New Zealand College of Midwives conference, Auckland

Friday, August 26, 2016 - 10:15


It’s great to be here today to open the New Zealand College of Midwives 14th biennial national conference.

I’d like to acknowledge the New Zealand College of Midwives Auckland region for hosting the conference, as well as the keynote speakers.

Midwifery contribution

The birth of a child is the most important event in life for most Kiwis. There are close to 60,000 new births annually in New Zealand.

The vast majority of Kiwi women, over 50,000, register with a Lead Maternity Carer for their primary maternity care.

This has increased from 82.5 per cent of women giving birth in 2009 to 91.2 per cent of women giving birth in 2014.

Last year, Lead Maternity Carers supported over 2,000 women to give birth at home, and over 5,000 women to give birth in primary or community facilities, and around 50,000 women in secondary and tertiary facilities.

I’d like to acknowledge the fantastic job you do for Kiwi women, babies and families throughout the country. You make an invaluable contribution.

Quality maternity services

The Government recognises the importance of delivering high quality maternity care.

We invested an extra $103 million over four years in Budget 2012 to improve maternity services.

Challenges facing midwifery

I know that midwifery is a challenging area to work in and that the profession, especially Lead Maternity Carers, face a number of challenges.

Earlier this year I announced that Lead Maternity Carers will receive a backdated pay increase of $2.1 million which is an acknowledgement of their important role.

I am aware the College is engaged in mediation with the Ministry on longstanding funding issues. It’s important that both sides maintain a constructive approach.

I know both parties recently agreed the current modular structure and payment system inadequately reflects the challenges of modern midwifery practice.

The Section 88 maternity notice defines and funds primary maternity care. Section 88 was not intended to fund Lead Maternity Care midwives for the provision of secondary and tertiary services.

The sustainability of Lead Maternity Care midwifery is central to the national primary maternity service and requires national support.

I know the parties have committed to a process that results in an understanding and recognition of the value of midwives to women and their babies in the health service.

Workforce issues

In terms of the workforce, I am aware that overall there remain pockets of shortage for Lead Maternity Carers and core DHB midwives.

New graduate midwives will assist with these shortages in 2017, and DHBs will appropriately roster staff to ensure safe and quality care for women in maternity facilities.

On the more positive, I note that the obstetric, anaesthetic and paediatric workforces remain relatively stable.

Health Workforce New Zealand has established a Midwifery Strategic Advisory Group to investigate issues affecting the workforce and to develop workable solutions.  

Other strategies to strengthen the workforce include the Midwifery First Year of Practice programme which is designed to strengthen the clinical expertise of midwifery graduates.

There has been good uptake of the programme with 161 midwifery graduates enrolled in 2015.

Maternity Clinical Information System

The Maternity Clinical Information System remains a priority for the Ministry of Health.

It’s important to have a shared electronic record of care that supports a woman’s maternity journey.

The system is currently implemented in Tairawhiti, South Canterbury, MidCentral, Whanganui and Counties Manukau DHBs.

I am aware there is a lot of work underway to ensure that the system is fit for purpose before it is rolled out to other DHBs.

The Health Strategy identifies the system’s roll-out in its Roadmap of Actions.

The Ministry will be calling for expressions of interest from DHBs interested in implementing the system from 2017/18.

I want to acknowledge the role that midwives and the College have played in helping to develop this system.

Quality and safety programmes

There has been considerable work done to strengthen quality improvement in maternity with new guidelines, standards and a monitoring group.

The Maternity Quality Initiative continues with funding over the next three years to achieve the following priorities:

  • strengthening primary maternity services, including more timely and more equitable access to community based primary maternity care and support;
  • better support for women and families that need it the most, including better health and social support for young mothers and for maternal mental health, and improving health literacy among vulnerable populations; 
  • embedding maternity quality and safety, including further support for local clinical leadership and review, and meeting the Ministry’s Maternity Standards;
  • and improving integration of maternity and child health services, including transition between services through improved co-ordination, service configuration and IT.

The Maternity Quality and Safety Programme is now well embedded in DHBs with excellent work plans driving quality and safe maternity care across the country.

The National Maternity Monitoring Group continues to play a key role advising the Ministry on further quality improvements that can be made and they will shortly release their 2016 Report.

I would like to acknowledge the role of Norma Campbell who was the inaugural chair of the Group and led them to a high standard of performance.

PMMRC review system

We have a sophisticated and internationally recognised perinatal and maternal mortality review system in New Zealand.

The work of the Perinatal and Maternal Mortality Review Committee (PMMRC) plays a key role in improving the quality and safety of perinatal and maternal care.

Earlier this year, the PMMRC’s tenth report highlighted areas where we’ve seen positive changes, as well as areas that need further improvement.

Disparities continue to have a negative impact on health outcomes. Mothers living in the most socio-economically deprived areas have higher stillbirth and neonatal death rates compared with mothers living in the least deprived areas.

In 2014 stillbirth rates per 1,000 births, varied from 6.8 for mothers living in the most deprived areas, to 4.4 for mothers living in the least deprived areas.

The proportion of potentially avoidable deaths was higher for babies of Māori and Pacific mothers, at 22 per cent, compared with all other ethnicities.

This is attributed to barriers experienced by Māori and Pacific mothers in accessing and engaging with health services.

In 2014 there were four maternal deaths, the lowest number since the PMMRC began reporting in 2006. The two leading causes of maternal mortality are suicide and amniotic fluid embolism.

Following a review of amniotic fluid embolism, the PMMRC highlighted that clinicians involved in the care of pregnant women should undertake regular multidisciplinary training in management of obstetric emergencies.

A review of maternal suicides found that many women had two or more risk factors for major depression, two thirds had a prior psychiatric history, and most were experiencing relationship stress.

The PMMRC emphasises the importance of clinicians involved in a woman’s care having knowledge of her mental health history so they are able to provide the best possible care.

Health overview

I’d like to finish with a general update on the health sector.

Health funding

It will never feel like there’s enough dollars in health. Health has remained the Government’s number one funding priority.

Budget 2016 invests an extra $2.2 billion in health over four years for new initiatives and to meet cost pressures and population growth.

The Government’s investment in health will reach a record $16.1 billion in 2016/17 – that’s an extra $568 million this year, the biggest single increase in seven years.

Claims that health funding has been cut are incorrect. Under this Government health expenditure share of GDP has averaged 6.5 per cent – that’s up from the previous Government’s level of under 6 per cent.

Over the last eight years, health funding has kept up with demographic pressure and inflation.

Health Strategy

To successively deliver on the health aspirations of New Zealanders, you’ve got to have clear direction.

I asked officials to work on a clearly laid out direction for healthcare which resulted in the release of the Health Strategy back in April.

The themes of the Strategy signal a focus on prevention and wellbeing, and more integrated services. At the same time we want to see support for innovation, better collaboration, and new ways of working to reach our most vulnerable. We want to give every child a healthy start, and ensure information and services are more accessible.


In terms of my priorities, I want to see more integrated services delivered in the community so people can get the care they need away from hospitals.

I want to see continued progress on non-communicable diseases.

Implementing the Childhood Obesity Plan is a key focus. We’re now one of the first countries in the OECD to have a target and a comprehensive plan to tackle childhood obesity.

Healthy eating and exercise in pregnancy and exclusive breastfeeding are key drivers to prevent childhood obesity.

Another key area of focus continues to be lifting elective surgery rates. We’re also working to quantify unmet demand and we’re one of a few countries collecting information of this kind at a national level.

The health targets continue to be a key focus. They are not just about numbers – they are about delivering better and quicker access to important health services.

Mental health is also a key area of focus. Mental health and addiction services are responding to increased demand.

The Government has increased mental health and addiction services funding from $1.1 billion in 2008/09 to over $1.4 billion for 2015/16.

However, there’s always more we can do, and that’s what we’re doing. For example, Budget 2016 includes $12 million of funding over four years to increase support for people to access mental health services at an earlier stage.

Also as part of Budget 2016, we’re investing $12 million over four years to expand a programme that provides intensive alcohol and drug support for pregnant women.

Waitemata DHB has successfully been running an early intervention programme which has led to the reduction of substance use by mothers and improved the outcomes for unborn babies and infants.

This funding in Budget 2016 extends the programme to three new areas, supporting around 100 women a year in each region.

Closing remarks

In closing, this conference is a great opportunity to celebrate the role of midwifery in our health system.

Continually improving our health services so they are easier to reach, easier to engage with, and safer for all Kiwis is at the core of what we’re all trying to achieve.

I want to reassure you that the Government remains committed to delivering high quality accessible health services for New Zealanders.