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The Manukau locality is the largest of the four localities with 35% of the Counties Manukau population. The age distribution overall is similar to that of the DHB as a whole. The locality has a relatively large high needs population with 53% of patients in this category. This is the second highest proportion of high needs patients of the four localities.
Manukau covers an area from Papatoetoe to Drury. There are three overlapping geographical areas: Papatoetoe/Manukau, Manurewa/Clendon and Takanini/Papakura/Drury.
The resident population of the Manukau locality is approximately 187,000 people, with approximately 157,000 enrolled with local general practices.
The resident population is multi-ethnic with approximately 56% of Counties Manukau Maaori, 37% of Counties Manukau Pacific, 53% of Counties Manukau Indian and 24% of Other Asian populations residing in the Manukau locality. The Manukau locality resident population is approximately 37% of the entire CMDHB resident population.
Of the enrolled population of Manukau 24% are Maaori, 17% are Pacific and 8% are Indian.
All sub-localities are predicted to grow in overall resident population numbers, with Manurewa and Papatoetoe sub-localities predicted to experience significant growth across all age groupings.
There are 44 general practices with most (39) supported by ProCare and others supported by National Hauora Coalition and Total Healthcare.
The Manukau locality has high rates of deprivation and associated social constraints. Many residents are on low incomes with high rates of unemployment and low rates of education overall.
The population is predicted to grow by about 28% over the next 15 years, equating to 54,100 extra people.
Manukau has over 17,000 people with one or more long term health conditions.
There are high numbers of potentially avoidable hospitalisations. Hospitalisations are predicted to grow significantly particularly for Maaori and Pacific adults.
The primary opportunities to help the people of Manukau realise their health potential are in:
Long term conditions – particularly diabetes, gout, cardiovascular disease, respiratory problems and congestive heart failure, and for those who have more than one long term health condition
Youth conception, maternity care and preventing perinatal mortality through better coordinated and planned sexual health, maternal care and support in the first few years of life.
The better co-ordination and integration of secondary and primary care services in these areas.
People affected by long term health problems may have better health if their care was better coordinated and more services were available close to where they live.
Those with significant health problems who have a high risk of an unplanned visit to hospital will be identified and given additional support from the general practice team. They will also be more effectively linked to other health professionals including pharmacists, specialists, district nurses, whaanau ora workers etc.
This initiative includes:
More coordinated use of CM Health services delivered in the community including district nurses.
Better utilisation of community pharmacists. It is felt that allied health services are not well coordinated with primary care. Integration would increase the capacity for patients to be safely cared for in the community. Closer alignment with primary care may result in greater efficiency and more timely response to patient need.
International evidence suggests integrating health and social care is desirable. Social issues contribute to undesirable health outcomes in the community. Whaanau ora addresses some of the needs of our high risk populations. It also provides a framework for more general integration of social services with health. The Manukau locality represents a partnership between clinical care and social factor.
The initial focus is reduction in unplanned hospitalisation. While it is recognised that this is not a comprehensive indicator of effective management of long term conditions or the health of the community, it is a useful starting point for more effectively integrating care provided by various health professionals. Unplanned hospitalisation is recognised as a poor outcome for patients, their families and the health system. It will not be achieved without reducing inequalities. A significant cultural shift is required by patients, clinicians and health managers.