Boards to consider three Regional Women's Health Service options
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The Whanganui and MidCentral District Health Boards (WDHB and MDHB) are to consider three options for the Regional Women’s Health Service (RWHS) plan.
 
The WDHB will discuss the options at its 1pm board meeting on Friday 22 June,  with the MDHB discussing the same paper at its 10am board meeting on Tuesday 26 June, 2012.
 
The board’s consideration of the three options follows an extensive public engagement and staff consultation process conducted across the Whanganui and MidCentral regions earlier this year.
 
A total of 3716 New Zealand College of Midwives-sponsored postcard submissions were received plus 368 full submissions bringing the total to 4084 received during the eight-week consultation period.
 
Three options for the RWHS are being put forward under a series of clinical, service user, operational, financial and risk headings. They are:
 
Option one: A regional women’s health service with secondary maternity and gynaecology in-patient services provided from Palmerston North Hospital; supported by a single consultant O&G roster

Option two: A regional women’s health service with secondary maternity and gynaecology in-patient services provided from Whanganui and Palmerston North Hospitals; supported by two consultant O& G rosters provided by DHB-employed doctors

Option three: A regional women’s health service with secondary maternity and gynaecology in-patient services provided from Whanganui and Palmerston North Hospitals; supported by two consultant O&G rosters with Whanganui’s doctors provided by way of a contracted third party, and MidCentral’s provided by MDHB-employed doctors.

The analysis confirms that options one and two provide a different and contrasting mix of benefits and risks within a robust regional service framework.
 
Option one requires the greatest change in service delivery arrangements, in recognition of the serious workforce sustainability issues confronting women’s health services. The long term sustainability comes with significant change in service delivery arrangements and the challenges inherent in providing acute services from a central hub. These changes are clearly a matter of considerable concern to patients, families and the wider community and stakeholders over the impact of the proposed arrangements.
 
Option two provides continuity of service delivery at Whanganui, within a regional service framework that would take a whole-of-service approach to managing the risks associated with a vulnerable workforce over time. While relatively secure in the short term, this option presents risks in the long term if current trends in relation workforce issues continue. It relies heavily on the regional service framework to monitor, mitigate and manage these risks both internally and externally. If adopted, there would remain a level of clinical risk in the long term that would need to be acknowledged and accepted.
 
Option three is a variation on option two that looks to secure the staffing arrangements with an external contractor. This is likely to come at an additional cost and with a level of disconnection in relation to achieving a seamless single regional service.
 
The intention was to develop the original proposal into a comprehensive service plan taking into consideration the engagement and consultation feedback. However aside from the consultation and engagement process two unexpected events enabled the development of two additional service options. These events were:
  1. A submission from an Auckland-based consultant obstetrician (O&G) and gynaecologist proposing a contracted-out O&G acute maternity and gynaecology service for Whanganui
  2. The imminent arrival of two O&G consultants – one recruited many months ago. The other appointed from another New Zealand DHB.
Feedback confirmed that for most people who participated in the consultation, the proposal presented a level of risk, cost and inconvenience for patients, families and the wider community that was not acceptable.
 
It was felt by many that the areas of concern could only be satisfied by continuing the provision of a full range of women’s health services based in Whanganui.
 
Consistent with the original proposal, MidCentral Health has been identified as the single provider to deliver the new revised service arrangements, and to carry that risk in relation to continuity of service provision.