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Review reassures Wellington on maternity

The review document is available on the Ministry of Health website:


EMBARGOED Noon Thursday.

9 October 2008
Media Release

Independent review reassures Wellington on maternity

Women and their babies in the Wellington region receive high quality maternity services which are as good as those elsewhere in the country, an independent review shows.

The review, commissioned by the Director General of Health in July, found that overall, maternity services were safe, although there were opportunities for improvement.

“This external assessment affirms the public’s confidence in maternity services in the Wellington area,” said Dr Pat Tuohy, the Ministry of Health's Chief Advisor on Child and Youth Health.

Systems quality expert Barbara Crawford, who led the review team said “The dedicated and highly capable midwifery and obstetric workforces in the Wellington area play an important role in the safety and quality of services.”

The review team looked primarily at systemic issues across the range of maternity services in the Wellington region, but their findings and recommendations are expected to benefit ongoing work to improve maternity services nationally.

The team acknowledged the work of many in the sector for their initiatives to improve midwifery and maternity services and commended Capital and Coast District Health Board obstetricians and midwives for their commitment to providing additional ante-natal services.

The review noted that:
 non-practising midwives in the Wellington area need to be attracted back to the workforce to help alleviate shortages
 there has been high satisfaction with quality care provided by individual lead maternity carers (LMCs) and DHB staff
 postnatal care in CCDHB maternity facilities needs to be improved
 better information is needed for pregnant women so they can make better choices about maternity services
 relationships between health practitioners working across the spectrum of maternity care need to significantly improve in order to ensure seamless, safe and high quality care for women
 access to emergency services at Kenepuru and Paraparaumu Birthing Units needs to improve
CCDHB has an excellent Pacific Health Unit that supports women in hospital and the community

The review team made 18 recommendations with respect to maternity services in the Wellington area. It also identified 19 issues that need to be considered in the light of national maternity services.

"We welcome this report and its finding that the quality and safety of maternity services in the Wellington region is on a par with other areas of New Zealand," Capital and Coast DHB's clinical director of Women's Health John Tait said.

"We embrace the report and accept its recommendations, which will play a significant role in shaping our services," Dr Tait said.

Dr Tuohy said the Ministry of Health supports Capital and Coast DHB's approach to the report and a formal update on progress towards implementing the recommendations at a local and national level is expected in six months.

He cited that the key national-level issues raised by the review team's report are addressed in the Maternity Action Plan, which has been developed by the Maternity Services Strategic Advisory Group and the Ministry of Health over the last year. The plan sets out the strategic vision for maternity services over the next five years, and is due to be released for consultation.

A copy of the report Review of the Quality, Safety and Management of Maternity Services in the Wellington Area is available on the Ministry of Health’s website.


Questions and Answers:

1. Why has there been a review into maternity services in the Wellington region?
In July 2008, the Director-General of Health commissioned an independent review of maternity services in the Wellington region following the death of a baby at Capital and Coast DHB's Kenepuru Maternity Facility. Although the review team looked primarily at systemic issues across the range of maternity services in the Wellington region, their findings and recommendations are expected to benefit ongoing work to improve maternity services nationally.

2. How was the review conducted?
The review team conducted more than 40 interviews and received written submissions from more than 140 consumers of maternity services. The team heard from the management and staff at Capital and Coast DHB, Hutt DHB, Ambulance Services, consumer groups, the NZ College of Midwives, the Royal Australian and NZ College of Obstetricians and Gynaecologists, the Royal NZ College of GPs, the Society of Anaesthetists, the Midwifery and Medical Councils, Accident Compensation Corporation and Ministry of Health officials.

3. What was the key finding?
The review team’s key finding is that maternity services in the Wellington area are as safe as anywhere else in New Zealand although there are a number of opportunities for improvement. The review also found that LMCs and DHB maternity staff in the Wellington area have made significant efforts to create and nurture effective working relationships across facility and professional boundaries. The committed and highly capable midwifery and obstetric workforces in the Wellington area contribute largely to this quality of care. Many key national-level issues are addressed in the Maternity Action Plan, due to be released shortly.

4. How can shortages of midwives and obstetricians be overcome?
The Ministry of Health has been addressing this issue progressively. It increased funding from July 2007 to encourage Lead Maternity Carers (LMCs) to continue to provide continuity of care to women throughout pregnancy, labour and birth and the post-natal period.
Further work is being carried out particularly by DHBNZ Workforce Strategy group. The Ministry is working alongside the Royal Australia and New Zealand College of Obstetricians and Gynaecologists and the Medical Council to establish what needs to be done to ensure the country’s needs for obstetric services can be met.

5 Will there be better national leadership and a strategy for maternity services?
This is being addressed in the MAP and will involve maternity sector stakeholders such as the New Zealand College of Midwives, the Royal Australia and New Zealand College of Obstetricians and Gynaecologists, the Royal New Zealand College of General Practitioners, DHBNZ, Nga Maia o Aotearoa me te Waipounamu and ParentCentre New Zealand. The MAP is due to be released for consultation.

6. How will the MAP help improve maternity services?.
The MAP proposes the development of national service standards and performance indicators for maternity services. It is important to note that audit requirements are already part of the primary maternity notice. Both programmed and random audits take place and include both claiming practices and service delivery.

7. Will there be a joint standard across all maternity services?
The Ministry would like to progress work to develop standards and evidence-based clinical guidelines that are agreed by all the groups and the DHBs. A first step was the development of the MAP and this involved these groups working collaboratively to achieve that. The Ministry will host multi-disciplinary meetings including consumer representatives to facilitate the development of national standards and guidelines for maternity services.

8. Will there be better monitoring of maternity outcomes?
The Ministry agrees there is a need to create a better maternity information and data collection system. As part of the consultation process for the MAP, the Ministry will be discussing the development of a set of maternity notes that can become standard throughout New Zealand and capture all the information needed about the outcomes for mothers and babies. This will include fuller reporting of unexpected deaths and other sentinel events.

9. Will there be increased supervision of first year midwives?
The three-year programmes approved by the Midwifery Council are designed to produce a Registered Midwife with all the competencies necessary to provide safe midwifery care to women having babies. The Council has recently revised its education standards and has approved a new curriculum for midwifery education to ensure that all midwifery students receive a comprehensive range of clinical experience.
To support the new midwife, the Ministry funds the Midwifery First Year of Practice (MFYP) programme through the Clinical Training Agency. The programme provides new midwives with educational support and mentoring by an experienced midwife for the first 12 months of their practice. About 97 per cent of new midwives are enrolled in the MFYP programme.


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