Maternity Services Review

As you may be aware from yesterday’s all-staff meeting, our Board has just released an External Review of Maternity Care in the Counties Manukau District. This independent report by a Maternity Review Panel was proactively commissioned by our Board in response to concerns about perinatal mortality rates in Counties Manukau. Today I’m joined by Board chairman, Professor Gregor Coster, to talk more about this report and how we intend to work through its findings.

The report, a full copy of which is available on the CM Health website, is very extensive in its scope and looks at all aspects of maternity services in our district. As the Maternity Review Panel has emphasized, it is not a criticism of our maternity services but rather a review to help us understand the areas where a high needs population needs extra input in order to improve the health of mothers and their babies. What is clear is that our clinicians provide excellent maternity services but unfortunately these are not being accessed by everyone who needs them. As you can read in the report, one of the challenges we face in Counties Manukau is supporting pregnant women to access maternity care early in their pregnancy (ideally before 10 weeks) in order to complete a comprehensive assessment and screen for clinical and social risk factors that may increase the likelihood of perinatal mortality or other harm. Another compounding factor in our higher than average infant mortality rate is our high number of young mums having multiple births who smoke, are obese and who have diabetes. Alongside this, we have an ongoing midwife shortage that will require innovative solutions to address.

Fortunately there are also some practical steps we can take to improve the standard of care for women in our district and ensure that limited maternity resources are targeted at those most in need. The report has identified nine key areas where changes could assist in improving our infant survival rate. These include:

  • The appointment of a dedicated project manager to ensure the recommendations are implemented
  • Educating the community on the importance of early pregnancy assessment, preferably before 10 weeks of pregnancy
  • Reviewing ultrasound services to ensure adequate access is available to all pregnant women
  • Prioritising vulnerable and high needs women, and ensuring they get continuity of care with a consistent care provider
  • Improving the availability of Lead Maternity Carers throughout the district
  • Urgently seeking a review of section 88 of the New Zealand Public Health and Disability Act with the Ministry of Health to seek incentives for midwives to be able to provide services in a high needs, high deprivation area
  • Reviewing the delivery of contraception and termination services available to the population
  • Reviewing the specific delivery of services to Maaori and Pacific women to ensure that the education material is appropriate and reflects the cultural needs of these groups
  • Reinforcing strategies to reduce the number of pregnant women who smoke and reduce obesity
  • Implementing an integrated IT system which would give all of a woman’s care providers access to the same information (currently being undertaken by the National IT Board)

We welcome the report’s findings and will be implementing all of the recommendations. I have asked our Director Strategic Development, Margie Apa, to lead this important work with our clinicians.

Gregor and I have every confidence in our maternity services team and its ability to adapt to our high needs population. We know that our maternity workforce is dedicated, skilful and loyal, and absolutely committed to providing the best care for our community. After adjusting for age, deprivation and ethnicity there were minimal differences between the perinatal mortality rates for women living in Counties Manukau and those living in New Zealand. However, we can’t overlook the challenges that are unique to our community and it is these issues we need to address if our community is to enjoy the same birth outcomes that the rest of the country experience and to which they are entitled.

Anyone with questions/comments on the report is welcome to email me confidentially at ceoblog@middlemore.co.nz.

Geraint and Gregor

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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