Primary maternity options in the Te Awamutu area Consultation with the community 10 February 2014

Introduction to Jan Adams

• Health Waikato chief operating officer • Health Waikato = Waikato DHB’s provider arm • Looks after

hospital and health services

, including Waikato Hospital, Thames Hospital, and three rural hospitals in Te Kuiti, Tokoroa and Taumarunui, plus mental health and addiction services, continuing care and primary birthing facilities, rural and community-based services, population health services, and associated clinical support and administrative support services.

Answers to some questions

Before we start we wanted to update you on the following questions and statements that have been made at some consultation meetings: • The DHB has purposely run down the maternity facilities so that no-one will use them • What is the money actually spent on?

Maintenance 2013

• Shared campuses – previously no separation • Matariki, Te Awamutu – 5 maternity requests for maternity: 1 outstanding (toilet seat) – 54 estate/ infrastructure requests e.g. commission copper / silver ionisation; planned maintenance heating systems • Rhoda Read, Morrinsville – 1 maternity request – outstanding bed maintenance

2011-2013 expenditure on Matariki Matariki $24,051

Recent work has been associated with general improvements to the Matariki facility such as: • lighting upgrades • new gas boilers • kitchen upgrade (in progress) • heating / air conditioning installation • sub kitchen painting upgrades (obtaining quotes) • flooring replacement (obtaining quotes) • Copper / Silver ionisation systems

Matariki maternity unit (2012 photos)

What are the costs to the DHB of running Matariki and Rhoda Read?

2012/13 maternity costs for Matariki and Rhoda Read Matariki

Salary related costs - nursing, administration, food and staff $557,736 Utilities/maintenance and rates $31,878 Other costs – food, laundry, cleaning, clinical and other supplies, laundry, accreditation $76,188

TOTAL $665,802 Rhoda Read

Salary related costs - nursing, administration, food and staff $519,137 Utilities/maintenance and rates $25,266 Other costs – food, laundry, cleaning, clinical and other supplies, laundry, accreditation $71,253

TOTAL $615,656 Important note:

The above figures are based on the costs internally reported within Waikato DHB. Some costs to the DHB are not allocated to a particular unit (e.g. insurance which is one organisational amount).

The process for this consultation meeting

We are seeking your feedback following a feasibility study of the primary maternity facility in Te Awamutu that demonstrated the facility is no longer meeting local needs.

This is the last of 3 meetings held in Te Awamutu; • The first meeting was to present the findings of the Feasibility Study • The second was to get your views and ideas • This evening will be the same process as the second meeting (above)

Process cont….

This meeting is planned to: • Present information from the study • Overview potential options • Engage you in group discussion • Receive feedback to assist with decision-making • Will take around 20 minutes • Discussion in groups after the presentation - 30 mins • Feedback and next steps 30 mins

Summary of review findings

• As they are currently configured, primary maternity services in Matariki are: – Underutilised – Building is no longer fit for purpose eg, risks associated with room size and access – Maternity is not connected to other local maternal and child health services – Poor use of the maternity workforce – Not sustainable over the long term – Costly

Hamilton Birthing Units Morrinsville Ta Awamutu

Recommendations from the study

The recommendation is that the Waikato DHB: • Close the birthing unit at Matariki and encourage birthing in the two urban primary units in Hamilton • Consult with the community to explore what community-based maternity services are more likely to be used locally.

Feasibility Study Matariki birth numbers

Matariki has 24/7 midwifery staffing on site.

Births in the facility are declining.

• Births in the area are not predicted to increase In the 6 months to July 2013, each month on average 13 women were admitted – 1.6 women transferred to Waikato Hospital intrapartally – 6 babies were born – 5.3 mothers and babies transferred in postnatally

Local women are preferring to bypass their local facilities to have their babies in Hamilton Mothers from the Te Awamutu area Birth year

2011/12 2012/13 Grand Total

Matariki

65 52 117

Rhoda Read

1 1

Facility used Te Kuiti Waikato Hospital

2 3 5 Above figures are updated from Feasibility Study p.21 & 25 253 232 485 Only women from the local area have been included in these tables

Hamilton Birthing

55 83 138

Grand Total

376 370 746 There were 16 ‘out of area’ mothers who gave birth at Matariki in 2012/13

Why are women preferring not to have their babies in their local facility? (taken from survey of women who had babies in Hamilton) Theme Factors Impacting on Utilisation Morrinsville

 The environment is small  Facility is old  Local midwifery rooms are a distance from the unit  No visibility of the unit  The food is unsuitable for maternity patients  EN being the 2 nd at births prevents usage by some LMCs  Distance perceived to be unsafe by some providers

Te Awamutu

 The model of care prohibits LMC utilisation  The environment is small  Facility is old  Population unaware of the unit  Lack of community involvement  No local antenatal classes  Distance perceived to be unsafe EN – Enrolled Nurse, LMC – Lead Maternity Carer

Other issues raised Theme Issues related to physical environment Morrinsville

 Small size of postnatal rooms  No room for partners sleeping over  Last refurbishment many years ago  Poor maintenance  No ensuites  Not soundproof  Needs better birthing pool

Te Awamutu

 Small size of postnatal rooms  Last refurbishment many years ago  Poor maintenance  Partners sleeping ‘under the sink’ on a mattress if they stay  No ensuites  Not soundproof  Needs better birthing pool

Financial viability

• At present, it costs the DHB a total of $1,281,459 to operate these facilities ($665,802 for Matariki, and $615,657 for Rhoda Read).

• This is $856,468 more than the DHB pays for the same number of births in Hamilton Per person

Hamilton Labour & Birth Postnatal Total $ 886.29 $ 1,329.42 $ 2,215.71 Rural facilities $ 1,821.13 $ 2,731.71 $ 4,552.84

Improving community-based maternity services may be a better use of taxpayers’ money than keeping underused, out of date maternity facilities open

Where would women go to have their babies if Matariki and Rhoda Read closed?

Alternative birthing venues: Where there are no risk factors, women are best served by using primary birthing facilities: • Hamilton has two primary birthing units; River Ridge East and Waterford • Thames, Te Kuiti, Taumarunui, Tokoroa and Pohlen hospitals have primary birthing units • There are primary birthing facilities in Huntly and Waihi

Waikato Hospital is best kept for women who have complications

We looked at what is currently available in Te Awamutu Currently in Te Awamutu Would no longer be available in Te Awamutu Will remain in Te Awamutu Could be enhanced locally Lead Maternity Carers (LMCs)

•

Midwife group practice in Te Awamutu with shared rooms None currently √

•

4 LMCs live in the area

•

21 LMCs service the area (but not all will use Matariki) √ √ √ √ Maternity Services at Matariki

    

Waikato DHB (caseload) midwives Antenatal clinics Birth/postnatal stays CTG Lactation service √ √ √ √ √ √ √ √

We looked at what is currently available in Te Awamutu Currently in Te Awamutu Would no longer be available in Te Awamutu Will remain in Te Awamutu Could be enhanced locally Other related services Pregnancy scans Postnatal checks in the woman’s home Pregnancy and parenting classes Well child providers (GPs, Plunket) Maternal Mental Health Service √ √ Currently available in Otorohanga √ √ Currently provided as needed

No decision has been made

but what could some options be if Matariki closes?

Maybe an option could be a resource or family centre

• A centrally located site could offer screening, immunisation • Room for classes such as pregnancy and parenting classes (particularly for those with high needs and who are Maori) • Midwives could maximise cover/relief for each other and ensure back up for home births.

• Resource centres currently exist in Levin, Otaki, Pahiatua and Palmerston North. http://mamaternity.org.nz/maternity resource-centres/

Resource/family centre could have:

•

Resources, eg

• Information/advice, monitoring, smoking cessation, pepi pods

Lactation services, eg

Out-reach service for those with higher needs and Maori

Nutrition advice, eg

• Support/advice for those mothers with pregnancy related nutrition issues

Tamariki ora/well child services, eg

• • Screening, immunisation, advice

Antenatal clinics provided by midwives Promoting connections, eg

Space for coffee mornings, toy library, playgroups

At the December and January meetings, we were told……

• It’s too hard for families to travel to Hamilton to visit the mother (cost, distance) • Women do not want to have their babies at Waikato Hospital • The DHB should give Matariki a ‘facelift’ and then women would go there • Would the DHB consider a proposal from a private provider?

• Meetings should be held in the evening so they’re after the children are in bed and fathers can go

Summary

• The birthing facilities are under utilised and not sustainable in the long term • There has been a recommendation to close these facilities • Waikato DHB wants your views on this and if facilities are closed, what maternity services your community needs and how they should be provided • No decision will be made until late March 2014 • If a decision to close is made things would go on as usual and we undertake to work with women and midwives to ensure alternative services are in place. We will keep you informed.

Now what?

• Submissions can be made in various ways: email, post, 0800 number. Details are in your submission document and on the next slide • The final decision will take account of: – the reviewers recommendations and the reasons behind them; and – the consultation feedback

Submission options

• Post to: Planning & Funding, Waikato DHB, PO Box 934, Hamilton 3240 • Email your submission to [email protected]

• Attend meetings in December, January & February • Complete your survey on line at www.waikatodhb.health.nz/birthing • Ring 0800 100 178 and leave your name and phone number. A member of staff will call you back within two working days and will guide you through the submission form

The rest of this meeting time

• Discussion in groups - 30 mins • Questions: – Views on closure of Matariki and how the issues could be addressed – What is most needed in the Te Awamutu area if Matariki Maternity Facility closed and all women have their babies in Hamilton? – What other ideas do you have for enhancements of community maternity services?

• Feedback and next steps 30 mins