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As in 2020, the travel involved in accessing health care proved a significant burden for some and as a result, it was considered that people were leaving the area for better health services, particular as they aged. Those without transport relied on others in the community to help and, potentially, some without good connections were vulnerable:

"I speak to people who are considering their options because they are a long way from health care. Older people. Definitely. Some are thinking move to Taumarunui, to be closer to that hospital, but some are thinking further afield because of the whole district having limited access."
"But so many people here, the older people, rely on friends to give them a ride. So (redacted) gets a ride from (redacted), up to Waikato or wherever he needs to go. And there are other older people who are effectively housebound here who may not have access to a friend to give them a ride."

Access and wait times to be seen in primary care were concerning.

"Taumarunui, four weeks to get to see the doctor. Some people have changed to Te Kuiti because you can get an appointment the next day."
"Primary care is probably the biggie. Getting access to a nurse practitioner or a doctor. "

Residents of Ōwhango were concerned that services appeared to be increasingly withdrawn or unavailable in Taumarunui:

"There used to be the eye guy, he would come to Taumarunui so you could go and do that. Well they don't do that anymore and it just seems like every year there is less and less."

Concerns were held that the health workforce in Taumarunui were stretched and overworked, and health services had difficulties recruiting and retaining staff.

"Plunket doesn't have a nurse anymore."
"Yep, yes she does. She started a month or so ago."
"That's good because they were without for...."
"Yeah, they were without for a long time."
"For quite some time."
"It was over a year, wasn't it?"
"We do have midwives, but again, they're stretched, tired. They're stretched."
"The hospital does have staffing issues. They're over worked."

Although it was noted that now there were local midwives available, many people accessed care closer to Hamilton due to risks of being isolated from specialist services, should they be required:

"And that's part of the concern for having children locally, it's not a slight on any of the staff who work at Taumarunui, it's just you’re closer to more specialised care if you needed it."
"What is typical is you go to Waikato to have your baby and then you go to the birthing centre in Te Awamutu for two or three days. As far as know, home births are not very common, and Taumarunui Hospital isn't interested."
"There is a birthing centre in Taumarunui Hospital and apparently they have had very good upgrades there. We had (redacted personal name) there and there were some complications and that was a concern, because it's relatively, there's not really specialists there per se. But plenty of people filled the room when issues arose. So when we had (redacted personal name) we decided to go to Te Awamutu so we were closer to Waikato if something went wrong. You probably wouldn't forgive yourself in hindsight for not going there. I don't know if everyone would have the luxury of going there, the travel, we had someone to look after our other child. Sometimes mums have two or three other kids and it's not so easy. Let alone having a grandparent to help. Or a partner as well. "

Health services for children were seen as lacking, understaffed, and inconsistent. Difficulties in recruiting and retaining workers meant services were periodically discontinued:

"The school's issues are dental - the mobile dental clinic is supposed to go to the school every year. It got pushed back to two years. Now it's every four years they might see someone there. Kids are only getting checked up once every four years. If they are squeaky. The last dental nurse they got they pulled in someone who was retired and she was saying the issue is they can't get people to staff it because people go through the dental clinic and they go private because they're paid much more. Recently I heard that if you call the 0800 Talk Teeth line, it just doesn't answer now."
"You gotta pay for it. You gotta pay for it if you want it. We have to go private if we want dental for our kids. "

Service unavailability was particularly salient for families with children who live with mental distress, or behavioural and developmental challenges or disorders:

"There is a lack of support for parents who are struggling with children’s behavioural or mental health. Some people are in crisis but there is no one out there. For children with behavioural or developmental disorders it changes year by year, it's very.... it's not solid. It depends on staffing. Social workers in schools struggle to keep good workers on board and so they tend to move off quickly. There is no consistency. If you've got money, you can pay for it. You can. So that's a barrier. Taumarunui Counselling has lost their contract so they're no longer doing it. They were the only ones for a while. Other services keep losing all their workers. There's really nothing. The workers, the workers burn out quite quickly. The ones who are good deserve to get paid lots of money but probably aren't paid lots of money."
"Mental health is a big issue, for all of New Zealand, for all ages."
"There is, at the moment, they have a really good speech language therapist, but for a couple of years there, there was no one. "

One participant felt that there were services available for both Māori and Pakeha in Taumarunui, but that Māori were more likely to access them.

"One difference between us and Taumarunui, is that in Taumarunui there is a higher Māori population. And Māori are better at looking after themselves. And I say that because I know that there are one or two little trusts, a few people, who are managing to get funds in and get it to people in need. There is nothing like that here. Pakeha can probably access those services too, if they knew about them. But we don't necessarily communicate in the same way. It's probably social media, or word of mouth. I don't think there is any prejudice, but they're more motivated to work together and may have access to more funds than the rest."

Concerns were held for those families who did not aggressively pursue services or treatment for their children with health problems, leading some children to fare worse in the health system than others.

"It also depends on the family. If you’re not always pushing, you just get pushed off and pushed off. Parents who are struggling often don’t know how to access things or how to be the squeaky wheel to get things."
"Parents have to push. You have to ask for it, request it. Otherwise there is not enough time, or…"

Ambulance services attended Ōwhango out of Taumarunui and locally there is a rural volunteer fire brigade who provide first response services.

"The ambulance covers a big area and is still very stretched for staff. You can wait forever for an ambulance here."
"And part of that is there is one ambulance, and they could be out at Ōhura. You call and the people in the communications in Auckland will assess the job and decide what needs to happen."
"The garage here is fantastic in my view. The people at the garage keep the fire station manned and what a lot of people don’t know that we found out recently is that (redacted) will go out, (redacted) will go and close the door for them so they don’t have to wait for the door to close automatically. There are some people do some really great, invisible work here."

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