Speech from minister of health Tony Ryall

Thank you for inviting me to open the NZ College of Midwives national conference.

It is a pleasure to be here.

A wit - who shall remain anonymous - once said   

"It sometimes happens, even in the best of families, that a baby is born. This is not necessarily cause for alarm. The important thing is to keep your wits about you and borrow some money."

As the father of two children, I would agree with that.

But I also believe that the birth of a son or daughter is probably the greatest experience a parent can have.

Greater even than becoming the Minister of Health.

As midwives you are fortunate.

You make your living bringing new babies into the world.

You spend countless hours supporting women through pregnancy, child-birth and beyond.  

You share that wonderful experience. For many, you provide that blanket of safety, assistance and reassurance that makes a new life so positive.

As I travel around the health service I have been impressed with the calibre of the midwives I've met -women - and men - who are dedicated to their work and passionate about it.

The National-led Government believes the mission of maternity services is the health and safety of mothers and their babies.

New Zealanders have high expectations of their public health service, and in particular, they have high expectations of maternity services

But everyone in this room would agree - sometimes things go wrong.

I don't need to set out the challenging media coverage, the petition to Parliament, or the concerns of Coroners. Nor issues raised by the Health and Disability Commissioner.

I mention this in the context of the ongoing challenge your profession and the public health service faces if we are going to truly say we provide safe, high quality maternity services for every New Zealand mother and child.

We need to acknowledge the steps your profession is taking in response to these challenges: the strengthened curriculum of greater supervision, mentoring, the first year of practice and more practical experience for students.

The Government is also investing strongly in maternity services: an additional $103 million over four years.

Rural recruitment and retention service

Health is a challenging portfolio. But the greatest challenge is workforce, workforce, workforce.

It is encouraging to note that we have more of you now than we used to.

The midwifery shortages of a while ago are improving. But there are still shortages in some rural areas.

Those rural midwives particularly need support - and the rural midwifery recruitment and retention service has been very successful in helping out.

To date, 158 midwives have been able to have locum relief provided by the service and we have 140 midwives on the rural midwife locum register.

The service has also assisted two midwives to set up practice in rural midwifery through relocation grants.

The Government's Voluntary Bonding Scheme is also supporting midwives in hard to staff areas.

In return for a commitment from doctors, nurses and midwives after graduation, to live in New Zealand and work in a hard to staff area we will write off their student loans.

95 midwives were enrolled in the Scheme in the first year.

We've accepted 46 more this year - which is around half of this year's graduate midwives.

Quality

Globally, clinical leadership is the fundamental driver of improved patients outcomes. That is why this Government looks to the health professions to work together to improve the quality of health services in New Zealand.

So I want to acknowledge and thank your college for your willingness to work with the College of GPs, RANZCOG and the Ministry of Health in our four priority maternity areas.

When I became Minister of Health I was given a Draft Maternity Action Plan with 97 proposed actions and things to do over some years to come. I didn't want maternity to be yet another one of the 65 wordy strategies sitting on the Ministry of Health website.

So we are focused on four priority actions over an 18 month period:

·         a national quality and safety programme including maternity service standards, and clinical indicators

·         new referral guidelines to include protocols for transfers of care and emergency transfers

·         maternity information systems and analysis, as recommended by the Perinatal and Maternal Mortality Review Committee and;

·         standardised, electronically transferable maternity notes, to improve communication in transfers to other professionals.

I'd like to comment on each of those priorities. When we have completed them, we will work together to identify the next priorities to complete.

National Quality and Safety Programme

You are working closely as a key partner with other professional colleges and the Ministry of Health on a set of national maternity standards to guide DHBs so they will deliver better, safer, maternity services.

The group will also establish a set of national clinical indicators that each DHB can be benchmarked against. That will make performance more visible to the professions, the DHBs and more importantly the public.

There will need to be strong clinical leadership and collegial relationships at the local level if we are to successfully implement these national standards and indicators.  

Strong multidisciplinary teams working together in each DHB will have to identify ways that services and care can improve, and work together to make it happen.

Maternity Referral Guidelines

As you know the existing Maternity Referral Guidelines describe the criteria that Lead Maternity Carers (LMCs) use to recommend to women that they should see an obstetrician or other specialist.  

They date back nearly ten years to 2002, and new evidence has emerged since then.   We need to review them to make sure they take that new evidence into account and that we still have the right guidance to support LMCs.

This includes situations where responsibility for care is transferred from a Lead Maternity Carer to the secondary maternity services team.  

The sector will be consulted on a draft of the revised referral guidelines and the processes for transfer of care in November this year.

Final versions of the documents will be available by May next year and national implementation will start from 1 July 2011.

Improving maternity information systems and analysis

In recent years a clunky Ministry of Health IT system has compromised our ability to monitor maternity services and outcomes for mothers and their babies.

Fixing the maternity information system is a top priority. I am advised it should be operational by June 2011.  

Standardised, electronically transferable maternity notes

The Ministry has named maternity as the pilot for the shared care record with the full support of the College. A lot of progress can be made in this area and would make a real difference to professionals and mothers alike, allowing information to be passed among the team of health professionals supporting mother and baby.

Conclusion

In achieving these priorities we're seeing great cooperation and collegiality across the maternity service. Participants from across the spectrum are working positively and constructively   

It is a challenge for clinical leaders:  midwives, GPs and obstetricians

But the results will make for an even better service for New Zealand mothers and babies.