For a long time, the people running the Waitaki District Health Service argued it needed more funding for beds and its emergency department, which was seeing nearly twice the number of people it was funded to see.
It was those two issues hospital management highlighted in the lead-up to a now resolved funding dispute with the Southern District Health Board (SDHB) that lasted more than a year.
Now a contract has been signed, the hospital’s management team has changed tack and has a plan it says "shifts focus" from what the hospital needs to what patients need — it looks across the entire service rather than just where pressure on beds and the emergency department can be reduced.
This new "model of care" proposes a "whole raft of ideas", says WDHS chief executive Robert Gonzales, though pressure on bed numbers remains a "very real" issue.
The plan aims to reduce admissions and readmissions, and inappropriate attendances, strengthening "the community side of things" so people would be cared for as long as possible in their own homes and come to the hospital only when they actually needed that service the most.
It would investigate any barriers to people being discharged in a timely manner, and why people might keep turning back up at hospital.
"And then, what things do we need to put in place to prevent those?"
The new plan says ED will remain open and staffed twenty-four hours a day, seven days a week.
But the "emergency department for emergencies only is one of the main switches", Mr Gonzales said.
Recommended changes include a sign at ED advising patients to go to their doctor if their situation is not urgent and providing the name, phone number and address of the on-duty general practitioner, noting there would be a waiting time to be seen.
The plan also recommends considering whether to have a general practitioner "co-located with ED to assist with triage".
"It would be new," Mr Gonzales said.
"I think at rural hospitals there is always that possibility and opportunity for integration with primary health, primary care. And so it’s not a new idea; in fact, if you look at a number of rural hospitals around the country, co-located, or co-existing, with GP practices is becoming more and more of a common flavour.
"Oamaru Hospital, of course, is an area where that is an opportunity and will remain to be in the future.
"It’s a decision our community would need to make on our own."
WDHS chairman Chris Swann said the plan was created by seven people representing the SDHB, Oamaru Hospital and the community, "and then there was consultation".
Among its goals for the 2017-18 financial year are: to put in place pilot projects for services aimed at keeping people out of hospital; to ensure patients and their families understand why they are being referred from primary care to a specialist, how to make appointments and what to do after being treated; to "fast forward" the introduction of technology; and a notable reduction in patients’ travel.
Whether there was enough funding to run the system as developed under the plan would be reviewed, Mr Swann said.
The new contract with the SDHB is for five years and the first year’s funding is set at just over $10 million.
Subsequent years’ funding will be reviewed annually and determined as the plan, whose progress will be reviewed quarterly, is put in place.
WDHS is owned by the Waitaki District Council. In its consolidated financial statements for the year ended June 30, 2016, it reported about 80% of its funding came from the SDHB.
Waitaki Mayor Gary Kircher said if patients’ experiences at the hospital or in the community improved, that would mean the plan was working.
"A lot of people currently have really good experiences when they go to Oamaru Hospital and certainly there are a number that don’t; we get to hear both sides of that. The idea obviously is to get as many people having as good an experience as possible, so they get the service that they need and they deserve."
