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Heather Roy's Diary - Friday, June 27 2008

Heather Roy's Diary
Friday, June 27 2008

"Heather Roy's Diary" is the weekly newsletter from Heather Roy MP.

It's been a frightening week in Health - a baby is dead after a midwife failed to detect a breech (feet first) presentation, the Health Ministry is proposing to make all those who 'go private' pay full cost for their prescriptions, and the Government is looking at introducing 'mega' hospitals and downsizing regional services.

Too Little Too Late For Lost Babies

Breech deliveries are never easy for mother or baby, but they're much worse if the Lead Maternity Caregiver - almost exclusively midwives, since doctors were driven out of obstetric care - fails to recognise that a baby is lying feet first.

A Wellington family lost its baby boy last month when a newly-qualified midwife failed to recognise the breech presentation. The baby's feet were delivered, but his head remained in the womb for another 20 minutes. Meanwhile, the supervising midwife assured her junior that "she was doing well". No help was called for, and the baby died of asphyxiation.

As a result of this tragedy, Health Minister David Cunliffe has ordered an inquiry - a mere three years after the Wellington coroner called for one following two similar tragedies in the capital. Properly managed, this family should have been enjoying its newborn son - but, instead, they have just buried him.

Why does it take a death to poke the Government into action? And what will an inquiry do? Chances are, it will turn into yet another report, and another round of recriminations absolving the Government of all responsibility - followed by recommendations that are ignored, resulting in no change.

The real issue is that GPs just don't deliver babies anymore, and obstetricians only have difficult cases referred to them.

I have five children of my own - the first in 1988, and the last in 1996 - and the standard of service declined with each delivery. As such, I was horrified to learn that the Public Health obstetric budget rose rapidly during that time. The litany of problems in obstetrics could fill a book, but I can give a taste of the type of problem that the field faces: New Zealand is unique in trying to run an obstetric service that excludes doctors. The General Practitioner Obstetrician who delivered me and my children has all but disappeared. That means that most maternity care is now provided by midwives, who call an obstetrician if they require specialist back-up. To put it mildly, there are considerable strains between obstetricians and midwives - which isn't healthy, but has never been resolved.

Mega Hospitals

A new report - released by the Hutt Valley District Health Board - proposes a 'hub system' to deal with health delivery in the lower North Island. Roughly translated, this means less of the same service. Services would be concentrated in Wellington, with a second hub - yet to be decided - in Palmerston North or Hawkes Bay.

Wellington's Capital & Coast DHB is one of the most badly-managed in the country, so to even consider concentrating resources there - while cutting back services at smaller provincial hospitals that perform well - is quite bizarre.

The reaction by various groups to this suggestion is interesting: doctors and nurses were reportedly "concerned", while the Association of Salaried Medical Specialists - the senior doctors union - called for calm and claimed that, in the recently completed negotiations, doctors would be consulted about and incorporated in decisions of this kind.

Clearly the Chief Executive of the ASMS rather naively believes that the clinicians will have real say - perhaps he doesn't know about Government favourites, who won't rock the boat, being picked to go on multiple committees in the name of 'clinical representation'. I don't believe for a moment tat doctors, or other clinical staff, will have any meaningful say in decisions like this.

The Government's real agenda seems clear: in the face of staffing shortages, it is organising a retreat from the provinces and the plan is for the whole country - not just the lower North Island. But staff may not move to the larger centres, and may well move overseas. To put it bluntly, it won't work. There is evidence that medium-sized hospitals are the most efficient, with those of about 300 beds being optimum. Creating regional mega-hospitals will make the situation less efficient, not more.

Health Ministry 'Own Goal'

Many people won't understand the implications of the Health Ministry's suggestion that prescriptions from specialists in private practice won't be funded.

If this goes ahead, the implications will be huge - if you see your GP, you'll receive subsidised prescriptions; if the GP sends you to a hospital specialist, you'll receive subsidised prescriptions. But if you see a private specialist, you will pay the full amount - and pharmaceuticals are expensive.

What no one seems to have considered is that those who go private relieve some of the pressure on the public system. Many can save, or use insurance, for an operation – but the additional cost of expensive medications will make private care unaffordable for many. They will be forced back into the public system to join waiting lists or, more likely, be banished and returned to their GP. The philosophical blinkers are well and truly affixed and, if scored, this 'own goal' will see even fewer patients having access to much-needed health care.


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