Closer to home

Ka aro mai ki te kāinga

This theme is about:

  • providing care closer to where people live, learn, work and play, especially for managing long-term conditions
  • integrating health services and making better connections with wider public services
  • promoting wellness and preventing long-term conditions through both population-based and targeted initiatives
  • investing in health and wellbeing early in life and focusing on children, young people, families and whānau.

Why is it important?

Good health begins at home and in communities, so it makes sense to support people’s health through services located close to these places where possible. This includes both preventative services that keep them well and treatment services that can be accessed easily.

We will always need specialist services provided in hospitals for complex treatments or surgery. But new skills and technologies are allowing us to shift some services closer to home. For example, minor surgery and intravenous antibiotics for serious skin infections are now available in primary and community care settings as an alternative to hospitals. Encouraging such shifts is important so that services can become more convenient, improve their quality and become more clinically and financially sustainable.

‘Cross-government agencies working in concert with a shared philosophy will be able to address complex, long-term problems that currently exist in New Zealand.’
–Professional body

To move services closer to home, we need to redesign the way that services are delivered. We also need to make sure the health and disability workforce have the skills they need to provide a wider range of services in community settings.

For people who live in remote locations or are unable to reach health services, we can use other approaches to improve the quality of service they receive. For example, telehealth, mobile vans and outreach clinics can all put these people in touch with the care they need.

If we are to provide preventative services and services closer to home, we need to work with other agencies in health and across the wider social and community sectors. By working collaboratively, and with an investment approach (see the box on page 6), we can more effectively understand and respond to the needs of populations that may be under-served or have high needs. Some people in these groups will be dealing with a number of health and other services. For these people, we know that it is very important to coordinate services. For example, effective work between health services and the Accident Compensation Corporation (ACC) helps older people to live well and stay safe in their own homes after a fall.

‘Health starts at home and local service delivery is sensible for many health services, certainly those that focus on wellness and prevention.’
–Non-governmental organisation

We already have good examples of health services providing integrated services closer to home. Māori and Pacific models and approaches are among these, and there are opportunities to adopt them more widely to make primary care more accessible and affordable.

Māori organisations are uniquely placed to contribute to closer-to-home health care. They are geared to be responsive to their Māori owners, who are often the very community they serve, and are inherently people-centred. This is important as Māori (and also Pacific) adults are more likely than the adult population as a whole to say that they are unable to access primary health care services due to cost (see the table below).

  All Māori Pacific
Percentage of adults reporting unmet need for primary health care, 2013/14
Unable to visit GP due to cost 14% 22% 21%
Unable to visit after-hours clinic due to cost 7% 13% 11%
Unable to collect prescription due to cost 6% 13% 16%

Source: Annual Update of Key Results 2013/14: New Zealand Health Survey.

The Ngāti Hine Health Trust is establishing an Integrated Family Health Centre on site at the Bay of Islands Hospital. It will combine four GPs with Ngāti Hine’s tapuhi (community nursing), Well Child / Tamariki Ora, podiatry, adolescent, oral health, mental health, alcohol and drug, physiotherapy, cafeteria and social services all under the one umbrella. It especially aims to meet the needs of rangatahi, kuia and kaumātua. The Centre will provide streamlined services between the hospital and primary care, making use of a single reception area, a common information technology system and common support services.

‘Key tips for a warmer, drier home’ is an information toolkit to support conversations with families and whānau about steps to take for healthy housing, including keeping space between sleeping children. The Ministry of Health has developed it with the Energy Efficiency Conservation Authority (EECA) and the Health Promotion Agency and with input from Māori, Tongan and Samoan communities. The Ministry of Education is using the resource in its work with community groups associated with early childhood education centres.

Children, families and whānau

Early investment in the health and wellbeing of our children, parents, families and whānau sets the foundation for lifelong health.

New Zealand has a strong base of universal, community-based services that are generally available to all children and families. These include maternity, general practice, immunisation, Well Child / Tamariki Ora, B4 School Check, and community oral health services. We need to continue these services but also increase their use by people who usually have difficulty accessing them. In addition, we need to make better use of them as opportunities for health professionals to work with families to promote healthy development.

For children and young people who are struggling with health or social problems, it is important that they have access to services that will help them thrive and contribute positively to their communities. To provide such access, it will be important to take a social investment approach and coordinate activities across agencies.

He Korowai Oranga, the Māori Health Strategy, uses the concept of whānau ora to reflect its focus on whānau as self-managing, living healthy lifestyles and confidently participating in te ao Māori (the Māori world) and in society.

Children’s teams work locally to respond to the needs of individual children at risk by bringing together the best mix of practitioners, including teachers, doctors, social workers and iwi. This work is guided by the Government’s Children’s Action Plan and the Vulnerable Children Act 2014 as a joint initiative of the ministries of Health, Social Development and Education. Children’s teams aim to help children thrive, achieve and belong by working together as one team on one plan with the child at the centre.

Long-term conditions and obesity

Like other countries, New Zealand faces a growing burden on its health system from long-term health conditions such as heart disease, respiratory conditions, cancer, mental health conditions, diabetes and musculoskeletal conditions, which is partly influenced by rising obesity. Many of these conditions affect populations in different ways. For example, as the graph below shows, diabetes increases with age but is more common among Pacific, Indian and Māori peoples.

Prevalence of diabetes, by ethnic group and age, 2013

This graph shows the rates of diabetes for different ethnic groups. At 20 to 24 years of age, around 1% of people in all group have diabetes. This rises, to a peak at around 70 to 74 years for Indian and Pacific people, a peak at around 75 to79 years for Māori people, and a peak at around 80 to 84 years for European/other. The peak for Indian people is almost 50%. For Pacific people, it is around 47%. For Māori, it is around 34%, and for European/other it is just under 20%.
Source: Health and Independence Report 2015.
‘… public health initiatives,  especially initiatives to reduce the prevalence of smoking, combat obesity and reduce the harms associated with alcohol, are essential to better long-term health outcomes.’
–Māori health network

Population-based strategies can help to prevent long-term conditions, and make healthier choices easier for all New Zealanders. Such strategies include safe sport programmes, public education initiatives, and initiatives with industry to support workplace safety or label food products with relevant health information. One important example of preventative action is Smokefree 2025; the Government intends to put a range of measures in place to accelerate New Zealand’s progress towards the goal of making New Zealand smokefree.

‘“closer to home” is about knowing who your people are and knowing your services, and [providing services] in ways that are more accessible to those people.’
–Health sector workshop attendee

Primary care and community services can work together to better manage long-term conditions. We need to take advantage of this opportunity, by providing people with easier access to community services.

Finally, as people age, they are more likely to experience long-term and complex health conditions. We need to support our expanding population of older people to live well by providing respectful, responsive and person- centred services, including in the later stages  of life. We also need high-quality palliative care services available for those of all ages who need them.

Obesity rates have increased. From 2016, obesity is expected to overtake tobacco as the leading risk to health.1 Children living in socioeconomically deprived neighbourhoods are more likely to be obese. Obesity is a preventable risk factor for diabetes, cardiovascular problems, dementia, some cancers, mental illness and chronic pain. Children with obesity may have attention problems that make it more difficult for them to learn.

A trial to improve the health and wider social outcomes of people in Porirua started in 2013. With the specific goal of slowing the rate of admissions to emergency departments and hospitals, it worked to strengthen the coordination of local social and health agencies to address the cause of health problems in the community. Important health problems among children living in Porirua improved after the trial started: the number of children enrolled for dental care increased and admissions for skin infections among 5- to 14-year-olds dropped from 34 per year in 2012 to 11 in 2015. This trial empowered local leadership to deal with long-standing causes of health issues in the community.

What great could look like in 2026

This is our vision for services that are closer to home in 2026.

  • People are safe, well and healthy in their own homes, schools, workplaces and communities.
  • Our health system contributes to lifelong health and wellness through its support for parents, children, families, whānau and older people.
  • We have well-designed and integrated pathways for the common journeys people take through our health and disability system (eg, cancer, maternity, diabetes), starting and finishing in homes.
  • Our workforce in primary and community-based services has the capability and capacity to provide high-quality care as close to people’s homes as possible.
  • We have adapted the way our services are configured (at all levels) so that we can get efficiencies of scale where appropriate and take advantage of cross-government partnerships, as well as public and private partnerships.
  • Māori and Pacific health models, such as Whānau Ora and ‘by Pacific, for Pacific’ approaches, are used to provide effective and accessible care that is responsive to the needs of their communities.
  • We are good at identifying key health problems, preventing them or slowing their deterioration, and keeping people well. We provide early and well-coordinated care and rehabilitation for people with complex conditions, injuries or disabilities, as well as for frail older people, and for children and families with unmet needs.
  • The health system works effectively with other agencies to improve outcomes in areas such as housing, social development and corrections for all children and young people, and particularly those at risk. It works through strong community links with early childhood centres, schools, marae, churches, local authorities and other social service agencies.

1. See the Annual Update of Key Results 2014/15: New Zealand Health Survey and Health Loss in New Zealand: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study 2006–2016.

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