1. Primary maternity options in the Morrinsville/Te Aroha area 4 February 2014

2. Introduction This presentation follows on from the presentation to the community in December about the feasibility study carried out by reviewers late last year. It will take about 20 minutes to complete. The presentation is a summary of: –What the reviewers found –What the issues are –What we’ve been told –Some options for consideration –What happens next? Discussion in groups after the presentation (30 minutes) Feedback and next steps (20 minutes)

3. Summary of review findings As they are currently configured, primary maternity services in these facilities are: –Underutilised –The building is no longer fit for purpose e.g., 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

4. Summary of review recommendations 1. That Waikato DHB consolidates current service provision (birthing) from Rhoda Read and Matariki into the two urban primary units in Hamilton. THIS DOES NOT MEAN ALL MATERNITY SERVICES SHOULD MOVE TO HAMILTON. Whilst the recommendation is to cease provision of local maternity hospital services for childbearing women, this does not mean that all maternity services should be removed from these localities. Engage the two affected communities in consultation to explore what community-based maternity priorities / initiatives are needed.

5. Feasibility study – Rhoda Read birth numbers Rhoda Read has 24/7 staffing on-site with 24/7 on-call LMC cover. Births in the facility are declining and that trend is expected to continue. In the 6 months to July 2013, each month on average: –4.2 women admitted –2.5 women were transferred to Waikato Hospital intrapartally –5.3 babies were born –6.3 mothers and babies transferred into the facility postnatally

6. Women are bypassing local facilities to have their babies in Hamilton - The above figures are updated from the feasibility study (pages 21 and 25) - Only women from the local area have been included in these slides - There were 12 out-of-area mothers who gave birth at Rhoda Read in 2012/13

7. Why are women choosing not to have their babies in their local facility? EN = enrolled nurse LMC = lead maternity carer

8. Other issues raised

9. Financial viability At present, it costs Waikato DHB a total of $1,281,459 to operate these facilities ($665,802 for Rhoda Read, and $615,657 for Matariki). This is $856,468 more than the DHB pays for the same number of births in Hamilton. Improving community-based maternity services is likely to be a better use of taxpayers’ money than keeping underused, out-of-date maternity facilities open

10. 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 also primary birthing facilities in Huntly and Waihi Waikato Hospital is best kept for women who have complications. Where would women birth if Matariki and Rhoda Read closed?

11. Travel time with and without Matariki

12. Has the decision to close these facilities already been made? No. Waikato DHB is consulting with the communities affected. We want your ideas on: The advisability of retaining or closing the local birthing facilities What primary maternity services would be needed in your area if all women were to have their babies in Hamilton. These could include: Improvements to existing community-based services Grouping some providers into a family / resource centre Other ideas from the community This is outlined in more detail in the consultation document and in the submission form.

13. At the Morrinsville meeting in December, we were told... Women do not want to have their babies at Waikato Hospital The DHB should give Rhoda Read a ‘facelift’ and then women would go there It’s too hard for families to travel to Hamilton to visit the mother (cost, distance) Would the DHB consider a proposal from a private provider? The DHB team needs to hold a meeting in Te Aroha Meetings should be held at 7.15pm so they’re after children are in bed

14. We looked at what is currently available in Morrinsville Currently in MorrinsvilleWould no longer be available in Morrinsville Will remain in Morrinsville Could be enhanced locally Lead Maternity Carers (LMCs) Midwife group practice with shared rooms √√ 10 LMCs live in the area √√ 26 LMCs service the area (but not all will use Rhoda Read) √ √ Total of 96 LMCs with access agreements to Rhoda Read (but not all will use the facility) √ √ Maternity Services at Rhoda Read  Waikato DHB midwife  Antenatal clinics  Birth/postnatal stays  CTG  Lactation service √ √ √ √ √ √ √ √ √ √√ √ √√ Other related services Postnatal checks in the woman’s home √ Pregnancy and parenting classes √ √ Well child providers (GPs, Plunket) √ Maternal Mental Health Service Currently provided as needed

15. A family / resource centre: an option? A centrally located site could offer screening and immunisation Room for classes such as pregnancy and parenting classes (particularly for women with high needs Midwives to work together to 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/ http://mamaternity.org.nz/maternity- resource-centres/

16. Family / Resource Centre possibilities: Resources: Information / advice, monitoring, smoking cessation, pepi pods Lactation services: Outreach service for women with higher needs Nutrition advice: Nutrition support / advice for those mothers with BMI over 35. Can lead to complications in pregnancy and birth Promoting connections: Space for coffee mornings, toy library, playgroups

17. Summary The birthing facilities are under-utilised and not sustainable in the long-term There has been a recommendation to close these facilities We need to know if keeping them open is the best use of the funding, which could be used to provide other services for our communities Waikato DHB wants your views on this and if facilities are closed, what maternity services your community needs and how they should be provided Submissions close 21 February A decision is planned for late March 2014

18. What happens next? The final decision on the proposed closure is planned in late March 2014. This decision will take account of the reviewers’ recommendations and the reasons behind them and the consultation feedback. Submissions can be made in various ways: email, post, 0800 number. Details are in your submission document and at the end of this presentation. There will be a further meeting in Morrinsville on 11 February from 6.30-8pm in the Events Centre, Ron Ladd Place Submissions close on 21 Feb 2014.

19. Submission options Post to: Planning & Funding, Waikato DHB, PO Box 934, Hamilton 3240 Email your submission to: support@waikatodhb.health.nzsupport@waikatodhb.health.nz Attend meetings in December, January and February Complete your survey online at: www.waikatodhb.health.nz/birthingwww.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.

20. The rest of this meeting time Discussion in groups – 30 minutes Questions: –Views on closure of Rhoda Read and how the issues could be addressed? –What is most needed in the Morrinsville/Te Aroha area if Rhoda Read 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 – 20 minutes