Speech from Hon Tony Ryall

Good morning.

I welcome the opportunity to be here today to speak at this Perinatal and Maternal Mortality Review Committee (PMMRC) workshop – the first of two such days hosted by the Health Quality & Safety Commission.

I would like to thank Professor Cindy Farquhar for her welcome but most importantly her dedication to ensuring maternity quality and safety in New Zealand.

This is Professor Farquhar’s last event as foundation chair of the Perinatal Maternal Mortality Review Committee, which since its inception has administered an internationally recognised measure of maternity quality and safety for New Zealand women and babies. Professor Farquhar’s dedication, determination and drive have led to the robust reporting that has contributed to improvements to our maternity service.

While Professor Farquhar’s departure is a loss – It gives me great pleasure to welcome Dr Sue Belgrave as the new chair or the committee.

Dr Belgrave hands-on background is the sort of experience this committee will benefit from, she was in charge of the biggest birthing unit in New Zealand (Director of Obstetrics at Waitemata DHB and consultant obstetrician and gynaecologist at North Shore and National Women’s Hospitals).

She also understands the work of PMMRC as Waitemata’s committee coordinator.

Welcome Dr Belgrave and thank you again Professor Farquhar for your leadership and hard work over the last eight years since the committee was established in 2005.

Role of the Health Quality & Safety Commission

Quality and safety is a top priority for this Government.

This Government created the Health Quality & Safety Commission in 2010 to provide leadership across health services on quality and safety issues.

This clinically-led Commission is responsible for assisting providers across the whole health and disability sector – private and public – to improve service safety and quality and therefore outcomes for all who use these services in New Zealand.

The lessons learned from the work and insights of the mortality review committees provide a key contribution to improving the quality and safety of health and disability services.

Value of reporting on data

The theme of today’s workshop, working towards safer beginnings is important.

This includes the presentation of the seventh annual report of the Perinatal and Maternal Mortality Review Committee.

A highlight from this report on 2011 data is that rates of both intrapartum deaths (during labour) and hypoxic peripartum deaths (dying from oxygen deprivation) have decreased significantly between 2007 and 2011.

That’s welcome news and demonstrates the value of reporting on mortality with the purpose of driving changes in clinical practice, leading to better patient care.

However we know there is still work to be done – the report suggests 19 percent of all perinatal related deaths were identified as potentially avoidable in 2011.

Workshops on improving outcomes for New Zealand mothers and babies today will help focus maternity quality and safety work.

On that note the Committee welcomes Professor Marion Knight as keynote speaker for the workshop.

Professor Knight’s experience as one of the UK’s first National Institute for Health Research Professors in the area of maternal morbidity is well suited to this forum and its work.

I understand Professor Knight will share her reflections from the UK on perinatal mortality, as well as messages for New Zealand from the UK Obstetric Surveillance System.

Government commitment to maternity care

The Government is making a substantial investment to continue improving maternity care for mothers and babies.

We recently announced in Budget 2013 an extra $18.2 million to be invested in maternal mental health care and resources over four years for around 650 mothers and their babies a year.

Pregnancy and giving birth can trigger a mental illness and at least 15 percent of mothers develop depression, anxiety, or a more severe mental illness at this time.

In announcing this plan the Government has taken on board expert advice, which recommends supporting mothers and babies in staying together at this critical early stage.

This not only has an immediate positive impact upon their mental health and wellbeing, but also helps prevent potential future mental health issues for the baby.

Currently new mothers with severe mental illness are often treated and supported in adult acute mental health units separated from their babies and families.

Mothers will now get the support of the new specialised maternal mental health services with their babies beside them, at the same time as receiving treatment for their mental illness, closer to home.

An additional 18 to 20 community health practitioners comprising doctors, nurses, midwives, psychologists, and support staff will be employed and DHBs will integrate the new services with their existing maternity and maternal mental health services.

These new services will mean women can access the best and right care available when they need it – and where extra help is needed the teams will be able to refer them to the right health professionals.

This initiative, starting from next year, will make a real difference to the families involved with post natal depression, and fits with other government policies aimed at improving the health of families.

While the announced residential beds will be centred around greater Auckland, this is a North Island service supported with funding for packages of care at other DHBs.

The South Island already as a service centre on Christchurch.

Other work to better support infant health includes early enrolment at GPs.

This new system introduced last year makes it easier for parents to enrol their baby with their family doctor soon after birth and therefore access vital healthcare, including on-time immunisation.

Previously fewer than half of newborns were enrolled with a GP at 12 weeks – not an ideal situation with the first whooping cough vaccination due at six weeks.
Under the enrolment policy, GP practices now enter the newborn into their patient database as soon as they are nominated as the baby’s GP by the parents at the birthing unit – rather than waiting to enrol them at their first doctor’s appointment.

GPs and district health boards are also well on track to achieve the Government’s Better Public Services immunisation target, which is to have 95 percent of babies fully immunised by the time they’re eight months old, by December 2014.

Already 87 percent of eight month olds are now fully immunised – exceeding the target of 85 per cent of eight months old vaccinated on time by July 2013.

To further protect vulnerable babies, we’ve introduced free whooping cough vaccination for all pregnant women between 28 and 38 weeks of pregnancy and frontline health workers who are in close contact with newborns and young babies.

Along with other Government initiatives such as the Children’s Action Plan and Rheumatic Fever programme, this Government’s spending shows strong commitment to supporting vulnerable children in New Zealand.

Maternity quality & safety programmes and clinical indicators

Safer maternity services are also a priority for this government.

In 2009, as part of delivering on our plan to improve maternity services, we implemented comprehensive Maternity Quality and Safety Programmes in all district health boards.

This Programme was supported by the development of the New Zealand Maternity Standards and the New Zealand Maternity Clinical Indicators.

All DHBs are participating in the Maternity Quality and Safety Programme and annual reports on the programme to the Ministry are due by the end of the month.

The Clinical Indicators show key maternity outcomes for each DHB region and secondary/tertiary maternity facility.

Their purpose is to increase the visibility of the quality of maternity services and to highlight where quality can be improved.

The benchmarked data are used to support local clinical review of maternity services.

The Clinical Indicators provide a national picture of maternity outcomes and highlight areas where improvements can be made.

The 2011 Maternity Clinical Indicators report has recently been published on the Ministry of Health website.

This is the third time the report has been published and it compares a range of outcomes for mothers and babies so you can see how maternity services at your DHB compare to others in New Zealand.

Closing comments

I’m sure you will get benefit from this workshop today and the opportunity to share information and consider future steps for maternity monitoring and improvement for New Zealand’s mothers and babies.

From the PMMRC report you will gain insight into how you can reduce clinical errors and improve the quality of services, outcomes and the health and wellbeing of mothers and babies.

Your presence and participation in this workshop today improves quality, reduces severity of harm and creates a culture of team work.

I wish you all the best for the rest of the workshop.

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