Report on the Maternity Services Review

The Federal Minister for Health, Nicola Roxon, released the much awaited report into maternity services over the weekend.

The Chief Nurse and Midwifery Officer, Rosemary Bryant, led the review and this report is an important step in developing a national plan for maternity services.

The Report makes a series of recommendations in the key areas of:
1. Safety and Quality
2. Access to a Range of Models of Care
3. Inequality of Outcomes and Access
4. Information and Support for Women and their Families
5. The Maternity Workforce
6. Financing Arrangements.

The report recommends that the Australian Government give consideration to providing access to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme to appropriately qualified and skilled midwives, working within collaborative team-based models.

This report recognises the importance of information and support for women. Without good information, women do not have options. The report does not refer to "health literacy" as such but the concept is embedded in the recommendations. The report acknowledges the critical role reliable information plays in assisting women to make decisions about their maternity care.

This is consistent with the Interim Report of the National Health and Hospitals Reform Commission which emphasises the importance of health literacy.

The report is available online as a pdf and as webpages.
Summary of recommendations is available online.

The Review Team received more than 900 submissions from consumers, health professionals, industry groups, researchers, professional organisations and national peak bodies. Submissions included women sharing their birth stories and experience of clinicians and midwives delivering maternity care, examples of existing effective models of care within Australia and internationally, and research papers on many aspects of pregnancy, birthing and postnatal care.

Interestingly, the personal stories of individual women made up 407 of the submissions received. About half of the women contributing to the Review had personally experienced homebirth. This is a much higher proportion than the proportion in the population overall. (Homebirths account for less than 1% of all births in Australia.)

In the media:
The Australian: Midwives seek access to Medicare
MIDWIVES will challenge doctors' financial monopoly over birth and pregnancy after a new government report proposed they be allowed to bill Medicare and the Pharmaceutical Benefits Scheme for their services.

The Canberra Times: Script-writing seen as new midwife role
Women will receive rebates for services provided by midwives and be able to turn to them for prescriptions if the Federal Government adopts recommendations from a report out today.

The Rural Doctors Association of Australia (RDAA) has welcomed the Report and said it provided a strong way forward for improving access to maternity services in the bush. They released a media statement.
“Families who live and work in rural and remote Australia should be able to access quality healthcare in their local communities without having to wait weeks for an appointment or having to travel hundreds of kilometres to get that care. This report offers the Government an opportunity to start making this vision a reality. RDAA commends the report and looks forward to working closely with the Minister and Government to implement its recommendations.”

The findings and recommendations of this Review will inform the development of the National Maternity Services Plan

Nursing and Midwifery Stakeholder Reference Group

I attended the first Stakeholder reference Group for the Department of Health and Ageing on 14 November 08.
Rosemary Bryant explained that the main purpose of the group is to provide a means for two-way exchange of information and advice between the CNMO and key nursing and midwifery experts. Members of the group are representatives of their respective organisations.

Maternity services review
Over 900 submissions have been received. The submissions have been prepared by consumers, health professionals and peak bodies.
The Chief Nurse and Midwifery Officer (CNMO), Rosemary Bryant, commented that there were lots of areas of agreement across the submissions including the importance of continuity of care, support for midwifery led models, and indemnity issues facing midwives. The Department is currently analysing the submissions and writing a report for the Minister of Heath, Nicola Roxon. It is up to the Minister whether this report will be made public. I think that this is a very important document that would contribute significantly to that this become a public document.

There was considerable discussion of membership of the Stakeholder Reference Group. In particular, there was discussion of the need for aged care nursing to be represented. The distinction between community based nursing and residential facilities was drawn.

The place of Community nurses around the table was also raised. This is a significant workforce for consumers, especially vulnerable people. With our work at Health Care Consumers Association we have heard a range of issues from advocates regarding competency standards and scope of practice of community nurses.

One issue that affects the wider consumer movement is that there is not a professional association for community nursing. The ACCNS folded around two years ago. For consumers this means that we need to work across a number of bodies to raise any issues we may have about standards and practice. This includes: the registration Boards, the Nursing Federation, the College of Nursing and Midwifery, deans of nurse education, CRANA and chief nurses in each jurisdiction.

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)

Maternity Services Review

The Government is undertaking a Review of Maternity Services. The Review is led by the Commonwealth Chief Nurse and Midwifery Officer, Ms Rosemary Bryant.

The Government Review is:

• canvassing a wide range of issues relevant to maternity services, including antenatal services, birthing options, postnatal services up to six weeks after birth, and peer and social support for women in the perinatal period;
• ensuring that all interested parties have an opportunity to participate; and
• informing the development of a National Maternity Services Plan.

The Department of Health And Ageing prepared a discussion paper, Improving Maternity Services in Australia: A Discussion Paper from the Australian Government, which is available online.

Submissions responding to the discussion paper close this week and I know a number of our members are involved in preparing individual submissions as well as contributing to those prepared by other organisations.

We consulted with our members on the discussion paper and have framed our response based on their experiences and perspectives. We have also received input from the Women’s Centre for Health Matters and ACT members of Women With Disabilities Australia and incorporated comments into our submission.

The HCCA submission is available on our website as a pdf (171kb).

We are interested in your comments.

As you know, planning is underway for the construction of a women and children's hospital and a Women's Health Plan is currently being developed. We will be drawing on our submission to the national review to provide input to both of these processes.