Monday, November 17, 2008

Maternity Services Review - Round Table on Workforce

National Maternity Services Review
Round Table Forum on Workforce Standards, Quality and Inter-Professional Collaboration

The Government is undertaking a Review of Maternity Services. I have posted on this already. The Review is led by the Commonwealth Chief Nurse and Midwifery Officer, Ms Rosemary Bryant.

Maternity services in Australia are in need of change. While we generally have safe services there is still room for improvement. This need has been recognised and there have been several inquiries into maternity services in Australian states and territories where consumers have provided feedback. The current review will (I hope) build on previous work to develop a national maternity services plan.

In October I attended a Round Table Forum on workforce issues. The Forum brought together over thirty people including academic and professional leaders in maternity services, representatives from unions (Nursing Federation and the AMA), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and two consumer representatives.

The discussion was structured around three questions:
  • What are the key professional development needs, including interdisciplinary, of the maternity workforce?
  • How will models of workforce vary in rural and urban settings?
  • Where are the key workforce barriers to integrated models of care?

There are significant issues regarding the maternity services and rural and remote communities. There was consensus that high quality care can be provided in rural and remote areas through outreach services.

The issue of culturally appropriate / sensitive services for women was raised. Indigenous women report not feeling safe in the care of the services and are reluctant to attend. There is a need to further consider the needs of a range other other culturally and linguistically diverse women. Put simply: if women do not trust the services they are not going to use them. The potential for poor outcomes in terms of perinatal and maternal deaths is considerable.

There is pressure on the number of training positions. The Department of Health and Ageing are funding a series of training positions for medical trainees in private settings. There was discussion about the degree to which private obstetric practice can provide these additional training places.

There has been a lapse in the communication between the College of Nursing and Midwives and the College of Obstetricians and Gynaecologists which they hope to rebuild. This can only be a positive move for consumers.

There are many workforce issues around maternity services, including training and shortages, and there has been considerable discussion whether the existing workforce is able to service the existing demand. There is a challenge of balancing workforce issues regarding roles, training and funding with the need to provide more continuity of care for women, and at the same time rationalising of services to fit within the health budget. The “turf” war between medical specialists and midwives places further pressure on the system to plan for and deliver safe and quality maternity services. These tensions and challenges influence the way in which reform of maternity services is framed. There is no better time to re-frame maternity services from a consumer perspective.

I do have some concerns around the level of consumer participation in the review. Representatives at Round Tables such as this goes some way but we need to work with the Department to have more meaningful engagement if we are to develop a national maternity service plan that reflects the needs of women and our babies.

Darlene Cox
(wearing my CHF Consumer Representative hat)

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