What if local community hubs could lift national health outcomes?

By catalysing Community Health Hubs, the government could increase access, lower costs over time, and improve health outcomes for Kiwis.

In brief

• In New Zealand’s current healthcare market, patients who could receive community-based care are ending up in already over-worked hospitals.
• Community Health Hubs could take the pressure off hospital waiting lists, releasing capacity so more care can be provided, including in rural communities.
• The government can play a key role in creating the right market incentives for the private and philanthropic sectors to deliver these hubs at scale, through workforce strategy and by supporting limited investment to stimulate hub creation.

New Zealanders continue to experience long wait times for GP appointments and specialist treatment, with 39% waiting for more than four months to see a specialist.1 These delays can result in people ending up in hospitals unnecessarily when an untreated minor issue becomes more serious.

The result is hospitals being clogged with tens of thousands of minor procedures that could safely be performed elsewhere. It also means many medical teams are experiencing COVID-19-style levels of burnout as they struggle to find the time to care for patients who require in-hospital treatment.

Community Health Hubs could ease the pressure

In New Zealand’s urban and provincial areas, community-based clinical hubs offering integrated care could provide faster care in more accessible environments while taking pressure off hospital capacity. Community Health Hubs reflect the communities they serve and support people to get appointments more quickly in more convenient locations, closer to home. They can also provide for greater digital connectivity – allowing specialists from across the country to see patients virtually while they are in an environment that allows for diagnostic testing. The result is an increase in access to care and adherence to treatment plans, leading to better health outcomes.

Hub design can be wide-ranging, offering combinations of primary, specialist, diagnostic Whānau Ora, and social services, depending on community needs. With co-located services, people can get a blood test done, see a specialist, have an ECG or an X-Ray, or see a dietitian or physio, kaiāwhina or kaupapa Māori service in the same place they see their GP. For example, hubs can be:

1. Locality-based: centred around primary and community care, with diagnostics and interventional care, and visiting hospital specialists, potentially including urgent care.
2. Specialist: centred around “decanted” secondary care, potentially including urgent care and/or be focussed on planned or regular care.
3. Integrated: including primary, community and secondary care, delivered in an interdisciplinary environment.
4. As a hub for virtual care: a physical location where hybrid care can be provided – with virtual specialist consults and in-person diagnostics allows for more efficient and effective treatment for a comprehensive range of health conditions.

Improving outcomes across the healthcare system

Overseas community hub models, including in Ireland, Slovenia, Australia, the US and the UK, have consistently succeeded in:

• Freeing up hospital surgical time: Community Health Hubs are good at taking demand out of the hospital system. International experience suggests the procedure load in hospitals could be reduced by up to 30%. In one study, using Child Health GP Hubs avoided 39% of new patient hospital appointments.2 In New Zealand, 70,000 minor surgical and 21,000 endoscopy procedures are conducted each year in hospital. We estimate that moving them to community hubs would release 45,000 hours of hospital theatre time for elective surgeries – the equivalent of adding 28 surgical theatres to our existing hospital infrastructure. Considering in-hospital costs, conducting 21,000 endoscopies in the community would release sufficient funds to perform an additional 2,400 elective hip replacements or 840 emergency coronary artery bypass grafts.

• Improving health outcomes for all: Treating simpler and less complex cases at community hubs can free up clinical time and resources in hospital settings, enabling the healthcare workforce to focus on more complex cases. Community hubs can also present integrated care in an environment reflective of community needs, increasing patient compliance and supporting better health outcomes, particularly for Māori and Pasifika.

• Better health and less wasted time: a win-win: International evidence suggests community hubs can reduce appointment non-attendance rates by 2-3% overall, by cutting the time and effort that patients need to invest to see specialists and get tests done. In New Zealand, 7-8% of people miss a scheduled specialist appointment, which can contribute to worse longer-term health and wasted specialist time. Reducing the drop-out rate would not only result in better care, but also release more than 3,000 hours of time for our overloaded specialists.

•  An opportunity for lower cost care: Community Health Hubs offer an opportunity to provide a lower cost means of expanding access to the health system, while attracting private, philanthropic, iwi and other investment. Hubs are present an opportunity to provide care at scale, reducing costs by leveraging shared facilities and equipment.

But Community Health Hubs will not form routinely on their own

New Zealand has a history of investing in innovative community health and integrated service delivery models, with some facilities that mimic the community hubs model already in place, but these have frequently been more rural settings to provide less acute care and reduce demand on hospitals. Hubs have sometimes emerged out of necessity, as happened in Christchurch when earthquakes decimated a significant amount of existing clinical space. It also occurred – briefly – in the late 2000s when some DHBs took the opportunity to drive investment in Integrated Family Health Centres.

This opportunity is different and requires a different approach: this model envisions community hubs that deliver primary and specialist care and incorporate virtual care models, providing a platform for an integrated health care experience where primary, specialist, and diagnostic care is more available to more people from one place.

Organised at scale with clear investment mechanisms, Community Health Hubs could also become recipients of private capital. But this will not happen without Government support – financial and non-financial. Systemic barriers, different and disconnected funding models, and the degree of risk mean community hubs are unlikely to naturally self-form at scale. In short, widespread progress is unlikely unless there is greater support for health and medical professionals to access the specialist funding, business development support, and property expertise needed.

Government can catalyse both Community Hub investment and formation

A workforce strategy that invests deliberately in community hubs, and capital planning and investment that makes them a priority will be key to their success, but Government support need not involve a large financial commitment. De-risking investment, channelling care funding into community hubs and providing comparatively small amounts of seed funding can have an outsized impact on hub formation. Reducing barriers to investment can draw in private investment and private capital – multiplying the impacts of investment. In practice, this can involve: