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Whereas in 2020 participants appears to be most concerned with health issues affecting older people, in 2023 participants expressed relatively more concern about the health of young adults, particularly their mental health and wellbeing. Participant felt that many young people in Taumarunui had immense pressure on them due to cost of living, cost of housing, and associated difficulties which had an impact on their mental health.

"Stress, especially on the younger ones. Mentally, they're just overwhelmed. All the time. It's, oh well, if mum and dad get behind on the rent then we're going to get evicted. Then where will my brother and my sister go?"
"When I was young I wasn’t thinking of working to do anything for my family, paying bills and things like that. Because life was good. It was. There wasn't so much worry. I think about the responsibilities that our kids have today. They're growing more mature, younger. But in saying that they're also too young to be doing these things."

Concerns relating to mental health issues and access to mental health services and emergency psychiatric response was a concern:

"Stress is huge here. And mental health is huge."
"People with mental health issues, a lot of them wouldn't catch that bus and that's part of the problem. It's all to do with funding. They're reprioritised everything to Hamilton and taken away the service here in the community. And the problem is our community doesn't respond to being delivered at, they respond to being delivered with. And so these sorts of services that are comers and goers and take a long time to getting access, it doesn't work for rural communities. The saddest things is they still talk about giving access, but never once since then have I seen one person come down from Hamilton and give a service. If they do it's not known to the ones who need it, eh."
"Mental health, depression. I see a lot of that and it's heartbreaking. Because I know a lot of people that have it and you try and help them as much as you can and you have to be on their level to understand how they're feeling and thinking. But the people that are in charge of them, they're not doing their job. That's how I see it. There's a few issues with these that have it, and I think, “Well, why aren't they helping you?” They don't do it. A lot of them are young, you know, like 25. They're still young. Too young to be having mental health issues and stuff. I see their parents struggling."
"It's the wait time. they do have counsellors, but they come from Waikato, I think, like, once a month. They come from the outer lying areas. Hamilton."
"We've got Taumarunui Counselling services so there are local services. Age Concern and all of those. For different types of people in certain situations they're appropriate, but for some they're not. Without disserving those services, but for some people it's more severe and where they're at."
"The thing that worries me is that people ring the police to come and control these people when they shouldn't do that. They're pretty rough with some of them when they pick them up because I’ve seen it with my own eyes, you don't do that to these sort of people. It makes them worse than what they are and I just wish they wouldn't do that - use that sort of force. They need someone based in town when someone is needing help."

Distance from secondary care services, which were, according to participants, increasingly delivered out of Hamilton, was a concern.

"The biggest problem in Taumarunui is its distance away from the hospital. Waikato Hospital is our main hospital. But regionally we're supposed to be going to Manawatu, Palmerston North. Because we're in the Manawatu Whanganui area. So we're in that DMZ zone where we are too far away from both centres to be worried out. So we actually need our hospital up here working."

Although public transport to Waikato Hospital was available it was not always considered positively in that it did not meet the needs of those who were very ill or elderly:

"So there's a bus that goes up every morning, eight o'clock in the morning. And it rattles all the way up there, and rattles all the way back. Our elderly can use that bus quite a lot. A lot use it to go up for appointments that they can only get done at Waikato Hospital. That's the main reason why they'll go up on that bus."
"I mean, look, our cancer patients have to travel all the way up and then if they want to come back they come back in a car, so they privately go out because coming home from chemo on that bus is horrible. You’re travelling home on that bus and puking in the back and trying to stay warm and that defeats everything. And then they wonder why our chemo patients are depressed. They can stay up at the lodge, at the cancer lodge. But a lot want to come home. They jump on the bus and come home. "

Similar to 2020, waiting times to access primary care were considered to be too long, resulting in some conditions worsening, while others accessed appointments through phone or video consults:

"Terrible. It's a three-week list. If you want to go and make an appointment, three or four weeks. If it's an emergency go to A&E. And then you'll get a lecture on why you didn't call the GP. And then you know that they know that you can't get an appointment for four weeks. So yeah. So because you've got to wait so long, that things get worse. I don't understand it that we've got a hospital, but a whole ward that's empty with lights on. I don't understand that."
"If you want to you can go and have a phone appointment with Dr Lance O'Sullivan. You go on and talk to him on the phone line or video call. And he diagnoses. A few take it up. I feel it works for some but not for all. At the end of the day if you really need to see a doctor you will take what you get."

Recruitment and retention of doctors was seen as a fundamental challenge to the sustainability and accessibility of primary health services in Taumarunui:

"Doctors don't see this place as a good, well, I don't know. They don't see this place as a good place to come. We struggle to keep them. We can't get any now. They've struggled for years with that, though. The funding's been there but it’s a matter of getting them coming and retaining them here, because they realise how far away, they are from everything here. And then they don't last long."
"We don't have local, local doctors anymore. The money they spend on locums is horrendous. So they can fund it, that’s not the issue. It's that the people don't want to be here. So it's like, even if you were to train a local up to be a doctor but the incentive for them to want to stay here has to be because of their whānau, but they could want to chase the international dream. So how are we going to retain our locals?"

Maternity and infant health related-services were considered to be available and accessible, though Well Child/Tamariki Ora/Plunket services were considered to be stretched:

"The Plunket nurse covers from here to Taharoa, Kawhia, to Taranaki. It’s underserviced. She must have 250 on her books."
"We have two midwives. I got in really easily."

Nursing triage services, as well as preventative services, such as screening and vaccinations, delivered through nursing services were considered to be well-delivered and accessible in Taumarunui.

"Yep, those nurses, they’re a god-send."
"We have great triage nurses. They make an appointment, and you go straight in. They're brilliant. But they’re overworked. They're doing the doctor's work. And if you're really bad they'll harass the doctor and the other patients have to wait longer. But if you want a little bulldog they are the person that you need."

Other allied health services, such as audiology, optometry, physiotherapy, and dentistry were considered satisfactory available and accessible, as was free dental care for under-18s.

"That’s good. I found it good for my kids."

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