A damning report sparked by a series of infant deaths has prompted a major shake-up of maternity services in the lower North Island.
Numerous hard-hitting findings are contained in an independent review of the Regional Women's Health Service shared by MidCentral District Health Board in Palmerston North and neighbouring Whanganui DHB.
The review was commissioned by the chief executives of both DHBs in October last year following concern that there had been seven reported "serious events" in the regional service over the past nine months: six at Palmerston North Hospital and one at Whanganui.
The cases involved two intrauterine deaths, three neonatal deaths and two newborns with significant problems.
The review findings, released early this month but not disseminated beyond the region, found:
- a poor working relationship within the maternity service at MidCentral;
- "dissonance" between medical and midwifery leadership;
- a lack of clarity over the responsibilities and accountabilities of the clinical leaders and management;
- a "service culture" that was too negative and in need of urgent attention;
- slow follow-up of adverse outcomes, or mistakes; a lack of increase over "many years" in senior maternity officer jobs.
There was also frustration by MidCentral staff that lead maternity carers, or LMC midwives, were inconsistent about when they could hand over the care of their pregnant clients and expect hospital midwives to take over.
The College of Midwives said it had been aware of this, and while it made sobering reading, it was relieved now to have it out in the open.
"There'll be some repairing and some healing to be done, but I think it is leadership, clinical leadership from midwifery and also from obstetrics," said the college's midwifery adviser, Norma Campbell.
The report said other medical specialities at the hospital, including anaesthetists and paediatricians, had identified concerns about the ability of the maternity service to provide a consistent level of service 24/7. One letter about these concerns had still not been responded to.
The report said the Regional Women's Health Service "has not been the success anticipated". It said its establishment in 2013 "has increased the complexity of service development and accountability, particularly at the MidCentral site."
The roll-out of the National Maternity Clinical Information System, and rising demands on the service added to the pressures.
The review recommended that the regional service be reviewed and a "less complex process be developed to enable reliable obstetric care for Whanganui to be maintained".
Palmerston North MP Iain Lees-Galloway urged the two health boards to boost funding and make sure they get regional maternity services right in the future.
The deaths were deeply worrying to the community, and the DHBs must ensure regional services are reliable in future, he said.
"If the two DHBs are continue to pursue this model they need to look again at what best practice is and they have to put into the service to ensure that it provides the level of care that we expect, and that it's something as a community that we can trust and have faith in."
DHBs to adopt recommended changes
MidCentral DHB chief medical officer Ken Clark said staff there had been over-stretched.
"I think we conclude that that is the case. That we put the staff in the situation over time, and it's crept up on the service and on the organisation. It's critical that we've realised that and are now doing all we can to return the service to where it should be."
Dr Clark said there had been no effort to restrict resources for the service.
"The reality is we need to consider extra investment in the service now to make sure that it's able to be what it needs to be."
He could not put a figure on that.
"I obviously haven't got a specific amount but it won't be approached that way, it will be what is needed to ensure that the service can function as it should," said Dr Clark.
A memorandum of understanding is recommended to detail the future of regional co-operation, to be finalised by July.
Dr Clark said he expected MidCentral DHB would support Whanganui in terms of staffing when needed in future. It would also continue ongoing efforts to share information and in training and other areas.
Whanganui DHB chief executive Julie Patterson said ironically, there were no staffing problems at the moment.
"That is quite ironic because the reason for doing this all in the first place [the regional service] was the instability with staffing, but for the past two years our staffing has actually been quite stable, and although we have had a recent resignation and one resignation can destabilise a small service like ours, we have already been able to replace the obstetrician."
The New Zealand vice-president of the Royal Australian and New Zealand College of Obstetricians, John Tait, said the two DHBs were working to address the recommendations and it would help.
"The reviewers identified a number of systemic problems, including resourcing, communication and team structure and the recommendations are very clear about the need for more effective team work.
"The midwifery and medical staff are well aware of the benefits to women and babies of seamless, collaboration care, and they will find ways with their colleagues' support, to overcome current challenges so that they are better equipped to work more collaboratively."