Information for midwives on the work the Ministry is undertaking in the maternity sector. This includes updates on the co-design process, midwifery funding and the mediation with New Zealand College of Midwives.
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Child wellbeing remains a high priority for the Ministry of Health (the Ministry), and universal health services, including maternity services, play a critical role in supporting and improving outcomes for women, babies and children.
Collectively as a sector we are focused on ensuring that New Zealand women, babies and whānau receive high quality maternity care from midwives, doctors, district health boards (DHBs) and other health and social service providers.
Currently the Ministry is actively collaborating with many people involved in maternity services including women, pēpi, whānau, communities, and with the New Zealand College of Midwives in a number of areas.
Delivering on Budget 2018 and Budget 2019
For the first time, the 2019 Budget contains a Wellbeing Outlook, in addition to an Economic and Fiscal Outlook. Further details are available at Budget 2019: Vote Health.
Over the past year, the Ministry has worked with the New Zealand College of Midwives on a number of initiatives that have benefitted midwives, including the uplift Section 88 fees, recognising the work of second midwives, and the Business Contribution Payment. The initiatives in Budget 2019 will continue to build on this work. These include:
- $7.425 million per year to allow a fee uplift to Lead Maternity Carers and Non-Lead Maternity Carers for the services they provide to women and infants. This is a fee uplift of 4.93 percent, which compliments the 8.9 percent uplift for LMCs in the 2018/19 year. An amendment to the Primary Maternity Services Notice 2007 (the Notice) has been notified which will implement this increase for claims with service date on or after 1 July 2019.
- $4.563 million of new funding for overall rural and regional workforce training. In the 2019/20 year and ongoing, $500,000 per annum will be added to the existing locum support provided for rural midwives.
- $10 million across four years for overall Māori health workforce development. This investment will provide wraparound support for Māori student nurses and midwives, and support Māori to progress into specialised professions such as midwifery.
- $4.335 million over four years for a wraparound support programme for Pacific students who would like to gain a nursing or midwifery undergraduate degree. This will reduce financial and other barriers faced by Pacific students.
The Budget 19 initiatives outlined above will assist working towards a more sustainable workforce by strengthening the pipeline into midwifery and then the support of the midwifery workforce. In addition, the Maternity Improvement Programme has a significant workforce component.
The recent Midwifery Accord, agreed between the Midwifery Employee Representation and Advisory Service, the New Zealand Nurses Organisation (NZNO) and DHBs, and the Director–General of Health, has the focus on ensuring safe staffing levels of midwives employed by DHBs.
Primary Maternity Services Review
There is commitment to the continuity of care approach and are using co-design principles to design future maternity services and systems. This approach will continue to inform future direction and decisions. The Ministry is focused on designing a service commissioning model that will provide a sustainable alternative to the Notice.
In June and July 2019, the Ministry will actively engage with both consumers and midwives. This consultation will include looking at funding options and the development of a national midwifery provider organisation, as well as determining a fair and reasonable service price for Lead Maternity Care midwifery services. Feedback on the presented options will be welcomed.
In preparation for this work, we have collaborated with Māori leaders for their input and insights to ensure that going forward maternity services will be able to better deliver for Māori women and their pēpi. The Ministry acknowledges that this is the start of a longer conversation with Māori and that there is much more work to be done in the area of Māori health improvement.
Following a request from the Health & Disability Commissioner in late 2018, the Ministry held a meeting in April 2019 to discuss New Zealand’s current and future approach to the assessment, diagnosis and surgical treatment of tongue-tie in breastfeeding babies. The meeting was attended by 35 clinicians representing a variety of professions including midwifery, paediatrics, surgery, general practice, dentistry and lactation consultancy.
Meeting attendees reached consensus that multi-disciplinary guidance is required for the sector. Several issues were identified including a lack of consistent information for consumers about the risks and benefits of surgical treatment for tongue-tie; inconsistent and inequitable access to treatment when indicated; and a lack of nationally consistent breastfeeding support in the community. The Ministry is leading development of this multi-disciplinary guidance for completion in 2019.
National Strategic Plan of Action for Breastfeeding 2008–2012
The project of refreshing the National Strategic Plan of Action for Breastfeeding 2008–2012 is well underway. The refreshed plan will re-focus on strategies to improve breastfeeding rates in New Zealand. An external advisory group is assisting in the development of this work. A framework for the refreshed plan has been agreed, which incorporates a kaupapa Māori approach. The timeframe for delivering a beta version of what will be an online plan is December 2019.
Maternity Quality and Safety Programme
DHB Maternity Quality and Safety Programme coordinators have recently shared their thoughts on how the Ministry can better support quality and safety initiatives at local, regional and national levels. This will inform our work going forward.
Health Information Standards
In the preparation for release of the draft Health Information Standards Organisation Maternity Care Summary Standard for public consultation, there has been collaboration with many groups across the sector.
Maternity Research Programme
The Ministry has recently been in discussion with the Health Research Council regarding the potential to establish a maternity research programme. At the April Health Research Council – Ministry Partnership Governance Group meeting, the group identified opportunities to fund maternity research. The NMMG has been helping the Ministry identify and recommend areas for research. Two immediate research priorities are preterm birth prevention and maternal mental health. The Ministry aims to progress preterm birth prevention research initially. There is need for wider discussion scoping the topic of maternal mental health in light of the recent Mental Health funding announcements and the response to the Mental Health Inquiry.
In May 2017 the Ministry of Health (Ministry) and the New Zealand College of Midwives (the College) reached an agreement to settle the College’s application for judicial review alleging discrimination against midwives based on gender.
As part of the agreement reached in May 2017, the Ministry and the College agreed to a process for the co-design of a new model for the funding and contracting of community Lead Maternity Carer midwives. The Ministry also agreed to prepare a bid for the 2018 Budget that reflected the findings of the Co-design report and job evaluation process.
While the Co-design process proceeded as agreed, the Ministry did not prepare a Budget bid that reflected the findings of the Co-design process. Accordingly, the Ministry acknowledges that it breached the May 2017 agreement that it had reached with the College.
Representatives of the Ministry and the College met in mediation on 14 December 2018. As a result of that mediation, the Ministry and the College have reached further agreement. Some, but not all, of the matters agreed are recorded in this statement.
The Ministry apologises to the College and its members for breaching the May 2017 Settlement Agreement. Having expressly and formally agreed to do so, the Ministry did not prepare a Budget bid reflecting Co-design. The Ministry acknowledges that its breach was through no fault of the College.
The Ministry has reaffirmed its commitment to the Co-design principles, including a Blended Payment Model for LMC midwives. The Ministry has also reiterated its support for the continuity of midwifery model of care as central to maternity services in New Zealand.
The Ministry has agreed to a process to ensure a ‘fair and reasonable’ service price for LMC midwives. The College and the Ministry will work on this together throughout 2019.
The Ministry and the College have agreed to work together in early 2019 on structural changes to the way LMC midwives are funded and contracted.
The Director-General of Health, Dr Ashley Bloomfield, reiterates that strengthening and stabilising maternity services is a priority for the Ministry. The Ministry and the College have renewed their commitment to work together in good faith.
The Ministry and the College of Midwives met in September and agreed to a number of recommendations from the co-design process. The co-design documents are available to view on this page.
This work includes agreeing the following principles when developing any new Maternity system which is a fundamental part of the Government's priority for child wellbeing.
- Primary maternity care will continue to be free to all eligible women.
- The midwifery led model of continuity of care will be maintained.
- The right for community midwives to choose self-employment will remain under any new contract arrangements.
- A National Community Midwifery Organisation will be developed.
- A national primary midwifery contract will be developed as an alternative to Section 88.
- The new contract will protect, strengthen and integrate the existing model of care, and will include a regular review clause, thus affording community midwives the right to regular renegotiation of the terms and conditions of the contract.
- The on call and 'self-employed' nature of community midwifery will be accounted for in the new funding framework to enable flexible service delivery based on individual need.
- Work is underway to develop a revised national strategy for breastfeeding as a cornerstone for child wellbeing.
- The Ministry is undertaking this work in partnership with the New Zealand Breastfeeding Alliance (NZBA), who will govern its progression with an aim to deliver a new strategy in 2019.
- The NZBA is also revising the baby friendly hospital initiative (BFHI) to better align with community based provision of breastfeeding education and support.
- Work is underway on the first recommendation of the Maternity Ultrasound Advisory Group (MUAG), which is the development of national quality standards and guidance for primary maternity ultrasound.
- The first phase is development of universal guidelines to support radiology and sonography professionals to deliver nationally consistent and high quality maternity ultrasound screening services.
- A clinical expert working group is developing the guidelines and are making good progress.
- The guidelines will be circulated for consultation before year end.
- It is anticipated the guidelines will be completed beginning of 2019.
- The guidelines will form the basis of work regarding commissioning of primary maternity ultrasounds.
The next update at the end of October will provide further information on how a new sector maternity oversight group will be established, and how it will work with an 'all of systems' approach.
The Ministry and NZCOM Co-design Project: 21 August 2018
The Ministry of Health thanks the NZCOM staff, Ministry staff, community midwives and women involved in a project to co-design a new community primary midwifery funding model. Recommendations were delivered to the Ministry in December 2017.
The outputs of the project are not government policy but are informing future service models for wider maternity care.
Maternity and midwifery workforce is a priority for the Ministry. A whole of sector approach is in place to deliver more equitable, high quality and sustainable maternity care through a broad maternity work programme.
- Community Primary Midwifery Payment Model Report (Word, 32 KB)
- Community Primary Midwifery Funding Model Report (Word, 25 KB)
- Community Primary Midwifery Pricing Model Report (Word, 481 KB)
- Covering Memo and Recommendations to Steering Group (PDF, 2.5 MB)
- Presentation to Steering Group (Powerpoint, 3.4 MB)
- FAQs to support the presentation to the Steering Group (Word, 26 KB)
Agreement on second midwife funding: 3 August 2018
The Ministry of Health has reached agreement with the New Zealand College of Midwives on terms and conditions for which funding for second midwives can be claimed, where required, to support community midwifery practice.
A definition of the scope of second midwife services during labour and birth and how payment for these can be claimed will be communicated directly to the sector by 31 August, and will also be available on this website.
Claims for payment for second midwife services within the scope of this definition will be able to be submitted for payment from 17 September 2018, for services delivered from 1 July 2018.
Maternity services: update April 2018
The Ministry of Health and the New Zealand College of Midwives are working together with urgency on a maternity programme designed to address current pressure on the midwifery-led service.
Acting Director-General Stephen McKernan acknowledges collaboration over the last month between the College and Ministry officials has resulted in a positive way forward.
“Addressing workforce shortages and collaborating on a maternity programme that delivers a sustainable midwifery model of care has guided discussions.
“The Ministry has taken on board advice from the College to include elements of the co-design process.
“As a result the Ministry has agreed to develop a Memorandum of Understanding with the College to improve ongoing collaboration on the maternity work programme,” says Mr McKernan.
New Zealand College of Midwives, Chief Executive Karen Guilliland says women, their babies and families need improved access to safe, integrated, high quality services.
“The College and the Ministry agree a midwifery continuity of care model must be resourced effectively to provide support during pregnancy, labour and birth and through the postnatal period until the baby is six week old.
“I am also pleased that the issues raised by the current workforce shortage will be prioritised for resolution; for example, continuing to provide rural primary maternity service provision in all areas,” says Ms Guilliland.
Maternity services: update March 2018
Joint statement: New Zealand College of Midwives and Ministry of Health
Tuesday 14 March 2018
The Acting Director-General of Health, Stephen McKernan, met the Chief Executive of the New Zealand College of Midwives, Karen Guilliland and Deputy Chief Executive, Alison Eddy this morning (14 March) to discuss the co-design process and the Ministry’s response.
Both parties acknowledge the importance of women’s access to and experience of care, and the health and wellbeing of the midwifery workforce.
Chief Executive of the New Zealand College of Midwives, Karen Guilliland says the Ministry of Health is taking the issue seriously and values the relationship with the College.
“We have been working together on the co-design project since May 2017. The process exposed the current vulnerability of community midwifery services and highlighted that many midwives are finding the workload unsustainable.
“I expressed the urgency needed to support the workforce and I am looking forward to exploring how we do this with the Ministry over the next month,” says Ms Guilliland.
The Acting Director-General of Health agrees the co-design process highlights the urgent need for a sustainable way of working for the community-based midwives.
“The Ministry values the role self-employed midwives bring to maternity care. We will continue to discuss with the College the range of measures required. This will ensure improved access to safe, integrated, high quality services that meet the needs of mother and baby and work better for our midwives in addressing hours of work, workload, income and support,” says Mr McKernan.