Kia Ora New Zealand

Getting down to some work and New Zealand did not disappoint. It is rare to land in a foreign country 11000 miles plus form home and feel like you have been before. Arriving in Auckland my initial thoughts were just how clean it is, not just the city but the air, the water is pure, and it feels cleansing.

New Zealand has a population of 4.9 million people, of this population, 16.8% are over the age of 65 and it has a wonderful cultural diversity not seen in Scotland. Māori descendants the indigenous people make up 19.6% of the population, Asian 17.3% Pacific peoples 8.9%.

Like many countries there is a financial pressure on service provision and people generally notice the cost of food, rent and commodities. The state provides ‘Supa” for everyone over the age of 65 if they have contributed through work in their lifetime. Much of what I heard was about their being poverty in this older population, asset rich but cash poor.

Generally, NZ have a differing life span and healthy life years lived, which follow the typical patterns of social economic impact, non-communicable diseases. Contributors such as homelessness, drug abuse and poverty, impact reduced Healthy life years. in 2022 cancer, ischaemic heart disease and cerebrovascular disease was the most common causes of death. Although improving life expectancy between Māori and non-Māori people in 2022 it is 6.6 years less in Māori. Incidence of cardiovascular disease, stroke, cancer, and diabetes all being higher in the Māori population.

During this stay I had the pleasure of meeting with Care providers, Housing Associations, Researchers, and health professionals delivering services both in the city and in the Bay of Plenty -Tauranga

Homelessness

By 2040, 50% of people over the age of 65 will be renting properties, there is a shortage of suitable housing both for families as older people who own property tend to stay in them and mid-market rent is expensive and often not fit for purpose. The social landlords, of which there are few do not have enough houses to meet demand and there is a pressure to build more affordable homes.

One thing I was very taken with was the Homelessness Strategy within the Bay of Plenty area. Not only is there a five-year action plan to address homelessness in the area but there is a diverse group of people working to build more homes and address some of the cultural issues of homes not being big enough for the pan pacific groups. It has a very strong feel of community working with the local authority to deliver change to improve outcomes for the population.

Wrapping services around vulnerable people is something we recognise in the UK/Scottish system. The Western Bay have a three-phase plan, to support homeless people find a home and helping to prevent vulnerable people losing their tenancy. There is also a one stop shop approach, bringing homeless people into a health facility to provide, basic healthcare, dental and mental health services, showers, food, and comfort.

They also recognise the need to be mobile to find homelessness people and meet them in their areas of comfort such as the park and on the streets. A mobile team and service is phase II of this plan, and a phase III involves building a community hub with temporary accommodation to enable people to get back on their feet and with an address they can access benefits.

All of this is supported by working in partnership between Public Health and Ewuare (Māori) services. Homelessness and Housing Stress (new terminology for me) are integrated within this strategy to help keep people in their homes as well as find homes for those without.

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Housing

I visited Huawei housing hosted by their Chief Executive and Quality manager to learn about the social housing space. It is evident that in New Zealand the number of social landlords is much smaller than in the United Kingdom, and they operate under similar regulated conditions. Interestingly the traditional development managers as we have at home are known as community managers and seem in many ways more focussed on people than the traditional buildings approach seen in so many Registered Social Landlords (RSL).

Huawei are not allowed in their contract to provide any services to their tenants; however, they act as connectors and ensure that people who have a need are linked with the organisations in their communities who can help them. This hub and spoke model are very sustainable and it is clear they have a true expertise as connectors in the community.

Care provision

The model in New Zealand is dominated for those that can afford it by the private ‘retirement home’ providers. It was interesting to observe the number of adverts during prime-time TV hours that channelled the idea of buying into a perfect life in a retirement village. The current model requires people to purchase the home and they can pay for additional services as and when the time comes. When the person passes the family do not get any capital gains if the house price has gone up instead this goes to the developer that owns the retirement village. This model seems to be well embedded and served by those that can afford it. There is some criticism from many, as this model serves pakeha populations well but does not serve Māori to same extent, exacerbating inequality in the elderly populations.

I visited a wonderful facility Elizabeth Knox hospital and rest home. This was bequeathed by Elizabeth Knox over 100 years ago in 1909, she left this money for the ‘purpose of building, endowing, and maintaining a hospital or home for poor people suffering from incurable diseases’.

This wonderful facility is well appointed and follows the Eden principles a philosophy of care dedicated to placing elders at the centre of everything to help them transform their lives. A team of primary care Doctors, physios, occupational therapists, and lifestyle/leisure teams work to enhance the quality of life for those they serve. The interim Chief Executive is progressive and dynamic, it is an organisation that will evolve, and the population needs change in coming years.

There is a very acute centric focus on health at the present time, a lot of change in a short period. The disruptive organisational redesigns currently, is arresting some of the traction achieved in a more integrated system a few years back.

This period of change is political in nature and as with many environments there is a need to trim public spending and the casualty of that is prevention and more community-based developments. There is no longer a mandate or legislation that promotes integration and working across systems. Several people commented on how it feels, the country has moved backwards as a result. Everything is cyclical and I am sure with the talent and enthusiasm of the people I met the work and good practices will prevail.

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Research

It was a pleasure to be hosted by Professor Ngaire Kerse Joyce Cook Chair in Ageing well, Co-director of the Co-Created Ageing research Centre University of Auckland, President New Zealand Association of Gerontology. Ngaire has a lifetime of experience of ageing research and extended an invitation for me to meet her team and present to the faculty. All of this offered a valuable insight into the challenges and constraints being faced by the academics in NZ and the funding available for research. It was a pleasure to share learning from work in the United Kingdom and to offer food for thought regarding prevention and the use of technology to support outcomes for older people.

Attending the conference ‘Mobility, staying upright and older people’ offered a rich discussion base from wonderful presenters from England, Europe and New Zealand and offered insights into new ways of assessing mobility, risk and falls prevention.

Takeaways:

1.??????? Complex health, social and cultural factors in addressing key population issues.

2.??????? Funding and political turmoil distracting for delivery arm and people seem to have change fatigue.

3.??????? Fabulous examples of working through others to have sustainable services for people in social housing space.

4.??????? Homelessness strategy in West Bay of Plenty driven by population data and known issues with a truly inclusive and collective approach to deliver on their strategy.

5.??????? Community managers offers an insight into the mindset shift required to move social landlord providers away from buildings focus and move more towards a people focus to contribute to improved outcomes for their tenants.

6.??????? Language and the differing opinions of whether older people should be referred to as ‘Elders’, Older People was interesting to listen to.

7.??????? Health has a strong acute focus and there is a loss of traction with other providers due to this that would look at the pathways as a systems wide approach.

8.??????? Care and housing for people across the life course falls short of demand and there is a propensity for private providers to offer expensive retirement village models for those that can afford it.

9.??????? Difficult environment for the diverse cultural groups in New Zealand and for those that can’t afford it, leading to housing stress and homelessness and people who don’t engage with medical /care services.

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Acknowledgements:

Thank you to all the people who hosted me, your kindness is much appreciated, and this just offers a taste of the learning i have had in your beautiful country.

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