T E R T I A R Y E D U C A T I O N R E P O R T : C A B I N E T P A P E R O N T H E S C H O O L O F R U R A L M E D I C I N E
Recommendations
Hon Chris Hipkins, Minister of Education
It is recommended that you:
1.
forward this briefing and draft Cabinet paper to the Minister of Health for his comment and
agreement; and
2.
agree that the Tertiary Education Commission release this briefing and the associated Cabinet
paper (potentially with some minor redactions for commercial sensitivity reasons), once it has
been considered by you and a decision has been made by Cabinet.
AGREED / NOT AGREED
p.p.
Tim Fowler
Chief Executive,
Tertiary Education Commission
10 April 2018
Hon Chris Hipkins
Minister of Education
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T E R T I A R Y E D U C A T I O N R E P O R T : C A B I N E T P A P E R O N T H E S C H O O L O F R U R A L M E D I C I N E
Purpose
1. This briefing summarises the accompanying draft Cabinet paper for your consideration. As per
your request, the Cabinet paper recommends rescinding the previous Government’s decision
to establish a School of Rural Health, which we have previously briefed you about1, and
replace it with a wider programme of work to address the issues associated with access to
health care.
Background
2. There have been two recent proposals which attempt to address issues in rural health care.
The first is from the University of Waikato and the Waikato District Health Board (DHB), which
proposes establishing a new post-graduate entry medical school. The second is from the
University of Auckland and University of Otago, which proposes establishing a National School
of Rural Health.
3. In September 2017, whilst both proposals were under consideration, Cabinet agreed in
principle to establish a School of Rural Medicine [CAB -17-MIN-0464 refers] through a
competitive tender process. The tender process was designed to ensure the best outcomes for
a School of Rural Medicine, which would not necessarily be either of the existing proposals.
The main purpose of the School of Rural Medicine was to address some of the issues with
rural health provision.
4. Reflecting discussions with your Ministerial colleagues, the attached Cabinet paper
recommends that Cabinet rescind the decision to establish a School of Rural Medicine in
favour of supporting a wider programme of work to address the issues associated with access
to health care, and the lack of availability of health professionals in some rural areas.
The rationale for rescinding the decision to establish a School of Rural
Medicine
A School of Rural Medicine is unlikely to address all the causes of rural health
workforce issues
5. There is a shortage of health professionals working in rural areas. Rural practice is
unattractive for a variety of reasons including: a lack of opportunities for spouses and families;
perceptions of long hours and low pay; and, a lack of infrastructure, opportunities and facilities
for families. In addition, those that initially select a rural career often report a lack of support
and training opportunities, which ultimately affects retention of rural staff.
6. Although a School of Rural Medicine could address attraction through positive profiling of rural
practice to new graduates, providing experience in a rural setting and highlighting its
importance in the health system, international evidence suggests it will only partially influence
graduates decision to try and remain in rural practice. In particular, addressing issues affecting
retention will need a variety of initiatives that are largely outside the scope of education.
The value proposition is uncertain
7. The Waikato proposal is very costly and although the Auckland/Otago proposal is significantly
cheaper, officials are of the opinion that costs to Government could easily escalate.
1 B17/00840 Next steps in the establishment of a School of Rural Medicine. 21 November 2017.
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8. International studies have showed that experience of practising in a rural setting during training
does encourage a small proportion of more graduates into rural practice. However, without the
wider support it is not certain that graduates selecting a rural career would be retained in the
long-term.
There are other possible solutions
9. There are a wide range of other possible alternative strategies that could be used, which may
be cheaper and more effective. For example: better support for existing practitioners by
providing locums to cover out of hours and emergency work; continuing professional
development and holidays; funding changes to provide sole transport costs; and, community
and social support for families of practitioners. These would all contribute to making a rural
career attractive and address factors affecting retention.
Alternative proposals
10. The Ministry of Health proposes developing a wider programme of actions to address the
issues associated with access to health care, and the lack of availability of health professionals
in some rural areas.
11. The Ministry of Health is in the very early stages of developing modelling frameworks on which
to base its programme of work and has outlined its next steps, including sector consultation in
the draft Cabinet paper. More work is required to refine the details of its plans and complete
the steps required to provide Ministers with its work programme in October 2018. This is
outlined in the Cabinet paper.
Consultation on the Cabinet paper
12. The draft Cabinet paper has largely been drafted by the Tertiary Education Commission. The
Ministry of Health provided information about the alternative programme of work it is proposing
and data from Health Workforce New Zealand. The Ministry also provided all of the content on
the alternative work programme (paragraphs 38-46)
13. We have consulted with and included comments made by the Treasury, the Ministry of
Education, and the Ministry of Business, Innovation and Employment (MBIE), which has
provided comment on regional economic development aspects. The Department of the Prime
Minister and Cabinet (DPMC) has been informed.
Public release of the paper
14. We propose that this briefing be published, alongside the Cabinet paper, once a decision has
been made by Cabinet.
15. We recommend redacting commercially sensitive information relating the Auckland/Otago
proposal and the Waikato proposal after consultation with the Universities.
Next steps
16. Once you have reviewed the draft Cabinet paper and we have addressed any questions you
have, please forward a copy of the Cabinet paper to the Minister of Health for his comment and
agreement. A covering letter for this purpose is attached in Appendix 1.
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17. Once this has been completed, we recommend consulting with other relevent Ministers,
including the Minister of Finance, prior to lodging it for consideration by the Social Wellbeing
Cabinet Committee.
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Appendix 1 – Draft covering letter to send to the Minister of Health
Hon Dr David Clark
Minister of Health
PARLIAMENT BUILDINGS
Dear David
Cabinet paper to rescind the previous Government’s decision to establish a School of Rural
Medicine
I attach a draft Cabinet paper which recommends rescinding the previous Government’s decision
to establish a School of Rural Health and replacing it with a wider programme of work to address
the issues associated with access to health care, and the lack of availability of health professionals
in some rural areas. This follows our recent discussions.
The Cabinet paper has been drafted by the Tertiary Education Commission. The Ministry of Health
has provided information about the alternative programme of work it is proposing to lead.
Please let me know if you have any comments on the paper by 23 April 2018. Once you have
approved the paper, I aim to get it to Cabinet Social Wellbeing Committee on 26 April 2018.
This briefing incorporates comment from the Treasury, the Ministry of Education, and the Ministry
of Business, Innovation and Employment. The Department of Prime Minister and Cabinet has been
informed.
I look forward to discussing with you how the Education portfolio can contribute to progressing the
Ministry of Health’s work programme, and the broader issues of the rural health workforce.
Yours sincerely
Chris Hipkins
Minister of Education
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