The Pokapū o te Taiwhenua Network is an exciting collaboration of health and wellbeing community providers, primary care and specialist care. The network, which sits within the Lakes District Health Board region, aims to close the technology gap so there is equal access to online health care. The initiative has a particular focus on groups who are currently excluded from using digitally-enabled health services.
The Pokapū vision is ‘Right care, right place, right time, right technology, right facilitation’. It seeks to use telehealth to make it easier for people to have appointments with GPs and specialists and reduce ‘did not attend’ rates. Pokapū facilitators walk alongside whānau and health and wellbeing providers, supporting the use of telehealth.
Jen Coatsworth, senior advisor and health service planner at Lakes DHB, says the network shows change is possible.
“It’s easy to be overwhelmed by inequities – the Pokapu o te Taiwhenua Network’s aspiration is making a positive impact for whānau in digital health equity. There is this huge appetite to do things differently, an appetite for innovation, and to provide options for whānau.
“For example, instead of people having to drive to appointments they choose video-telehealth. Instead of having to physically present at general practice or hospital, whānau have options to manage their health from home virtually through self-monitoring devices.
“There is a menu of virtual health care offerings which is constantly changing and growing – the Pokapū o te Taiwhenua Network is focused on making sure these offerings are available to those who most would benefit from them.
“Ultimately, it’s about supporting whānau to be digitally empowered. Not just to access health services, but online services more widely, such as online banking and grocery shopping.”
An initial focus for the network is supporting consumers who are offered and would like a health or wellbeing video appointment but don’t have the digital literacy or digital devices to do so. That support might be live video telehealth facilitation or simply a technology check in advance of the appointment.
The rural communities of Mangakino and Reporoa have been instrumental in the drive for digital health equity and the development of the initiative. The Pokapū Network includes Mangakino Orangatanga and Te Arawa Whānau Ora from Mangakino and Ngati Tahu Ngati Whaoa Whare Hauora from Reporoa.
Leanne Karauna (Te Arawa Whānau Ora) and Sue Westbrook (Ngati Tahu Ngati Whaoa Runanga Trust) both see huge opportunities for Pokapū to give whānau much greater choice about how they access health care services.
Sue Westbrook says the COVID lockdown showed very clearly the importance of having a choice of online or face-to-face care.
“Our elderly don’t generally have access to digital communication. Their only real way of getting information is through the TV and the phone. Internet isn’t really something they are interested in. Their main concern is having power and heating.
“During COVID there was confusion, people were worried, our kaumatua felt isolated. They had a lot of questions. COVID brought back memories of previous illnesses that had affected whānau – losing siblings or relatives, in those older times.”
She says, even pre-COVID, having to go to face-to-face appointments was a barrier for people living in this rural community.
“It’s about 30 to 40 minutes from Reporoa to Taupō and about the same to Rotorua. People have to find someone to take them into town, and they don’t want to be a bother. They know the person will then have to stay around while the appointment is happening.
“Sometimes whānau wait so long before going to see a doctor that their condition becomes more serious, and they need to be admitted to hospital.”
Having the option of telehealth means people can have the consultation at home, in their own environment, she says.
“They can have it in a place where they feel comfortable, they don’t feel that they’re being a bother, they have that sense of home and safety. They can also have family or a friend with them, to help them decipher some of the clinical information.”
Leanne Karauna says one of the most exciting things about the development of Pokapū o te Taiwhenua is that it is community- and whānau-driven.
“It feels like this is the DHB and us all working together for the betterment of our communities. It’s something new, it’s something a little bit brave, it’s something we are being trusted to help develop and roll out in our own right.
“We don’t often as communities get asked what we want, how we want to do things, how do we see things? That in itself has been an amazing journey. The DHB came to our marae and said ‘what do Mangakino people want?’ The response loud and clear was that we needed better access to health services.”
She sees the network as providing tools for better managing whānau health.
“It’s about removing the barriers – addressing those inequities that exist, and preventing them happening.
“One of the big things I’ve said from the beginning is that this is a choice. Therein lies the tino rangatiratanga of it – telehealth is not the replacement, it is a choice. Because we still have our kaumatua and elderly people who like to go and meet with the specialists. But at least they have a choice that day.
“I’ve seen the gaps with whānau I’ve worked with who miss an appointment and then they’re dropped off the list. It’s keeping whānau informed, it’s keeping them close, it’s giving them access to more easily manage their own health.”
Sue and Leanne mihi to kaumātua Eru George, who named the Pokapū o te Taiwhenua Network and has now passed; and to Jen Coatsworth for her passion and commitment.
Jen says the COVID-19 experience laid bare the need to close the divide for digitally isolated whānau and communities.
“COVID was a scary experience. The message was ‘stay in your homes, monitor your health, interaction with health services is virtual first’. We learnt that we needed a lot of
strategies and processes to support virtual health care. Primarily, we needed to support whānau who were inhibited by digital exclusion – they didn’t have access to the internet, or digital devices to connect with.
“We want to walk alongside whānau to the point where they have can actively manage their health from home using virtual tools and technology.”
Jen says one of the challenges she can see with Pokapū is keeping it at a manageable size.
“There is so much great stuff happening, so much potential. We don’t want Pokapū to get so big that our Māori providers and our relationships in the community disconnect – they are the heart and soul of this kaupapa.”
Pokapū is supported by the Ministry of Health and its Digital Enablement Oversight Group – one of a number of initiatives being supported that focus on improving digital equity. Funding is one-off, to test the Pokapū model of telehealth facilitation. The next step for the network is to embed the Pokapū model, or do a business case for further, sustainable funding.
Jen says the initiative isn’t as straight forward as it may appear!
“It’s really a monumental effort. It sounds simple, but you have to get everything in alignment. As one of the team says – it’s like the sport of curling, where you have people standing alongside with brooms trying to smooth out the surface to get that stone into the target. That has to be done, not just for clinicians but for the community, and whānau.”