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Ministry to Consult with Maternity Sector

Ministry of Health to Consult with Maternity Sector

The Ministry of Health has commenced consultation on the Maternity Facility Access Agreement, a contract which sets out the obligations of Lead Maternity Carers (LMCs) accessing maternity facilities when bringing women into hospital for labour and birth services.

It is being reviewed following recommendations released by the Health and Disability Commissioner in January.

Chief Advisor Child and Youth Health Dr Pat Tuohy says, "in his January report on a case concerning a midwife and a medical practitioner, the Commissioner investigated whether the care provided was of an appropriate standard. This brought the national Maternity Facility Access Agreement into the spotlight."

"As a result, the Ministry began a review and has already had preliminary talks with maternity stakeholders to seek their views on how the agreement could be improved. This consultation document we are releasing today sets out six clear recommendations on how the agreement could be improved", says Dr Tuohy.

"New Zealand has a high quality maternity system and the Ministry is committed to making sure it stays this way. We encourage maternity stakeholders to share their views on the consultation document before submissions close on 21 September, 2006", says Dr Pat Tuohy.

To view the Maternity Facility Access Agreement online, please go to


Questions and Answers -

1. What are some of the key areas in the access agreement that need improvement?

Recommendations have been made in three main areas. These are amending current provisions to clarify intent and update outdated clauses, adding clauses that promote quality of care and providing accompanying guidance about the clauses in the agreement.

2. Is the consultation document available?

The consultation document is available online at A submission booklet has been developed by the Ministry and submissions can either be sent electronically or via post. Oral submissions will not be heard in this consultation phase. Additional copies of the consultation document and submission booklet can be accessed from the Ministry Of Health - or (04) 496 2218.

3. What feedback did the Ministry have from the initial consultation with maternity stakeholders over the access agreement?

The Ministry had consultation with key stakeholders including consumer groups, health professional organisations, the HDC's expert obstetrician and midwife advisers and DHB maternity services. Feedback from stakeholders showed that the current generic, simple and nationally consistent agreement works well most of the time. There is room for improvement particularly with clarifying the obligations of both parties, encouraging participation of LMCs in quality assurance activities and ensuring LMCs who continue to provide care when women require secondary care have appropriate certification.

4. When will the Ministry of Health make a final decision on the access agreement?

A final decision will be made in November 2006.

5. Is the Ministry still consulting on the Section 88 Maternity Notice?

The Ministry of Health began a 12-week consultation on the Section 88 Maternity Notice on July 3, 2006 and will finish on September 26. The Section 88 Notice is the contract through which the Government pays for primary maternity services. The current consultation
includes proposed changes to some of the service specifications and updating the Section 88 Maternity Notice in line with recent legislation changes such as the Health Practitioners Competency Assurance Act. The new Notice is expected to be implemented from 1 July 2007.

6. What did the Health and Disability Commissioner recommend be included in the review of the access agreement?

The Health and Disability Commissioner began an investigation into the death of a baby boy born at North Shore Hospital in Auckland on 5 November 2003. The investigation looked at whether the midwife and the obstetric registrar provided services of an appropriate standard to a woman and her baby during the labour and delivery and whether there was any unreasonable delay in commencing a Caesarean section once the direction had been made to perform it.
Following the investigation, The Commissioner recommended in January this year, that the Ministry review the national access agreement to ensure that it specifies the duty of the LMC to ensure clinical safety, to work co-operatively and collegially with secondary maternity services to ensure that the woman and baby receive well co-ordinated, high quality care, comply with their DHBs information and credentialling requirements, comply with all relevant DHB policies and procedures and participate in all relevant DHB quality assurance, audit and review processes.

7. What are the recommendations?
• Include the duty of the LMC to ensure Clinical Safety (not just Cultural Safety).
• Refer to the Midwifery Council of NZ as the registering body for midwives.
• Clinical Policies and Procedures to be developed and agreed by DHBs and LMCs and for these policies and procedures to underpin practice.
• Add requirement for all practictioners involved in an adverse outcome to participate in the quality assurance activities that follow.
• Add requirement for LMCs offering secondary care services to have certain secondary care skills endorsed.
• Provide accompanying guidance about clauses in the agreement, particularly those pertaining to the relationship between maternity facility and practitioner, policies and procedures, complaints and dispute management and administrative requirements.


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