural communities are overall poorer, older, more likely to be Maori and have poorer health outcomes than in more populated cities.
The rural communities are also more vulnerable due to the understaffed nature of rural health services (both primary and secondary), which have limited specialist services and equipment. Hospitals in these areas are largely driven by acute need and are often at capacity in the winter months. They do not have outpatient clinics or elective surgery that can be cancelled to create additional capacity.
The health specialist team from Otago University are asking District Health Boards to put in place rural-specific plans developed with rural health services, in order for these hospitals to not be overrun during the pandemic. They are also asking for processes which ensure a single point of contact for specialist advice for rural clinicians to co-ordinate the care of deteriorating and critically unwell patients, as well as access to intensive care services across the rural regions including continuing access for non-COVID acute emergency cases.
The protection rural areas do have is their isolation. “It is now time for the Government to implement travel restrictions of non-essential travel to rural remote areas, as this will maximise the one protection rural communities might have – their isolation.” the Otago University health specialists say.
Rural hospitals are made more vulnerable by their lack of “surge capacity”. They are largely driven by acute need and are often at capacity in the winter months. They do not have outpatient clinics or elective surgery that can be cancelled in order to create urgent additional capacity.
We would urge DHBs to put in place, if they have not already done so:
- Rural-specific plans developed in partnership with rural health services.
- Processes to ensure equitable access to specialist and intensive care services across their regions, including continuing access for non-COVID acute emergency cases
- A single point of contact for specialist advice for rural clinicians, to co-ordinate the care of deteriorating and critically unwell rural patients.
- Plans to shift workforce into rural health services that have pre-existing serious shortages or when they (especially small services) become overwhelmed.
- Processes to ensure access to sufficient equipment including personal protective equipment for rural services.
- Additional resources for inter-hospital transfer, of both ventilated patients and those patients who are deteriorating and likely to need intensive care.
- Plans to ensure the rural health services that are now managed by community trusts are given the same consideration and support as those that are managed directly by the local DHB.
It is now time for the Government to implement travel restrictions of non-essential travel to rural remote areas, as this will maximise the one protection rural communities might have – their isolation.
While we expect much of this work is underway, it will be easy for DHB managers and clinical leaders to become focused with their base hospital services and the patients immediately in front of them and to inadvertently neglect rural-based patients. Geographic equity will be important in the coming weeks and months.
During the COVID-19 pandemic, it is crucial that urban and rural referral sites support each other and act as a unified system of emergency care.