A proposed framework for maternity services has spectacularly failed to deliver on its promise
The federal government has dumped a new national framework for maternity services, which obstetricians and GPs have slammed as an “ominshambles” and a wasted opportunity to improve maternity care.
A draft report released in March drew scathing criticism, with rural doctors and city specialists united in calls for it to be scrapped and the work to start again with input from medical practitioners in the field.
Dr Steve Robson, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), told The Medical Republic that the effort had been an “omnishambles” and was comprehensively mismanaged from the start.
The working committee included no obstetricians or GPs among its 12 members, and RANZCOG did not even know work was under way until six months after it had been commissioned by the Council of Australian Governments health ministers, he said.
“It’s just been a monumental missed opportunity,” Dr Robson said. “An extraordinary opportunity to do something positive has been turned into a heap of motherhood statements.
“My view is that the women of Australia should feel completely ripped off.”
The draft, prepared by the independent consultant Deloitte, ignored pressing national issues such as disparities in care for Aboriginal women, rural workforce issues, obesity, barriers to care for migrant communities, and the prevalence of suicide and mental health around pregnancy, he said.
It also appeared to ignore a 48-page detailed submission that RANZCOG put forward. Exasperated, Dr Robson surmised it had “got lost” at Queensland Health.
RANZCOG and the National Association of Specialist Obstetricians and Gynaecologists (NASOG) both boycotted a stakeholder forum in Melbourne last week.
At Friday’s forum, not one stakeholder came forward in support of the project, prompting the government to ditch it.
“If it was an episode of Yes Minster or Fawlty Towers, you could have a bit of a laugh,” AMA President Dr Michael Gannon, an obstetrician, said before the decision. “Even if you had a predicted outcome in mind, you could at least window-dress it with at least one obstetrician or one GP.”
Dr Gannon said he had written to Health Minister Greg Hunt expressing the AMA’s disappointment that the “framework” provided only “vague and superficial guidance for the future of public-sector maternity services in Australia”.
He said the interim report had falsely asserted that the AMA was included among stakeholders for consultation, but it did not record the view that the AMA had provided at its only meeting with the project consultants.
Midwives were on the working committee, but not involving a single obstetrician was like holding an inquiry into law and order without talking to the police, Dr Gannon said.
ACRRM President Dr Ruth Stewart, a GP obstetrician for 25 years, said the framework did not address the 30% of Australians who lived in rural and remote areas, adding its authors appeared to be unfamiliar with the clinical terminology and concepts discussed.
“I am a rural woman and I have given birth to three of my children in a small hospital cared for by a team of a GP obstetrician and midwives. I found scant reference to my personal or professional context in this document,” she said.
“I finished reading it worried that a framework was being formulated by people who have an inadequate grasp of the scope and complexity of maternity care in Australia.
“I think they need to start again and involve the clinicians in developing the new framework.”
Dr Gannon said Minister Hunt had seemed “mildly embarrassed” over the report’s shortcomings. AMA members had reported that maternity services and outcomes in their states had deteriorated under the previous National Maternity Services plan, he said.
