The Hutt Union and Community Health Service, with centres in Pomare and Petone,celebrates its 20th birthday this month. The service has been at the forefront of the development of primary health care not just in the Hutt Valley but throughout New Zealand.  Foundation manager and ex- Hutt District Health Board chair Peter Glensor said setting up a patient- owned primary health service funded on a population basis and employing staff who workedin a multi-disciplinary team was greeted with scepticism when HUCHS was launched by localtrade union and community activists in 1991.‘‘Twenty years later the model is praised by commentators of all shades of political opinion, was the inspiration for the Labour Government’s Primary Health Organisations and the National Government’s Integrated Family Health Centres.’’

The trade union movement had set up similar services in Newtown in 1987 and Porirua in 1990but met resistance from local GPs in moving the concept to the Hutt Valley.

Jim Kebbell, who was employed by the unions to set up a Hutt Valley service, said it would neverhave got off the ground if it wasn’t for the determination of the Pomare andPetone communities and the support of then-mayor Glen Evans and the new Area Health Board primary health manager Warwick Frater. ‘‘The Hutt Council, under Glen Evans, was hugely supportive of community development initiatives and combined with a local health authority that was putting a greater emphasis on primary health care, it was all good for our initiative.

‘‘Warwick Frater and Jan Ewart seconded a public health worker to do the demographic work, the Service Workers Union surveyed its membership in Petone and Pomare and within a short period of time we had a proposal for a new primary health service,’’ Mr Kebbell said. The service started in the Pomare Community House in September 1991 with a full time nurse, Iunita Vaofusi, a part-time GP, David Bailey, and a part-time manager, Peter Glensor. Mrs Vaofusi remembers the first months of the service trying to see new patients at the same time as other activities were occurring in the community house. ‘‘The set up of our service was totally different to what I had experienced in the children’s ward at Hutt Hospital. We didn’t wear uniforms and we had very few resources but we welcomed heaps of low-income families that had a desperate need for our services,’’she said.

Many of the people who first enrolled at HUCHS had no regular GP because they could not afford the charges. ‘‘David Bailey and I worked very hard to set up quality systems and protocols that we followed in regard to diagnosis and treatment, but also heavily emphasised patient involvement in their own health care,’’ Mrs Vaofusi said. She was also impressed with the ‘‘nurse practitioner’’ title she was given, ten years before the Nursing Council reserved it for nurses with high academic qualifications. ‘‘The philosophy of our service was the respect for the independent role of the primary healthcare nurse as an equal partner with the general practitioner.

This was a revolutionary change in status for nurses and one that I am proud of.’’ In early 1992 HUCHS opened up a second centre as part of the Te Huinga o te Whanau building at the eastern end of Petone’s Jackson St, with GP Mary Basire and nurse Siloma Masina headingthe health care team. Part of this primary health team, for the first time in the Hutt Valley, was a community worker funded through a COGS grant. Muriel Tunoho worked with HUCHS’ Petone patients to build up local support networks and organise around patient issues. The HUCHS maternity team started in 1993, staffed initially by two midwives. They were doing shared care with the GPs, but even after the GPs stopped doing births the midwives would meet weekly with the doctors, nurses and community health worker to share information and plan care for the women and families they were supporting.

Sally Nicholl, currently the HUCHS manager, but previously a HUCHS midwife, said that the HUCHS maternity team was at the centre of the community development work. ‘‘We worked as a team, visited our women in their homes and involved them in the weekly antenatal classes, the annual mother/babies Christmas parties and in other activities that were occurring in our service.’’ HUCHS has not been immune to funding cutbacks and Government change of policy pressures. Mr Glensor said it was set up during the time of the then National Government’s attack on benefit levels and the introduction of the Employment Contracts Act, which devastated unions and cut wages for the lowest income earners. Later reductions in funding for the service meant that its subsidy for after-hours care was radically reduced and the closing of the maternity service occurred in 2009.

These moves were offset by the DHB finally accepting responsibility for late night after hours care, the construction of a new Pomare building housing an integrated family health service and innovative measures that combined hospital specialists working with the Pomare primary health team. HUCHS chairwoman Muriel Tunoho said their service had been created out of a need for low income people to have a health service that met their needs and was accessible to those who relied on the hospital Emergency Department for care. ‘‘Even though 20 years has passed our service is still trying tosupport good health for our patients despite the housing, employment and low-income issues that in many ways are worse than when we started [including the current battle over Pomare state houses].’’