The West Coast District Health Board (DHB) is one of twenty DHBs charged by the Crown with improving, promoting and protecting the health and independence of their resident populations.
The West Coast DHB has the smallest population of any DHB in New Zealand. We are responsible for 32,410 people, 0.6% of the total New Zealand population. We own and manage three major health facilities in Greymouth, Westport, and Reefton and five general practices across the West Coast.
We are a major employer, with over 1,000 people employed across our hospital and primary care services. We also hold and monitor more than 40 service contracts with other organisations and individuals, who provide health and disability services to our population. This includes the West Coast PHO.
On the West Coast in 2019/20 there were over 11,900 presentations at the Grey Hospital Emergency Department, 12,700 specialist outpatient and minor operation appointments and 129,677 general practice consultations at private- and DHB-owned primary care practices within the PHO.
We also delivered 246 babies, provided 1,546 elective and 422 acute surgeries, and over 6,000 primary-referred radiology tests.
While we are the smallest DHB by population, we have the third largest geographical area, making the West Coast DHB the most sparsely populated DHB in the country with only 1.4 people per square kilometre.
Our district extends from Karamea in the north, to Jackson Bay in the south, and Otira in the east. It comprises three Territorial Local Authorities: Buller, Grey, and Westland districts. Grey district has the largest population, with an estimated resident population of 13,750 people.
Like all DHBs, we receive funding from Government with which to purchase and provide the services required to meet the needs of our population, and we are expected to operate within allocated funding.
In 2020/21 we will receive approximately $163 million to meet the needs of our population of services across our health system, both locally and through tertiary services provided at other DHBs. In line with legislation we use our funding to:
Our DHB team of just over 1,000 people, and all the others working together in the West Coast Health Alliance, put their hearts and souls into making a difference for the people on the West Coast.
As residents of the Coast, we recognise the importance of good access to general practice services, to hospitals and specialists, to oral care and to mental health services; for ourselves, our family, our friends and neighbours, our colleagues and people we see in the streets.
Collectively, we are involved in several projects focused on specific service improvements.
When we are thinking about better ways to keep our older folk safe and well at home, we are talking about our mums and dads and aunts and uncles and grandparents, or those of our friends and neighbours. So much of what we hear back from people is how wonderful staff have been, how caring and compassionate, how attentive and enquiring. Of course there are also times when we make mistakes, and our system encourages us to speak up so we can learn and find ways to avoid making them again.
We work closely with our transalpine colleagues in Canterbury, and many departments span both Coasts. We can draw on the best specialists available, either through appointments on the Coast, or helping people to get to appointments in Canterbury. We are intently focused on increasing the number of services available on the Coast where it’s feasible, so people don’t have to spend time and money getting over to Christchurch. We proactively support the use of telehealth, both transalpine and up and down the Coast itself – where it is clinically safe and useful for our patients.
Our vision is to have the patient at the centre of our system, and this means we have to be creative to find ways that our health system can be flexible, sustainable and provide the right care, in the right place at the right time. A health system that centres care around the individual, reducing the need for multiple visits, increasing access to care through the use of technology, and wrapping services around the patient through a single integrated service model.
Like many small DHBs, population numbers on the West Coast cannot support provision of a full range of specialist services. In some instances, we must refer patients to larger centres with more specialised capacity.
Since 2010, West Coast DHB has shared executive and clinical services with the Canterbury DHB. This includes a joint Chief Executive and clinical directors, as well as shared public health and corporate service teams.
While the West Coast has always had informal clinical arrangements with the Canterbury DHB, the shared model has allowed these to be formalised through clinically-led transalpine service pathways. This formal arrangement enables the West Coast DHB to develop the workforce and infrastructure needed to ensure we can meet the needs of our population, in a clinically and financially sustainable way.
Canterbury specialists now provide regular outpatient clinics and surgical lists on the West Coast. Deliberate investment in telemedicine technology is also improving access to specialist advice while saving families the inconvenience of travelling long distances for assessment and treatment.
488 West Coast patients had their specialist appointments using telehealth technology in 2019/20, saving patients in time and cost of travel to get to appointments at Te Nikau Hospital & Health Centre in Greymouth or further afield to Christchurch.
The West Coast Alliance is a collective of healthcare leaders, professionals and providers from across the health system, backed by formal commitment to work together. The Alliance provides leadership to the transformation of the West Coast health system on behalf of the community.
The Alliance Leadership Team has leaders from across the health system with specific and relevant competencies and perspectives. Through the Alliance, the West Coast’s healthcare providers operate collaboratively through clinically led workstreams. Their aim is to deliver better health outcomes by exploring new service delivery approaches that provide healthcare in the community and closer to people’s homes.
We have continued the work that needs to happen as we have transitioned to our new integrated health facility Te Nīkau Hospital & Health Centre in late 2020 . Notably we merged our two DHB-owned general practices in Greymouth so they now work together as and are based in Te Nikau.
In Buller, we are well underway with the construction project which will see our new purpose-designed Buller Health facility due to being built during 2021.
These facilities are the building blocks. The people who work in them depend very much on the work going on in community settings. We have strengthened our home-based support services teams; our allied health and district nursing professionals are travelling to deliver health care closer to home; plus, we’re increasing our use of telehealth so it’s not costing our patients as much in time and money to travel to appointments.
We are focused on looking at how we deliver the health of older people across the Coast, how we support people to stay at home, and ways to empower people to keep themselves well. Our diversional therapists are actively working with people previously isolated at home, to get them active and back in touch with their communities. We continue to work with residents and their families to come up with solutions that work for them, within the options we have available.
The vision for the West Coast health system is one born out of past experience and collective clarity around the future challenges we face. Developed with input from our partner organisations, staff and community – our vision is already guiding the decisions we make and the actions we take as an organisation.
Our vision is of an integrated West Coast health system that is both clinically and financially viable, a health system that wraps care around the patient and helps people to stay well in their own community.
At the centre of this vision is our community; our whānau; our patients. The foundational goal is that future health services on the West Coast will be:
People-centred: This means services will be focused on meeting people’s needs and will value their time as an important resource. We will minimise waiting times and reduce the need for people to attend services at multiple locations or times, or far from home, unless there are good clinical reasons to do so.
While this provides our foundation, further clarity is required to guide our decisions and actions and ensure success in developing a truly person-centred service. To this end, our vision also provides us with clarity in how we will achieve this. This clarity will be critical as our teams and our people face complex decisions on determining the future of our health system.
Future health services on the West Coast will be:
Integrated: This means the most appropriate health professional will be available and able to provide care where and when it is needed. Services will be supported by the timely flow of information to enable clinical decision-making at the point of care.
Based on a single system: This means services and providers will work in a mutually supportive way for the same purpose, to support people to stay well. Resources will be flexible both across services and across the wider West Coast health system.
Viable: This means our health system will achieve levels of efficiency and productivity that will allow an appropriate range of services to be sustainably maintained. There will also be a stable workforce of health professionals in place to provide these services.
Meeting the health needs of the West Coast population is a complex business, further complicated by the challenges of delivering health services to a relatively small population over a large geographical area.
While many of the challenges we face are the same as other DHBs, our biggest challenge is our rurality.
The total land area we cover is 23,283 square kilometres but our population is just 0.6% of New Zealand’s total population. Geographically we are the third largest DHB in the country but the most sparsely populated, with a population density of just 1.4 people per square kilometre.
Our geography creates significant challenges, often requiring patients or health professionals to travel long distances to receive or deliver services. This magnifies operating the pressures we face and means that we must consider all our other challenges with this overarching factor in mind.
Workforce challenges: Our workforce is relatively small, but must provide a broad range of complex services at a consistently high standard. In our rurally isolated environment we face significant difficulties in recruiting and retaining a suitable health workforce.
Facility pressures: A number of our current health facilities are outdated, inefficient and expensive to maintain. Many are poorly located and do not support the model of care needed to deliver our vision. Careful consideration must be given to the long-term future of all the facilities we own and operate.
Fiscal pressures: Meeting growing service demand, increasing treatment and infrastructure costs, and expectations around wages and salary increases is an ongoing challenge. We are also balancing community expectations regarding access to new and complex services in a small rural environment.
In meeting these challenges the West Coast will become a leader in the provision of rural health services: identifying opportunities to add value, reducing duplication across our system, and redirecting funding into services that will provide the greatest return in terms of health gain.
We have taken important steps towards enabling our vision, including connecting clinical information systems, establishing shared transalpine pathways with the Canterbury DHB, introducing the Complex Clinical Care Network and commencing the development of Integrated Family Health Services.
We have been deliberately investing in a rural generalist model, a proven strategy for creating a more integrated and sustainable workforce in more remote rural health systems. It involves all professions – medical, nursing, midwifery and allied health – working to the full extent of their scope of practice as members of a multi-disciplinary team. A rural generalist doctor, for example, may be qualified to work in both general practice and hospital settings with a speciality in obstetrics or anaesthetics. They would also be supported by local and Christchurch-based specialists, enhancing the capacity, capability and resilience of our health system.
Developing a core workforce of rural generalists will improve the sustainability of services, support a more integrated model of care and provide continuity of care for our population. By improving service access, it will also help us to support people to stay well, reduce health inequities and improve health outcomes – all key goals for our health system.
As part of the expansion of their scope of key clinical roles, professionals can access education and leadership training.
The West Coast DHB will always need to refer people to larger centres for highly specialised care, such as: neurosurgery, forensic services, some cardiac care and cancer treatments, specialised burns treatments and neo-natal intensive care.
The following critical success factors are the strategic components needed for us to achieve our vision and become a leader in the provision of rural health services.
The integration of services to improve patient flow:
Page last updated: 8 December 2020
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