I want to take this opportunity to give the community more detailed insight into what’s happening in relation to maternity services in Parkes and Forbes – collectively known as the Lachlan Health Service – and how expectant parents can access our services.
I also want to reassure the community that we are committed to maintaining a safe and high-quality service while we are consulting with the community on how to respond to our current challenges.
Firstly, I believe the one thing all interested parties can agree on is that the safety of birthing mothers and their babies is the most important issue in this discussion. That’s our starting position, and I don’t believe anyone in our community believes differently.
The challenge now is to craft maternity services that are safe, and which are able to be delivered in the circumstances we face, and with the resources we have.
It is also true that these services need to be sustainable. Not just in the financial sense, although that has to be a consideration, but also in terms of these services being able to be maintained longterm. Families deserve to have confidence as they go through a pregnancy that they will be able to access the services they expect to.
We currently have issues with accessing enough doctors with obstetrics or anaesthetics qualifications across Parkes and Forbes.
Finding doctors to fill these roles is not an easy fix.
Recruiting skilled doctors to rural and remote regions has been an ongoing challenge across Australia. In each of the last two years there has been a 30 per cent decrease in the number of GPs coming to our region to train.
There are many reasons why recruitment, particularly in rural locations, is a challenge.
Quite rightly, young doctors want to maintain a good work/life balance. That means having enough doctors to maintain a reliable on-call roster that doesn’t risk doctors becoming fatigued.
Doctors who have trained hard to obtain specialist skills want to be able to practice them. In Parkes and Forbes combined there were fewer than 280 babies born last financial year.
For doctors and anaesthetists performing surgical work, such as caesarean sections, it’s also important that they be doing this type of work frequently. This helps maintain the skills and confidence needed to operate a safe service. In 2017/18 there were fewer than 60 caesareans performed in Parkes and Forbes.
It is true that these problems have been emerging for some time but it is not true that we have done nothing to try to address them.
Over the past year alone, we have advertised a number of positions across emergency, obstetrics and anaesthetics with limited success. We have however been one of the most successful rural regions in NSW to recruit young GP trainees with specialist skills in obstetrics and anaesthesia. Whilst these young doctors are a great start, we still have significant gaps on our rosters. When recruitment efforts haven’t been successful, we have used locums
but even now that stopgap measure is failing us.
These are the circumstances we face, and so we need to look at options, where safety is the number one priority.
Like most of the community, we want to see babies continue being born at both hospitals wherever possible. One option is to consider a midwife-led service at one location, with a maternity service supported by obstetricians and anaesthetists at the other.
For most families, this will mean they will birth at the hospital of their choice. Where there are known risks, families would receive care before and following birth in their hometown, but birth at the hospital where more specialised medical services are available.
Midwife-led maternity services are not uncommon. They are not suitable for every location, or every mother, but they are successfully used in many regional and metropolitan locations.
We believe this is a model that is worthy of consideration and so we currently have a team of local staff, with input from consumers and the local Health Council, developing what this – and other options – could look like in the Lachlan Health Service.
Our plan is to then talk to consumers and to the broader community. This work is planned to occur in August.
We especially want to talk to mums and dads who have either had recent experience with maternity services, or who expect to have that experience in the near future.
As well as talking with people from Parkes and Forbes, we will also reach out to consumers and communities in places like Condobolin, Peak Hill (and others) which use maternity services in Parkes and Forbes.
We’ve already had discussions with both local Councils, the Lachlan Health Council, the Member for Orange, Yoorana Gunya, the NSW Ministry for Health, and with local nursing, midwifery and medical staff. We will be hosting the State’s Obstetric and Midwifery Advisors to further inform our discussions.
We all wish there was an easy solution. In a perfect world, all babies would be able to be born in their hometown, safely and surrounded by all the services possible. Our reality is different, and we
want to respond in a way that maximises choice for families, in a setting which prioritises safety for mothers and babies and is supported by a high-skilled and dedicated local workforce.
Mark Spittal
Executive Director Operations
Western NSW Local Health District
16 July 2019