where should we locate primary maternity facilities in ... · 30 minute travel time - increases...

Where should we locate primary maternity facilities in Central Otago/ Wanaka?

Public Meeting– 23 July 2020

New System of Primary Maternity Services in the Southern District

2018 Integrated Primary Maternity System of Care

Aims to provide more equitable care for women across the district by: • addressing service gaps • better distributing resources and facilities

Not only about considering specific facilities: • sustainability of workforce• additional payments to remote rural

midwives

Current scenario

Maternal and Child Hubs: Wanaka and Ranfurly

Primary Birthing Units: Queenstown and Alexandra

Primary Birthing Unit (PBU)

• Provides a physical setting for assessment, labour and birth, and postnatal care

• Stand-alone facility or a unit within a Level 1 or Level 2 hospital• Suitable for giving birth if you have a normal, low-risk pregnancy• You can have a postnatal stay once your baby is born• You can transfer from a hospital to have your postnatal stay• No inpatient secondary or tertiary maternity services such as:

• Epidural• Caesarean section• Medications to induce or augment labour

Primary Birthing Unit (PBU)

Birthing is only one part of the

services delivered by Primary

Birthing Units.

A large component of their work

involves women transferring to

them, after birthing at Queen Mary,

Southland or home, for a postnatal

stay.

Primary Birthing Units can also

offer a range of other services

including:

- Pregnancy testing

- Breastfeeding support

- Car seat installation checks

Transfers in for Postnatal care

2015 2016 2017 2018 2019

Charlotte Jean Maternity

Hospital 118 119 113 152 146

2015 2016 2017 2018 2019


Hospital

53 58 60 57 68

Births

Maternal and Child Hub

• Provide antenatal and postnatal support

• Some provide access to medical specialists through teleconferencing

• Not a replacement for a Primary Birthing Unit

• Provide an additional layer of support for women in areas further from other maternity facilities

• Have midwifery equipment and are accessible to LMC midwives in case of rapid births

Case for change

The Southern DHB is required to provide or fund primary maternity facilities for urban or rural communities with a catchment of:

• 200 pregnancies per annum where the facility is 30 minutes from a secondary service

• 100 pregnancies per annum where the facility is 60 minutes from a secondary service

Number of births by Territorial Authority

TA 2015 2016 2017 2018 2019

Wanaka/Hawea/Matukituki 106 109 123 110 *

Central Otago 153 183 182 205 *

Facility 2015 2016 2017 2018 2019

Lakes District Hospital 64 59 72 71 75


Hospital 53 58 60 57 68

Number of births by Facility

*2019 data is not currently available

Estimating birthing numbers

Based on Statistics New Zealand projections, we estimate there will be 42 and 66 births per year that are appropriate for primary birthing in Central Otago and a further 126 – 132 in the Queenstown-Lakes area which includes Wanaka

Projected number of births

Projection Territorial Authority 2021 2022 2023 2028 2033 2038

Medium Central Otago district 200 200 200 180 180 180

Queenstown-Lakes district

480 480 480 480 480 480

DHB Total 3,320 3,320 3,320 3,260 3,160 3,070

Projected number of births appropriate for primary birthing

(30% of total)

Projection Territorial Authority 2021 2022 2023 2028 2033 2038

Medium Central Otago district 60 60 60 54 54 54

Queenstown-Lakes

district

144 144 144 144 144 144

Central +

Queenstown Total

204 204 204 198 198 198

Consultation

“What are the most important issues for us to consider when deciding on a location?”

What we heard

1. 24/7 midwifery availability at birthing facilities is preferred by LMCs as this provides additional back up in remote rural areas

2. Rapid access to urgent transport, especially a helicopter, is essential. A significant proportion of the online feedback focused on safety and the importance for women and whānau to know that there are excellent arrangements to deal with emergency situations

3. Equity of travel times and access to primary birthing facilities for all parts of the region is important

4. Co-location with other health services especially medical support is highly valued by public and professionals

What we heard

5. Need to take account of pace and locations of population growth and develop a future proofed proposal

6. Quality of the whole pathway of maternal care emerged as a key theme. While people want to know facilities are available, many respondents focused on care quality and availability of a highly skilled workforce

7. Feedback from Māori respondents noted that Māori have experienced care in the community (not birthing unit) that was not respectful e.g. ‘being talked down to’ and in particular have not always received supportive care in the weeks following birth

8. Charlotte Jean Maternity Hospital is highly valued by women and the community

Options design

In designing the options we considered:

• Current configuration of services

• Potential co-location of services

• Where the population is growing

• The requirements of the Service Schedule

• Workforce availability

• Affordability

• All stakeholder and community feedback

Options design

Our aim is to deliver a facility that is:

• the preferred place of birth for healthy, well, low-risk women

• the preferred place of postnatal care for all women/families in the area

• a safe place for coordinated emergency maternity care

Proposed Options

Option One: Single new facility at Cromwell

• Locate a single new primary birthing unit in Cromwell

• Decommission Charlotte Jean Maternity Hospital

• Supplemented by Maternal and Child Hubs in Wanaka, Alexandra and Ranfurly

• Possible emergency birthing facilities in Lawrence

Option One: Single new facility at Cromwell

Advantages• Central location – 30-50 minutes of all larger population groups• Strategic location for potential future health developments• Potential to co locate with a general practice• Build Helipad onsite• Single unit means it is more likely that we can provide a model of care with 24/7 cover

Disadvantages• Further away from a secondary hospital than current facility in Alexandra• Increased travel times for primary birthing for people from Ranfurly / Roxburgh

The percentage of the 15-49 female population* who would have a Primary Birthing Unit within:

30 minute travel time - increases from 73.6% to 74.4%


*15,858 women in 2019

Option Two: Single new facility at Dunstan Hospital in Clyde

• Locate a single new primary birthing unit in Clyde at Dunstan Hospital

• Decommission Charlotte Jean Maternity Hospital

• Supplemented by Maternal and Child Hubs in Wanaka and Ranfurly


Option Two: Single new facility at Dunstan Hospital in Clyde

Advantages

• Within 60 minutes of all larger population groups

• Co-location with secondary services at Clyde (not obstetric support)

• Easier access to Helipad for emergency transfer and retrievals

• Single unit means it is more likely that we can provide a model of care with 24/7 cover

Disadvantages

• Only slight improvement in travel times for Wanaka women and families from present situation




*15,858 women in 2019

Option Three: Two facilities, Charlotte Jean and Wanaka

• Locate a new Primary Birthing Unit in Wanaka AND

• Retain the current unit in Alexandra (Charlotte Jean)

• Supplemented by a Maternal and Child Hub in Cromwell and Ranfurly


Option Three: Two facilities, Charlotte Jean and Wanaka

Advantages

• Increased coverage

• Potential to co locate the Wanaka service with General Practice and close to a helipad

Disadvantages

• Operating costs and workforce availability will make it more challenging to provide 24/7 cover at 2 units

• Wanaka unit may not be utilised to full potential due to distance from secondary services

• Wanaka and Charlotte Jean may not be utilised to full potential due to splitting the catchment area

• Women's preference is to not travel backwards or away from secondary services

• Charlotte Jean relies on road ambulance transfer to helipad




*15,858 women in 2019

Option Four: Two facilities, Clyde and Wanaka

• Locate a new Primary Birthing Unit in Wanaka AND

• Relocate the current unit in Alexandra (Charlotte Jean) to be co-located with Dunstan Hospital in Clyde

• Supplemented by a Maternal and Child Hub in Cromwell and Ranfurly


Option Four: Two facilities, Clyde and Wanaka

Advantages

• Increased coverage

• Potential to co locate the Wanaka service with General Practice and close to a helipad

• Co-location with secondary services at Clyde (not obstetric support)

• Easier access to Helipad for emergency transfer and retrievals at Clyde

Disadvantages

• Operating costs and workforce availability will make it more challenging to provide 24/7 cover at 2 units

• Wanaka unit may not be utilised to full potential due to distance from secondary services

• Wanaka and Clyde facilities may not be utilised to full potential due to splitting the catchment area

• Women's preference is to not travel backwards or away from secondary services




*15,858 women in 2019

Options comparison

Decision making criteria

As part of our decision making process we will consider:

• stakeholder and public feedback, their preferred option and in particular weighting given to the following statements:• the option chosen offers acceptable travel times to primary birthing facilities for the most people• the option chosen is co-located with an existing health services, 24/7 support and access preffered• the option chosen can allow for highest level of midwifery staffing at a primary facility• the option chosen expedited transport to secondary care in an emergency

• the requirements of the Service Schedule

• safety and quality

• workforce availability

• sustainability

• affordability

Help us evaluate relative priorities:

• the option chosen offers acceptable travel times to primary birthing facilities for the most people

• the option chosen is co-located with an existing health services, 24/7 support and access preferred

• the option chosen can allow for highest level of midwifery staffing at a primary facility

• the option chosen expedited transport to secondary care in an emergency

• Fill in very easy survey at

www.engage.southernhealth.nz/maternity

http://www.engage.southernhealth.nz/maternity

Next Steps

• Online feedback: open until 22 August

• Contact us: [email protected]

• Central Lakes Locality Network and the DHB Project Team will make a joint recommendation on a preferred option in September

• DHB Board decision in October 2020

mailto:[email protected]

where should we locate primary maternity facilities in ... · 30 minute travel time - increases...

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