Speech to the Perinatal and Maternal Mortality Review Committee, Te Papa, Wellington
Thanks Alan. It’s a pleasure to be here today at the Perinatal and Maternal Mortality Review Committee’s conference ‘building capacity in the maternity sector’.
This is my first key opportunity speaking to members of the maternity sector. I would like to take this opportunity to thank you all for your commitment and dedication in providing important healthcare services to New Zealanders.
Before I talk about the work underway to strengthen maternity services, I’d like to start with a brief overview of the health sector and my priorities.
I believe New Zealand’s health sector is in good shape. The feedback I’ve been getting is that although there are still challenges, we are heading in the right direction. However, there’s no doubt that challenges remain.
It will never feel like there’s enough dollars in health. The Government has made health our number one funding priority despite economic challenges. Investment in our public health services has risen from a budget of $11.8 billion in 2008/9, to a record $15.9 billion in 2015/16.
Health is receiving the largest share of new funding in Budget 2015. We’re investing around $1.7 billion over the next four years for new initiatives and to meet cost pressures and population growth.
In terms of my priorities, I want to see high levels of clinician engagement in the leadership of the health system, increased focus on moving services into the community, and responsible financial management across DHBs.
I want to see continued progress in the battle against NCDs and obesity. There will also be a continued focus on the health targets.
We need to change the way healthcare is delivered, with more people getting the care they need away from hospitals. We need to further harness the skills of our workforce so we are utilising the full range of skills of the wider health team.
Delivering quality maternity services
In terms of maternity issues, there are close to 60,000 new births annually in New Zealand.
It’s important to deliver high quality care for mothers and babies. The birth of a child is one of the most important events in life for many New Zealanders.
The Government recognises the importance of delivering high quality maternity care and we invested an extra $103 million over four years in Budget 2012 to improve maternity services.
We constantly want to improve health outcomes for New Zealand families. The work of the Perinatal and Maternal Mortality Review Committee (PMMRC) is absolutely crucial to this.
The PMMRC fulfils a vital role helping to improve the quality and safety of perinatal maternal care in New Zealand. Since its inception in 2005, the PMMRC has developed a sophisticated, internationally recognised review system.
ACC treatment injury liability
One thing that’s become apparent, ACC’s treatment injury liability account is subject to a rising number of claims. It’s very important from a clinical and fiscal point of view that we know why this is happening.
We want to deliver better outcomes for individuals and the population as a whole. Secondary to that, the Government has a financial interest as well.
There are many factors - an ever increasing climate of litigation, the ability of technology to deliver better outcomes, as well as raised public expectations.
We need to ensure that all the quality data we’re gathering is properly fed back to clinicians to improve outcomes over time. The first step is to develop a full understanding of what’s driving this increase.
PMMRC’s 9th report
As you all know, the PMMRC’s ninth annual report released today has some encouraging aspects.
The perinatal mortality rate in 2013 is the lowest rate reported since the PMMRC began collecting annual data in 2007. It is also encouraging that the rate of stillbirths at term has fallen significantly – from 117 in 2007 to 69 in 2013.
However, spontaneous preterm birth was a cause of death for almost 1,000 babies during this period, accounting for 21 per cent of all perinatal related deaths.
Māori, Pacific and Indian newborns were at least twice more likely to be born and die at 20–23 weeks than New Zealand European newborns.
We know that 10 per cent of women are not engaging easily with community primary maternity care and addressing this is high on the Ministry of Health’s work programme.
So as always in health, there is more to be done.
Maternal mortality and morbidity
The PMMRC’s latest report also looks at maternal mortality and maternal disorders in pregnancy.
Sadly suicide and amniotic fluid embolism were among the most frequent causes of maternal mortality in 2006-2013.
This is concerning because New Zealand’s maternal suicide rates are seven times higher compared to the UK, and nearly six times higher for amniotic fluid embolism.
I know the PMMRC’s intends to review all cases of amniotic fluid embolism in the coming year, and further analysis is also planned on maternal suicides.
Ministry of Health report
While New Zealand has very good maternity services, there are always areas where we can improve.
The Ministry’s Report on Maternity, published in April, shows 63 per cent of women who registered with a LMC and gave birth in 2012 had registered in their first trimester - a 28 per cent increase on 2008. Over 90 per cent had registered with a LMC by the end of their second trimester.
It is encouraging to see that more women are opting to register with a LMC in the first three months of their pregnancy. This means they have access to personalised, high quality care and advice sooner. But we still want to see these numbers increasing.
Maternity Quality and Safety Programmes
There has been considerable work done to strengthen quality improvement in maternity with new guidelines, standards and a newly formed monitoring group.
Launched in 2012, DHB Maternity Quality and Safety Programmes play an important role. They support local clinical leadership, quality improvement initiatives and engagement with the public.
The roll-out of the maternity clinical information system to DHBs will mean that midwifery information can be shared to better contribute to integrated care across all maternity providers. This will also help to improve the quality of care for women and their babies across the country.
The National Maternity Monitoring Group, which is entering its fourth year, plays an important role in maternity quality and safety. I recently met with members of the Monitoring Group, and I know that the Group is well positioned to help maintain momentum in the quality improvement space.
Earlier this year, I announced that the Ministry is investing $2 million over the next four years into the Severe Acute Maternal Morbidity Audit programme.
This programme funds a multi-disciplinary panel of experts - including obstetricians, midwives, anaesthetists, and intensive care specialists – to review factors that may have been avoidable in cases of severe maternal morbidity.
So far over 300 cases have been reviewed by the panel, and the information gathered fed back into the sector to inform clinical education and policy.
Maternal mental health
Mental health is also a priority area for the Government. In Budget 2013 we invested an extra $18.2 million in maternal mental healthcare. As a result, more new mothers in the North Island are receiving better specialist mental health support.
A new Auckland unit is now the sole dedicated inpatient unit in the North Island for mothers with mental health needs. Since opening in October 2014 the Starship unit has supported 14 mothers, with babies aged from three weeks to 11 months.
It’s also good to see new initiatives to tackle the issue of family violence. For example, the new domestic violence social worker role at Auckland DHB’s National Women’s Hospital will focus on further improving the DHB’s ability to respond to domestic abuse.
In terms of the workforce, there has been a reversal in the midwifery shortages that affected the profession eight years ago, although there remain pockets of shortage.
The Midwifery Council has implemented a number of strategies to strengthen the workforce, and increase the numbers of midwifery students across New Zealand. For example, satellite training centres enable students to remain in their communities and only travel for essential education.
Other strategies which have strengthened the workforce include return to practice programmes - the Midwifery First Year of Practice programme, the Midwifery Council Recertification Programme and Health Workforce NZ postgrad study grants.
The Midwifery First Year of Practice programme is a great example of the sector working together. The programme is now a mandatory requirement for all graduate midwives in New Zealand. It has a stronger mentoring component to better support new midwifes, as well as performance requirements for mentors.
In closing, while there are many initiatives underway to further improve maternity services in New Zealand, there will always be more we can do.
The care of mothers and babies around the time of birth has to be an absolute priority. The Government remains committed to providing quality maternity services and continuing to engage with the maternity sector.
This workshop is a good opportunity for further discussion on how to reduce perinatal and maternal morbidity and mortality, and improve the quality of perinatal and maternal care. I wish you all the very best for a productive and informative day.