Healthcare in New Zealand faces the same challenges as most first world countries; we are experiencing a rapid growth in the prevalence of non-communicable disease. The misdistribution of this reflects inequalities in modern society and has a direct link to deprivation. Healthcare providers are seeing more patients requiring repeat episodes of acute and long-term hospital care. For society, these health inequalities lead to premature death and people living restricted or dependent lives. Current health systems and models of care do not have the resource to meet future needs unless our approaches change. The challenge for governments and healthcare providers is how to address this inequity, flatten the growth curve and reduce the associated human and financial costs. It is now generally acknowledged that social factors are the fundamental determinants of health, equity and wellness, and it is these which policy must address to improve the quality of health for our populations.
The Scottish government recognised a number of years ago that focusing on our children to offer them the best possible start in life would lead to long-term health gains. Their Early Years Collaborative is founded on an underlying philosophy that children deserve an equal opportunity to thrive, learn and succeed. As Chief Medical Officer of the Lakes region I am acutely aware that our population has some of the worst levels of social deprivation and inequity in the country. This impacts many of our children and with the disparities widening these greater inequities are ultimately driving the growing burden on health services. To create a local solution for integrated care in the style of the Scottish collaborative will require currently siloed agencies to reach into communities, families and whanau and consider and address multiple issues from education, welfare and health.
Legislatively District Health Boards are responsible for the health of its geographic population, moving forward it must play a fundamentally different role within local community. Our DHB is currently building a new community based children’s centre and this offers the ideal nexus for driving integration at all levels. This will require a systems approach, engaging a wide group of stakeholders to develop networks that span organisational boundaries. These partnerships need to utilise expertise from across the whole systems, but key to success will be a sense of shared responsibility and accountability.
The aim of this Fellowship is to leverage off the development of the Children’s Centre and create a focus on improving health and wellbeing outcomes for the children of Rotorua. To achieve this requires a number of pieces of work that will be based on reviewing some high performing international examples. Specifically this Fellowship will be aiming to:
1. Create a plan to improve children’s health and wellness in the Lakes region. Critical to success is to create a shared vision, strategy and governance structure to oversee implementation and continued monitoring of any models. Currently there is no governance system or explicit strategy to support an integrated approach to improving child health and wellness at the macro level. I will be researching the best international examples and how are they transferable to a New Zealand model.
2. Review international outcome measures for children’s wellbeing. Measuring and determining appropriate outcomes is challenging and any new approach needs to ensure it supports children and their families in ways that are person centred and effective. I will look to identify what is adaptable for enhancing social and health integration at the local context.
3. Identify what models of commissioning have been successful in relation to child health and wellness and what a local solution might look like. Specifically I will be researching how this can be accomplished across different sectors with a focus on wellness not illness.
4. Identify areas of excellence that can support the evolution of models of care for the Children’s Centre.
5. Identify opportunities for the models to be transferred to other populations within Lakes DHB such as the elderly or patients mental health issues.
A major challenge for this work is that implementation of any new model will require greater collaboration amongst organisations with differing cultures and legislative requirements. The demographic make up and size of our population should theoretically enable and support the requisite relationship development. I am confident that adoption and adaptation of some of the excellent examples internationally where these challenges have been addressed will enable us to achieve our goal.
Martin Thomas,
Chief Medical Officer
Lakes District Health Board
New Zealand