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The desire of Steering Committee members to involve the community in planning processes was discussed regularly at Committee meetings. There was a general view that the community’s knowledge of the national primary health care strategy and PHO development was minimal. Some Committee members reported that most questions asked by people coming to see their GP or practice nurse related to cost of service. This was confirmed at the public information sharing day which took place in February 2004. From a stall set up in the main street of Levin Ministry of Health and locally developed brochures about PHO formation were distributed. The public had an opportunity to have questions answered on an informal basis. Approximately one thousand pamphlets were distributed over the two days. Twenty people completed a questionnaire and comment sheet. Comments ranged from whether the cost of primary health care would reduce, to transport issues as they related to access to health services for the Horowhenua communities, to the need for improved reassessment and coordination of personal primary health care - and some took this opportunity to state their views on the Horowhenua/Otaki Health Services Review Project. All Steering Committee members agreed that there was a need for tangible messages to be developed before the general public would engage an interest in the PHO and see the new development as meaningful and relevant to them.

We need to get a project up and running to increase community awareness.

Iwi Representative II, Steering Committee Meeting, 19 April 2004 There were two GPs on the Steering Committee initially, with a Foxton (Kere Kere) GP joining the Committee in May 2004. These GPs provided the link between the planning process undertaken by the Steering Committee and general practices. A number of meetings for GPs were convened by either the MIPA or the GPs themselves during the establishment period. None were convened by the Steering Committee. I understand that much of the discussion at these meetings focused on the primary health care strategy implementation and PHO administrative changes which would be required in general

practices before joining the PHO. Very importantly, the financial implications for practices of moving to capitation-based funding, uncertainty about eligibility for Access funding, the new funding streams which would be available to PHOs and issues around patient register “cleansing” and ongoing register management were key issues for the general practices. The Steering Committee had one meeting with providers during the establishment period (January 2004). This meeting gave opportunity for the Committee to provide an overview of PHO establishment plans and update providers on how the Committee was managing the integration of national requirements and the unique needs of the local communities. Comment was received on current service provision, its strengths and weakness as well as the opportunities which would be available to the PHO to assist with the development of new services. Feedback was also sought on how relationships amongst primary health care providers could be enhanced and the best way to establish channels of communication between all interested and prospective providers and the PHO. Twenty-one providers attended with representation from rural GPs, Plunket, midwives, physiotherapy, pharmacists, District Nursing, Public Health, Practice Nurses, Iwi Providers, Aged Care Services and specialist nurses (e.g. Diabetes Educator).

While a meeting was planned for one month later, Steering Committee members did not proceed with this meeting as they were of the opinion that they could not provide sufficient tangible new information. It was agreed that the best way to keep providers informed of progress was by newsletter – however, this form of contact did not eventuate. Workload of Steering Committee members was the reason for this not occurring.

Plans in the initial Establishment Plan for engaging the community were considered to be weak by the Funding Division. The PHO Steering Committee Chairperson pointed out:

And I did try to get [people identified] to actually see that the community wasn’t in that proposal. However, yeah - I just don’t think that they had that sort of a perspective at that time. And so indeed I found myself arguing on my own for the community, and then ended up in one awful rush after it came back [the Application returned to the Steering Committee for further work] to actually get it back in again quickly - putting the “community” into it.

I observed Steering Committee members, over the nine month period, gaining increased knowledge and understanding of the primary health care strategy, the role and scope of the PHO and the notion of community participation. This learning was experience-based. I also observed an increased dependence on the MIPA for completion of the technical requirements. Because of the skill mix within the Steering Committee there was limited ability for the Steering Committee to make judgments about the MIPA’s outputs. In short, the MIPA, who were the advisors and providers of administrative support to the Steering Committee, were central in decision-making processes.

A final comment needs to be made about the manner in which health professionals and the community external to the Steering Committee, were engaged in the planning. The perception held by the Steering Committee was that these stakeholder groups had the expectation that they would be kept informed of decisions made, rather than be involved in the determination of decisions. This perhaps reflects the experience in previous years of being consulted, but not having the ability to contribute in a meaningful way to decisions being made. The community may not have understood the opportunities for involvement that were available to them.