The question I sometimes ask myself when I’m reading anything to do with consumer engagement is: ‘Can I see myself or my experience in what I am reading and/or does this resource reflect behaviours I can identify with or encourage me to read further?’
At the recent virtual Consumer Health Forum summit, it’s likely that many people attending would have seen themselves or people they know reflected in the presentations.
New Zealand and Australia are soon expected to open a two-way travel bubble allowing residents from both countries to travel without the imposition of managed isolation and quarantine. Personally, I can’t wait. All my family, although New Zealand born and bred, live in Australia and I miss visiting them and that family face-to-face banter and fun.
The summit offered the opportunity to share experiences about consumer leadership in the two countries and further afield. Although the traditional banter we might expect between Kiwis and Aussies was not as obvious, we nevertheless shared and networked over the three days and learnt more from each other about our similarities and differences.
While we are close neighbours and share a common language, we are not the same. We have different cultures that influence how we experience health services. Both countries were colonised largely from Europe and suffer side effects of this particularly in relation to loss of identity and power of mana motuhake (self-determination). The impact of colonisation, racism and inequities in health care can be seen in the poor health outcomes for the indigenous people of both countries.
The welcome during the opening plenary delivered by KARI (an Aboriginal vocal performance group) was dynamic and youthful. Many years ago, I spent time in Australia working in different psychiatric hospital settings and have attended many conferences where there was no recognition of the indigenous people in opening ceremonies. Times have changed and Australian sessions at the summit opened with an acknowledgement to their tangata whenua.
There was an impressive range of streams and sessions which illustrated the depth and breadth of consumer involvement. I would also like to have seen a plenary session and concurrent stream designed by and dedicated to the indigenous communities of both New Zealand and Australia. The content would be rich including the challenges resulting in poor health outcomes, how consumers can and have influenced health and care services leading to better understanding and improvements, what the barriers and enablers are for those ‘hard to reach’ communities and how we can change the scripting of ‘hard to reach’ to put the focus on services rather than consumers. If we can design and provide health care and services that meet the needs of indigenous communities then everyone will benefit.
We can learn from each other.
The Australian consumer endeavours are strong in research, particularly supporting consumers with training to understand research. While there are some examples in New Zealand they are certainly not well developed or frequently seen.
It was timely to see a focus on COVID-19 and reflections from consumers on this. Work to understand some experiences for example, telehealth appointments, has been undertaken in some areas. However, we have not so far gathered our collective thoughts from consumers in the same way Australia has. The number of consumer presentations describing governance roles was heartening to see and learn from as we strive to achieve similar levels of achievement and recognition in New Zealand.
We promote co-design as a method to understand consumer and provider experience at service delivery level; the New Zealand stream demonstrated this well. We have undertaken significant work to measure the level and impact of consumer engagement across the health system in order to better understand how we can improve it. Presentations around the evolving consumer engagement quality and safety marker described the development of this new tool; we wait with somewhat bated breath the findings of the first round of submissions due to be published by the end of June 2021.
The New Zealand stream opened and closed with a karakia delivered by a consumer who identifies as Māori. He explained the significance of this in terms of setting the tone and expectations of the encounter and what it means to the indigenous people of New Zealand.
Our health and social sector must work in partnership with Māori to plan and deliver health services. Te Tiriti o Waitangi brings the responsibilities of the Crown to the forefront in ensuring this partnership is articulated and implemented. Māori are not all the same and different affiliations and iwi (tribes; people) and hapu (descendent groups) have different cultural perspectives. It is important to recognise this and build relationships over time that are mutually respectful and value trust.
Australia has no treaty and it is certainly not the role of a pākehā New Zealand consumer to offer advice on how to improve health outcomes for the indigenous population of Australia. But there may be some learnings from Māori consumers and other ethnic populations which, when shared, can provide crucial insights.
We are not all the same, but we want similar things from our health systems.
One thing both countries might collaborate more on is a shared understanding of how the growth and development of consumer leadership is critical to shaping and influencing the future of health and disability services in our respective countries.
Consumer leadership would benefit from active high-level engagement by providers and agencies across health who understand the value of good, effective and confident well-informed consumer leaders ‘sitting at the table, at the time’. Consumers are an untapped resource in health. Let’s see if we can get this tap turned on so the trickle turns into a torrent. It is not unusual to hear commentators reflect about future health care being ‘unaffordable’ as it stands. It’s time to change the narrative and find out what really matters to those at the centre of care and treatment.
The summit opened the door to the collective voices of consumers and providers. These partnerships must evolve further so we all see ourselves reflected in health policies, resources and in authentic partnerships.
Author: Dr Chris Walsh, director of Partners in Care