How do we improve healthcare rehabilitation pathways in New Zealand?

Rehabilitation service pathways in New Zealand could do with a rethink.

Using stroke patients as a case example, they are failing to recover properly because of patchy provision of rehabilitation on discharge from hospitals. Patients are also not covered by the no-fault state insurance scheme because it is judged a non-injury disability despite the devastating effects.

Early intervention is deemed crucial as patients experience a heightened state of neuroplasticity immediately after a stroke, giving a better chance for the brain to rewire itself. Studies show rehabilitation plans should be in place two days after an event to speed up recovery, but 50% of patients are waiting more than seven days to be transferred to a rehabilitation ward. Post-clinical care varies from hospital to hospital in a postcode lottery of services. Stroke is the country’s leading cause of adult disability, with one occurring every 55 minutes. New Zealand’s population is ageing, and those in Maori, Pacific and Asian communities are also having strokes at a younger age. The Stroke Foundation is also predicting a 40% increase in stroke rates over the next decade, increasing the economic cost from $1.1 to 1.7 billion a year.

It is also inequitable that those who have experienced a stroke are not able to access Accident Corporation Compensation services, like rehabilitation and income cover. It was always intended that the scheme be extended to non-accident disability, but the second stage of that implementation was never completed.

Staffing numbers makes a big difference in delivering quality care. It is not a money issue. It is being able to find, recruit and retain. Currently, we have dedicated stroke units covering nearly all areas in New Zealand. However, what happens to that life after it is saved is highly dependent on how much specialist rehabilitation is available and how early. So in a nutshell, timing, intensity and continuity. Therein lies the problem.

Rehabilitation is not covered by any form of private health insurance, acquired brain injury rehabilitation (not from an accident) is not covered by ACC. So, are we stuck dependent on an under-funded and inefficient system that could be preventing people from reaching their full potential unless they have the means to do it themselves?