Where should we locate primary maternity facilities in Central Otago/ Wanaka?

Public Meeting– 9 September 2020

New System of Primary Maternity Services in the Southern District

2018 Integrated Primary Maternity System of Care

Aims to provide more equitable care for women across the district by: • addressing service gaps • better distributing resources and facilities

Not only about considering specific facilities: • sustainability of workforce• additional payments to remote rural

midwives

Current scenario

Maternal and Child Hubs: Wanaka and Ranfurly

Primary Birthing Units: Queenstown and Alexandra

Primary Birthing Unit (PBU)

• Provides a physical setting for assessment, labour and birth, and postnatal care

• Stand-alone facility or a unit within a Level 1 or Level 2 hospital• Suitable for giving birth if you have a normal, low-risk pregnancy• You can have a postnatal stay once your baby is born• You can transfer from a hospital to have your postnatal stay• No inpatient secondary or tertiary maternity services such as:

• Epidural• Caesarean section• Medications to induce or augment labour

Primary Birthing Unit (PBU)

Birthing is only one part of the

services delivered by Primary

Birthing Units.

A large component of their work

involves women transferring to

them, after birthing at Queen Mary,

Southland or home, for a postnatal

stay.

Primary Birthing Units can also

offer a range of other services

including:

- Pregnancy testing

- Breastfeeding support

- Car seat installation checks

Transfers in for Postnatal care

2015 2016 2017 2018 2019

Charlotte Jean Maternity

Hospital 118 119 113 152 146

2015 2016 2017 2018 2019

Charlotte Jean Maternity

Hospital

53 58 60 57 68

Births

Case for change

The Southern DHB is required to provide or fund primary maternity facilities for urban or rural communities with a catchment of:

• 200 pregnancies per annum where the facility is 30 minutes from a secondary service

• 100 pregnancies per annum where the facility is 60 minutes from a secondary service

Number of births by Territorial Authority**

TA 2015 2016 2017 2018 2019

Wanaka/Hawea/Matukituki 106 109 123 110 *

Central Otago 153 183 182 205 *

Facility 2015 2016 2017 2018 2019

Lakes District Hospital 64 59 72 71 75

Charlotte Jean Maternity

Hospital 53 58 60 57 68

Number of births by Facility

*2019 data is not currently available**Excludes home birthing data

Wanaka will continue to grow: Queenstown Lakes District Council Demand Projections

The Queenstown Lakes District is considered to be a high growth district within New ZealandThese projections consider COVID-19 in the short-term, all figures are projected out 30 years.

The demand projections consider a range of things including national data from Statistics NZ, migration and tourism numbers, building and resource consent data, analysis on existing zoned capacity and a review of development trends.

https://www.qldc.govt.nz/community/population-and-demand

Deb Harvey & Peta Hosking

• 161 women received care from Deb and Peta July 2019 – July 2020

• 104 (65%) of women had uncomplicated pregnancies

• 55 (34%) of births took place in Wanaka or at Charlotte Jean Maternity Hospital

Location TotalHome 31Charlotte Jean 24Base Hospital, In District 95Base Hospital, Out of District 7Out of District 4Total 161

Options design

In designing the options we considered:

• Current configuration of services

• Potential co-location of services

• Where the population is growing

• The requirements of the Service Schedule

• Workforce availability

• Affordability

• All stakeholder and community feedback from round one

Option One: Single new facility at Cromwell

• Locate a single new primary birthing unit in Cromwell

• Decommission Charlotte Jean Maternity Hospital

• Supplemented by Maternal and Child Hubs in Wanaka, Alexandra and Ranfurly

• Possible emergency birthing facilities in Lawrence

Option One: Single new facility at Cromwell

Advantages• Central location – 30-50 minutes of all larger population groups• Strategic location for potential future health developments• Potential to co locate with a general practice• Build Helipad onsite• Single unit means it is more likely that we can provide a model of care with 24/7 cover• The percentage of the 15-49 female population who would have a Primary Birthing Unit within a 60

minute drive increases from 79.9% to 97.8%

Disadvantages• Further away from a secondary hospital than current facility in Alexandra• Increased travel times for primary birthing for people from Ranfurly / Roxburgh

Option Two: Single new facility at Dunstan Hospital in Clyde

• Locate a single new primary birthing unit in Clyde at Dunstan Hospital

• Decommission Charlotte Jean Maternity Hospital

• Supplemented by Maternal and Child Hubs in Wanaka and Ranfurly

• Possible emergency birthing facilities in Lawrence

Option Two: Single new facility at Dunstan Hospital in Clyde

Advantages

• Within 60 minutes of all larger population groups

• Co-location with secondary services at Clyde (not obstetric support)

• Easier access to Helipad for emergency transfer and retrievals

• Single unit means it is more likely that we can provide a model of care with 24/7 cover

• The percentage of the 15-49 female population who would have a Primary Birthing Unit within a 60 minute drive increases from 79.9% to 91.4%

Disadvantages

• Only slight improvement in travel times for Wanaka women and families from present situation

Option Three: Two facilities, Charlotte Jean and Wanaka

• Locate a new Primary Birthing Unit in Wanaka AND

• Retain the current unit in Alexandra (Charlotte Jean)

• Supplemented by a Maternal and Child Hub in Cromwell and Ranfurly

• Possible emergency birthing facilities in Lawrence

Option Three: Two facilities, Charlotte Jean and Wanaka

Advantages

• Increased coverage

• Potential to co locate the Wanaka service with General Practice and close to a helipad

• The percentage of the 15-49 female population who would have a Primary Birthing Unit within a 60 minute drive increases from 79.9% to 98.6%

Disadvantages

• Operating costs and workforce availability will make it more challenging to provide 24/7 cover at 2 units

• Wanaka unit may not be utilised to full potential due to distance from secondary services

• Wanaka and Charlotte Jean may not be utilised to full potential due to splitting the catchment area

• Women's preference is to not travel backwards or away from secondary services

• Charlotte Jean relies on road ambulance transfer to helipad

Option Four: Two facilities, Clyde and Wanaka

• Locate a new Primary Birthing Unit in Wanaka AND

• Relocate the current unit in Alexandra (Charlotte Jean) to be co-located with Dunstan Hospital in Clyde

• Supplemented by a Maternal and Child Hub in Cromwell and Ranfurly

• Possible emergency birthing facilities in Lawrence

Option Four: Two facilities, Clyde and Wanaka

Advantages

• Increased coverage

• Potential to co locate the Wanaka service with General Practice and close to a helipad

• Co-location with secondary services at Clyde (not obstetric support)

• Easier access to Helipad for emergency transfer and retrievals at Clyde

• The percentage of the 15-49 female population who would have a Primary Birthing Unit within a 60 minute drive increases from 79.9% to 98.6%

Disadvantages

• Operating costs and workforce availability will make it more challenging to provide 24/7 cover at 2 units

• Wanaka unit may not be utilised to full potential due to distance from secondary services

• Wanaka and Clyde facilities may not be utilised to full potential due to splitting the catchment area

• Women's preference is to not travel backwards or away from secondary services

Options comparison

Consultation Round 2 – July / August 2020

Who we heard from

We received 277

responses to our online

survey

Who we heard from

65% of online

responses came from

Wanaka/Hawea

Note that higher

proportions of Wanaka

and Hawea populations

provided feedback than

other areas.

Who we heard from• Otago Rescue Helicopters

• Charlotte Jean Maternity Hospital Staff

• Maternity Quality and Safety Programme members

• Representatives (clinical and management) of Dunstan Hospital

• Wanaka based Lead Maternity Carers and colleagues

• Alexandra/Cromwell based Lead Maternity Carers

• Central Otago Mothers Group

• St John

• Paediatrics/Obstetricians

• New Zealand College of Midwives

• Roxburgh Medical Services Trust

• Members of the public

• & more…

Options preference

133

38

69

15 13 9

0

20

40

60

80

100

120

140

CJ and Wanaka Clyde Clyde andWanaka

Cromwell No preference Other

First Preference

Options preference

27

6

51

20

169

40

20

40

60

80

100

120

140

160

180

CJ and Wanaka Clyde Clyde andWanaka

Cromwell No secondpreference

Other

Second Preference

Rating importancePriority (4 = most important)

Offers acceptable travel times to primary birthing facilities for the most people

4

Expedited transport to secondary care in an emergency 3

Can allow for highest level of midwifery staffing at a primary facility

2

Co-located with existing health services, 24/7 support and access preferred

1

What we heard

• 24/7 midwifery availability at birthing facilities is preferred by LMCs as this provides additional back up in remote rural areas

• Rapid access to urgent transport, especially a helicopter, is essential. A significant proportion of the online feedback focused on safety and the importance for women and whānau to know that there are excellent arrangements to deal with emergency situations

Estimate Helicopter Transport TimesFrom Helicopter Base Estimate Total

Times

To Dunstan 35mins

+ loading & Dunstan return 1hr, 30mins

+ pick up of team from Dunedin Hospital 1hr, 50mins

To Cromwell 40mins

+ loading & Cromwell return 1hr, 40mins

+ pick up of team from Dunedin Hospital 2hrs

To Wanaka 50mins

+ loading & Wanaka return 2 hrs

+ pick up of team from Dunedin Hospital 2hrs, 20mins

What we heard

• Equity of travel times and access to primary birthing facilities for all parts of the region is important

• Co-location with other health services especially medical support is highly valued by public and professionals

• Need to take account of pace and locations of population growth and develop a future proofed proposal

• Quality of the whole pathway of maternal care emerged as a key theme. While people want to know facilities are available, many respondents focused on care quality and availability of a highly skilled workforce

What we heard

• Feedback from Māori respondents noted that Māori have experienced care in the community (not birthing unit) that was not respectful e.g. ‘being talked down to’ and in particular have not always received supportive care in the weeks following birth

• Charlotte Jean Maternity Hospital is highly valued by women and the community

• It is important that this work progresses as quickly as possible

• We need to enhance public understanding of what is available at a Primary facility vs a Secondary facility

• There is enhanced understanding of the decision making trade offs i.e. financial sustainability and 24/7 staffing vs shorter drive times

• Wanaka residents strongly prefer a facility based in Wanaka

Decision making criteria

As part of our decision making process we will consider:

• stakeholder and public feedback

• the requirements of the Service Schedule

• safety and quality

• workforce availability

• sustainability

• affordability

Next Steps

• Central Lakes Locality Network and the DHB Project Team will make a joint recommendation on a preferred option

• DHB Board decision in November 2020