My View: Now is the time for Change

Return to eHealthNews.nz home page

Guest column by HiNZ Chair Rebecca George

Occupational therapist and HiNZ board chair Rebecca George argues  that now is the time to change the public health sector’s reactive model of service delivery to provide early and timely intervention.

Within our public health sector, we operate under a model of service delivery commonly described as the ‘ambulance at the bottom of the cliff’. This usually evokes images of urgency, reactive action, and crisis management. The dedicated and highly trained health staff responding to a community of people in need, in a timely and expert manner. This model of service delivery is a reactive model, responding to health events and incidents that occur ‘unpredictably’. It is premised on ensuring that those facilities providing this response are operationally managed to provide swift service and fix the immediate problem.

This model needs to change, the image needs to be re-drawn. We need to shift our health service provision to the top of the cliff, to early and timely intervention. We need to focus on meeting needs where they occur and provide them in a timely manner. We need to utilise the full breadth of Allied Health professions, who already have the skills and training, to support the prevention of deterioration and crisis. 

The New Zealand government has invested over recent years, in partnership with the District Health Boards (DHBs), to ensure that people admitted to hospital are managed swiftly, leaning heavily on operational outcome measures to identify success. Patients are moved into streams of health rehabilitation or back into the community with support where appropriate, to manage the identified concern. They are urged back to the top of the cliff again you could say.

The collective of professions that congregate under the term Allied Health have long played a part in this reactive model. However, a number of the professions including; Physiotherapy, Social Work and Occupational Therapy among others, have straddled their delivery model between the top and the bottom of the cliff. Their practice philosophies and theoretical frameworks are based on the knowledge of beneficially preventative intervention and sustainable recovery. They recognise the significance and value that prevention and pro-action has over reaction and response after the event.

Despite this being theoretically obvious, measuring the impact of preventative intervention against reactive treatment is difficult. This is why Allied Health clinicians have had a tough time evidentially proving the return on investment that they would be able to provide if their services were provided at the top of the cliff.  Identifying those at risk in the community via primary care services i.e. General Practitioners (GPs) and Pharmacies would lead to environmental, physical and social changes before a situation deteriorates and a crisis occurs. It would impact on health service costs and social support dependency whilst benefitting community health, economic participation and the individual’s physical and mental wellbeing.

With the emergence of the COVID-19 Pandemic we have been presented with an extraordinary opportunity. Awareness is emerging that there will be a need to address a coming wave of chronically ill and vulnerable people who are isolating at home and at risk. Now more than ever, this cohort of vulnerable people need to be supported to remain well and be kept out of hospital.

Some DHBs have responded to the pandemic already and changed their models of service delivery to increase the integration of services and make them more accessible. One example provided has been the creation of pathways to triage patients by GPs, Pharmacies and provide quick access to Allied Health clinicians. This integrated care system approach is well known across New Zealand, we have a unique demographic platform on which to evolve it. The Kings Fund promotes integrated care as a way to break down service barriers and have a significant impact on population health. Right now, sustaining the health of our population is more important than ever.

Why not take it further though, establish allied health clinicians within primary care services in the community; supporting triage and providing intervention? If we can identify, assess and provide the appropriate intervention to the vulnerable or chronically ill, they will be empowered to sustain their own health, physical and mental wellbeing.

Due to COVID-19, models of service delivery have had to change. Providing services via Telehealth has taken off over the last few weeks. More than 2000 registered Allied Health (AH) practitioners in New Zealand, working across public and private services, have had to rapidly shift to providing telehealth care.

People are receiving; rehabilitation for stroke recovery; advice on swallowing and feeding; environmental guidance and physical exercise prescription all via screens and/or phones. Clinical digital literacy needs have been urgently met, guidance drafted, and ongoing training platforms developed. If we can see the benefit of community connection now, why not maximise the model for health intervention and crisis avoidance?

Allied Health clinicians have embraced the digital shift and are creatively meeting the needs of their clients at home. If we could extend the triage capability and support those at risk of deterioration more, often the subsequent intervention could make the difference between life or death. The prevention of a fall, deconditioning or deterioration in health can have significant positive impact on both the person and their family.  

Conversely the negative impact can be life changing and life limiting. If we persist in providing the existing model, reacting to crisis and health events, there will be continuing growth in dependency on health care and support services. This will mean rising costs to the government and the public; it will perpetuate an imbalanced partnership with recipient consumers.

If we were to establish early intervention services across our communities, why not sustain it beyond this immediate opportunity? The use of telehealth to complement face to face contacts would provide efficiencies and enable population-based health initiatives to reach significant numbers. If Joe Wicks can reach 2.2million subscribers and provide physical health advice, why don’t we re-think our national outreach initiatives? 

Our Director General of Health, Ashley Bloomfield stated recently that leadership is a ‘call for collective action’ – I believe that we need to use the current leadership and the opportunity for change to take collective action. Now more than ever we need to change the image of the ambulance at the bottom of the cliff and create a network of integrated health hubs at the top of cliff.  Allied Health clinicians are poised and ready – lets change the face of healthcare and put our communities first.

Rebecca George is a registered Occupational Therapist, a Clinical Informatician and Chair of the HiNZ Board.

If you want to contact eHealthNews.nz regarding this View, please email the editor Rebecca McBeth.

Read more views/CIO Interviews:

Kevin Ross: Industry View: What’s in a model?

Christopher Dawson: Industry View: Safe harbours or cruise ships?

Return to eHealthNews.nz home page