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SDHB's set up of rural maternity services slammed in reviews

SDHB’s set up of rural maternity services slammed in reviews

Southern District Health Board chief executive Chris Fleming has apologised to the northern Southland community for the teething problems relating to turning the Lumsden Maternity Centre into a maternal and child hub.

But he has stopped short of sorry to the four women who experienced rapid births at the hub, because a separate report found that of the two women who were interviewed, both of their birthing outcomes were unavoidable.

A damning independent report from Ernst Young, which was released by the DHB on Friday, was critical of the DHB’s “informal” management processes during and after hubs were set up at Lumsden, Te Anau and Wanaka.  

It was critical of the DHB’s project management, governance framework, and communications and change management, and it has made 10 recommendations.

 

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Fleming said while he thought the EY report was “reasonably balanced and quite fair”, he said there should have been a much more structured set up in place before the primary birthing unit became a hub.

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The report says there was no clear definition of what a maternal and child hub would be, and what services it would provide.

When Fleming was asked how it could implement a hub service if it didn’t know what that was, he said: “We should have done better.”

“Clearly some of the things we know know, we could have done better at the time.

There should have been much more structure.”

It was clear that hubs would be used for emergency births, but there were issues with how they were to be equipped, and the there should have been a more structured handover, he said.

However, he said there were “tensions and challenges” in the community in terms of opposition to the transition to a hub, and the DHB had not done a good job at communicating with the northern Southland community.

“Given that, we should have redoubled our efforts in the set up, before the transition.

The hub setup had been “exceptionally difficult” for all of the DHB staff involved and it had lost some staff as a consequence, Fleming said.

But he says despite the issues raised in the reports, he has confidence in the hub model, there is no going back and the hub will remain.

Associate Minister of Health Julie-Anne Genter said the DHB has a lot of work to do to regain people’s trust, particularly in northern Southland.

“The Southern DHB didn’t bring the community along with their changes from 2016 onwards, and didn’t have a viable substitute in place before downgrading the birthing unit in Lumsden.

The Lumsden Maternity centre was run by the Northern Southland Health Company

Company chairperson Carrie Adams said the reports vindicated the concerns that the community had about the hub setup at Lumsden.

“The outstanding biggie in all of this is what happens now? 

“I don’t think the result will be a surprise to anyone.

The reports are helpful but they don’t establish a clear path that things are going to change and there’s a lot of unknowns attached.”

Clutha-Southland MP Hamish Walker was critical of the fact that the reports didn’t look at reinstating full services at the Lumsden Maternity Centre.

The reports were the second to identify major failings by the SDHB in relation to Lumsden and he called on the Government to intervene.

“They need to stop treating rural mothers and babies like second-class citizens, listen to the experts and reinstate full services at Lumsden.

Only two of the four women who had rapid births at Lumsden agreed to be interviewed for the report from the The NZ College of Midwives 

The review found both of the women‘s birthing outcomes were unavoidable.

“An additional contributory factor pertaining to one woman was the lack of essential equipment available in the Lumsden hub in the presence of specific risk factors which could constitute the need for full resuscitation capacity,” the report says.

It says now, some women are planning to have a home birth out of necessity rather than preference, while other women are having unplanned homebirths because they are not confident that there is enough time to travel the extra distance to a birthing unit.

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