When the room is funded but the skills aren’t

In late March this year, Health New Zealand opened a tender for urgent care centres and rural hospitals to apply for one-time funding to set up private digital consultation spaces. The equipment list is specific: laptops, screens, headphones, audio hardware, booths and pods. The purpose is to give people somewhere to sit and do an online GP consultation.
The problem statement, quoted directly from the tender, is this: to help people who find it difficult to reach or enrol with general practice.

Reaching people who struggle to access general practice is exactly the right goal but is the solution, a room with a screen, the right salve?

What happens when someone sits down in that booth? Do they know how to set up an account? Can they navigate a booking platform? Are they comfortable describing symptoms into a camera to a stranger on a screen? Do they trust the system enough to engage with it at all? Do they have the digital skills to manage a video call or the confidence to advocate for themselves in a format that may feel unfamiliar and clinical at the same time?

The booth is funded. The skills and trust required aren't.

This would be worth noting at any time. But recently it became more urgent. The Ministry of Health is finalising a Health Sector Fuel Response Plan. New Zealand is facing a fuel supply crisis and under escalation, one of the contingency measures being considered is shifting health services to phone and video appointments. Telehealth is being positioned as a resilience tool, a way to keep the health system functioning when people can't physically travel to care.

When the government shifts to telehealth as a contingency for people who can't afford to travel to a GP, it assumes those same people have a device at home, a data connection and the skills to use them. That assumption is doing a lot of work.

Even if the funded hubs are available, this still requires them to travel to that hub. The people least able to afford rising fuel costs to see a GP are likely the same people who don't have a device at home, don't have a reliable internet connection and haven't had the support they'd need to use a telehealth platform confidently.

Patient Voice Aotearoa's Malcolm Mulholland, speaking about the fuel response, warned that "if barriers are put in place, then patients won't get the care that they so desperately need." He was thinking about transport costs. The same logic applies, directly, to digital barriers.

There's also a broader picture here. The government invested $165 million in 24/7 telehealth services in mid-2025, projecting 410,000 subsidised consultations annually. By mid-January 2026, just over 60,000 had been delivered. The General Practice Owners' Association has attributed some of this to patient preference, with their survey of nearly 1,800 patients found 87 percent prefer in-person consultations. But there's another explanation that isn't being named: the people this investment was meant to reach may simply be unable to use it. Who those consultations reached and who they didn't, hasn't been broken down publicly.

DECA uses a framework called iMASTS to understand what meaningful digital participation actually requires: identity, motivation, access, skills, trust and safety. The health system's telehealth investments, taken together, address access in a narrow physical sense. They do not address motivation, skills, trust, or safety in any systematic way. What we're watching here is a government that has identified the right population, people excluded from healthcare by barriers of distance, cost and circumstance and designed solutions that acknowledge those barriers exist without meaningfully engaging with what they are.

A booth in an urgent care centre is not a digital inclusion strategy. A phone appointment during a fuel crisis is not a substitute for the supported, trusted, relationship-based access that the people furthest from the system actually need.

We do not oppose telehealth, by any means. Phone and video consultations have real value and for many people they're genuinely useful. The question is always: which people?

DECA will continue to watch how this develops, particularly as the fuel situation puts more pressure on the health system to digitise by default. We'll be looking for opportunities to ensure that the people hardest to reach are not simply left further behind each time a new digital solution is designed without them in mind.