Keeping maternity local a priority under new networks

MATERNITY remains a concern for healthcare providers across the North East, with shadow assistant minister for health Annabelle Cleeland warning the state government has been quietly amalgamating health services by stealth for some time. “Now, with the creation of a bureaucracy network that merges multiple health services, (the opposition’s) worst fears have been confirmed,” she said. “We’ve seen this at Kilmore, where the merger with Northern Health resulted in maternity services being restricted to business hours.” Ms Cleeland said mergers threaten the whole-of-life care currently available in the region with skills being lost. Midwifery is one such area. For midwives to renew their registration each year they must maintain recency of practice and meet continuing professional development obligations. Should these lapse, it can very costly and time consuming to get re-registered and is not an automatic process. The closure of maternity represents not just a loss of these services at a local level, but the loss of these trained professionals within the community. Yarrawonga Health suspended its birthing services in 2020 redirecting expecting mothers to Albury Wodonga. NCN Health which encompasses Nathalia, Cobram, Numurkah and the greater Moira Shire does not provide maternity services, and Alpine Health which takes in Bright, Mt Beauty and Myrtleford also does not have the capability. Alexandra, Seymour and Yea are unable to deliver babies and birthing has temporarily been paused at Benalla Health whilst under review. However, with no confirmed date as to when this service will once again be offered in our neighbouring township, the focus is directly on the importance of retaining maternity locally at Mansfield District Hospital (MDH). In Hume, only Albury Wodonga Heath, Northeast Health Wangaratta and Shepparton-based Goulburn Valley Health along with MDH have maternity. “It has placed more emphasis on other regional providers - especially North East Health Wangaratta and Albury Wodonga Health - to support our service,” said principal general practitioner and obstetrician, Dr Graham Slaney. Dr Slaney believes mergers under Local Health Service Networks have the potential to improve opportunities for collaboration across the current maternity sectors in the region. “Assuming there is further funding and supports put in place by the state government,” he said. As far as provision of services, he suspects little will change at a clinical level citing close ties and referral pathways that already exist between MDH and our nearest larger provider Northeast Health Wangaratta. “In the obstetric space we already have regional clinical processes developed in partnership with Wangaratta and Albury Wodonga,” Dr Slaney said. Mansfield represents the Hume region’s southern-most service, with Seymour, Alexandra and Yea hospitals initially included in the Hume network moved out in the final groupings. Dr Slaney assumes the alignment of Yea and District Memorial Hospital and Alexandra Health with metropolitan hospitals under the East Metro and Murrindindi network will not affect current birthing arrangements. “Women from Yea and Alexandra choose to come to Mansfield for their obstetric care and I see no reason this will be any different,” he said. “We are closer for low-risk obstetrics than the other options available to them. “I also think the reputation of our health service and the care it provides will have more influence than some arbitrary grouping of hospitals in a network that the person in the street has no connection with.” Dr Stephen Duckett a leading professor in public health policy and management at the University of Melbourne believes the state government does not appreciate the crucial role rural hospitals play within their communities. He said the failure to fully understand the role contributes to muddled policy thinking and poor policy prescriptions. Dr Duckett’s view is that there is a failure to conceptualise what small rural hospitals are and what they do, and this needs to be addressed. “There is plenty of evidence that health in rural and regional Australia is worse than in metropolitan Australia…and small rural hospitals, with their preventative focus, can help a lot in redressing the health gap,” Dr Duckett said. “There is an important social benefit that rural hospitals provide that goes beyond the narrow clinical benefit to the wider social and economic determinants of health. “If a merger takes away local leadership and de-emphasises this community development role, the merger will undermine social capital and potentially accelerate the withering of smaller rural communities.” Country hospitals have several strong motivations for wanting to maintain maternity services, with community health and wellbeing at the forefront. The reduced travel distance and stress for women especially in labour, alongside continuity of care throughout the pregnancy and postpartum can lead to better health outcomes for mothers and babies, particularly in low-risk pregnancies. Access to familiar faces and support networks within the community can also be crucial for new parents. Maternity services provide and support local jobs for midwives, nurses and other healthcare professionals, and more importantly contributes to community vitality. And a functioning hospital is an anchor for the local economy, attracting and retaining residents, and building on a sense of community and belonging for residents with the ability to give birth locally strengthening ties to the region. It is not an area of local expertise that should be amalgamated or reduced in rural hospitals, rather it should be encouraged and enabled. “If mergers are to occur, the smaller hospitals should not be subsumed into clinical programs of the larger entities,” Dr Duckett said, when looking at the services rural hospitals provide overall. “Rather local management should be protected, and the internal organisational structure should recognize their distinctly different role from the larger regional hospitals. “Small rural hospitals have a distinct and different role….which extends beyond what we traditionally think of health care, into the health of the community. “It is this that must be built on as we work to improve rural health care and its governance.”

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