DHBs to consider a proposal for changes to maternity services

The Whanganui and MidCentral District Health Boards (WDHB and MDHB) will shortly be considering a proposal to make changes to the Regional Women’s Health Service. The proposal, led by the clinical leaders with management from both DHBs, is driven by ensuring the safety and quality of services for women and their babies, well into the future.
While the DHBs have good Lead Maternity Carer (LMC) services available to the women of their districts, both District Health Boards have for many years had difficulty in recruiting permanent obstetricians and gynaecologists (O&Gs). Whanganui has had a serious staffing crisis that has impacted on services for around a decade. There has had to be a heavy reliance on high turnover locums, which risks compromising patient safety.
Clinicians from both DHBs have driven the development of the new service model which centres on much of the specialist care, especially that which is unplanned, being provided from Palmerston North Hospital. The LMC services and some of the planned specialist services would continue to be provided from local birthing centres in Wanganui, Taihape, Raetihi, Dannevirke, and Levin.
Regional clinical director obstetrics and gynaecology, Digby Ngan Kee, regional midwifery advisor Cheryl Benn and Whanganui-based consultant obstetrician and gynaecologist Mark Stegmann say that while both DHBs continually strive to achieve excellence in women’s health, the critical staffing situation that exists has seen them struggling to provide the desirable level and quality of care.
“We have explored many alternatives and, from a clinical perspective, the proposed change is the only viable option,” Dr Ngan Kee says. “The ‘patchwork’ staffing arrangement in both hospitals, and especially Wanganui Hospital, is the result of difficulties that many New Zealand provincial hospitals are facing with their recruitment of obstetricians and gynaecologists.
“It’s widely recognised that there is a worldwide shortage of obstetricians and gynaecologists, that smaller provincial hospitals such as ours are particularly disadvantaged by this, and that the situation is unlikely to change.”
The DHBs are concerned that existing staff cannot continue to work the level of after hours calls needed to maintain a safe and sustainable service at both hospitals, 24 hours, seven days a week.
Dr Stegmann says clinical leaders believe consolidating specialist care on a single site at Palmerston North Hospital is the best way forward. “This will ensure we can provide the best service possible and attract the medical specialists we need to achieve this,” Dr Stegmann said.
Dr Benn says the plan proposes that Whanganui district women having a normal pregnancy, labour and birth will continue to have their babies in their local birthing centres, including Wanganui Hospital.  However, services will be provided from the larger regional health service at Palmerston North Hospital for those women who require specialist O&G care, and for those having a normal pregnancy who arrange it with their LMC.
Board members of both DHBs are being asked to support the proposal in principle, to allow a public engagement process to take place.  A final decision on the plan will be made once public feedback has been sought and carefully considered.
Whanganui DHB chief executive Julie Patterson says the clinicians and managers recognise that the proposed plan will have a significant impact on the communities, particularly women and their families/whanau who reside in and around Whanganui.
“We recognise that the proposed change will cause disruption for those women and their families who need to travel,” Mrs Patterson said. “And the proposed change is also very difficult for the independent LMCs who may not be able to continue to support their women in Palmerston North.
“We believe this will directly impact on up to 400 Whanganui women which is about 50 percent of the Whanganui women who are expected to give birth each year.”
MidCentral DHB chief executive Murray Georgel said:  “We are putting this proposal to our boards and ultimately to our communities because we believe this is more preferable than continuing to provide a service for patients that is less than ideal from a quality and safety point of view.
“All going well, public and staff feedback will then be reported back to both boards so a final decision can be made in April.”
The proposed plan does not include paediatric and neonatal care.
More information is available on the Whanganui and MidCentral DHB websites www.wdhb.org.nz and www.midcentraldhb.govt.nz.
If you wish to submit your feedback in advance of the public meetings you can do so by emailing communications@wdhb.org.nz and communications@midcentraldhb.govt.nz.