Page 93 - Regional Services Plan 2016/19

Table 6: Future trends affecting healthcare provision
Type of Change
Prevention & health promotion
Primary care & early intervention
Secondary care- elective and acute
Rehabilitation, home support & palliative care
Technology
Technological advances in fields such as:
 Genomics
 Imaging
 Diagnostics
 Pharmaceuticals  Medical devices  Nanotechnology  Telehealth & IT
Preventative technologies,
for example, new vaccines, such as Gardasil (HPV vaccine) will reduce demand for some services (such as cancer and screening services), while increasing demand for other services (such as vaccine services).
Screening programmes to identify genetic predispositions to common conditions (e.g. heart disease, diabetes) may be introduced.
Screening and early detection initiatives, for
example, for bowel cancer screening programmes, may reduce demand for treatment services, while improvements in clinical imaging technologies will result in increased provision of those services.
The use of near patient testing is likely to increase. Genomics will require additional knowledge of a new set of tests and will introduce ethical complications about predictive testing.
Information systems will allow easy access to health records from home and consumers will expect email/videoconference options to contact their primary care provider.
Expanding treatment options are likely to
result in the provision of more complex and
expensive treatments and procedures.
An Australian report calculates that technology changes have accounted for a third of the increase in real health expenditure in Australia over the last decade. Average length of stay declined more than 50% between 1989 and 2006, and while improving treatments will continue to reduce ALOS, the older age of patients will work to counteract this trend. Minimally invasive surgery will result in more use of day case surgery.
Improvements in tele-health and
improvements in remote access to health records may assist health professionals in managing the expected increases in those requiring care at home.
Technological advances together with reduced cardiac and accident mortality mean that people with incurable diseases are likely to survive for longer, resulting in increased demand for palliative care services.
Models of care
Changing models of care incl:
 Integrated family health centres
 Clarification of roles/functions of small rural hospitals
 Strengthening of secondary services with increasing nursing specialization
 Use of specialty centres
 Greater integration of Māori models of care
Health promotion and prevention services maybe integrated to a greater extent in primary care settings in future.
Future trends in changing models of care include using the workforce more efficiently, ensuring that GPs and nurses only see patients when necessary. For example, healthcare assistants providing health education for patients with long-term conditions. Improved coordination and potential shifts of secondary care services to primary care setting will result in GPs having better access to diagnostics, and undertaking more simple procedures such as minor surgery.
New practitioner roles may emerge – nurse endoscopist, physician assistant, nurse anaesthetist, etc. resulting in more multidisciplinary service provision. Volume – outcome relationships will drive greater aggregation of volumes in larger centres. However, changes in location of activity are unlikely to have a major impact on demand for specialist services overall, although potential shifts of secondary services to primary care may free up specialist time for more complex work.
Encouraging people to remain living in their homes for as long as possible and self-managing healthcare, with support from allied health and primary care professionals, is preferred model of care for the elderly, aimed at improving quality of life. Home care and rehabilitation services are becoming more integrated with primary care, to provide patients with seamless care. Increased communication between primary care and workers within the community is key to this change.
Workforce changes
 Ageing & retiring workforce
 Reduced willingness to work
antisocial hours
 More part time employees
 Increased subspecialisation
 Changing workforce roles
Providing lifestyle advice and improving health literacy may become a greater part of most clinical roles.
Willingness to provide after-hours services may continue to decline. Ability to support rural towns and rural hospital services may also decline. Services may retrench to urban areas.
Increased specialisation may erode the ability of small hospitals to provide 24/7 surgical services, unless generalist approach can be strengthened. Workforce shortages likely to be supplemented with international recruitment, but increasing awareness of importance of ‘grow your own’ recruitment programmes will counterbalance this.
Workforce shortages are likely to be plugged with international recruitment.
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