Confusion around what exactly defines a "Maternal and Child Hub", an "informal" governance framework, and a lack of formal project management practices — the Southern District Health Board (SDHB) has released its long awaited independent review of how it implemented its often controversial Primary Maternity System of Care Strategy.

The review was undertaken by Ernst and Young Limited at the request of the SDHB. Click here to read in full.

The review was limited in scope only to how the SDHB implemented its maternity care strategy. The move caused deep controversy among Northern Southland and Fiordland communities when it eliminated birthing services and postnatal stays at the Lumsden Maternity Centre earlier this year. 

The centre is now one of several "Maternal and Child Hubs" across the southern district, which the report regularly states is a concept that has not been clearly defined.

In Southland, the SDHB has also designated such hubs for Te Anau and Tuatapere.

Key observations from the report cite a lack of clear roles and accountabilities, making decisions more "reactive and issues driven." Expectations between the SDHB and stakeholders were sometimes misaligned, such as having complications with Hub chattels, equipment delivery timelines, and supplier contract delays. Core roles for the SDHB remained vacant during critical periods, and the project "suffered from the absence of a structured communication and stakeholder engagement plan."

Delivering a "hub" concept would have been more effective if there had been a commonly shared definition of their purpose within the communities they operated in, the report says.

The report includes recommendations and a final list of lessons learnt by the SDHB.

The SDHB has also released a separate review of four rapid births that took place near the Lumsden area soon after the downgrade of the Northern Southland maternity centre. 

Click here to read the Review of Lumsden Rapid Births in full.

Midwives Sue Bree and Robyn McDougal of the New Zealand College of Midwives undertook the review.

Only two of the four mothers agreed to be interviewed for the review.

Based on the information they had at hand, the midwives concluded both of these outcomes were "unavoidable."

Midwives practising in the area have had to adjust their practice in light of the recent changes in the area in order to keep mothers and babies "as safe as the significant rurality permits," the review says. 

As a result of the reviews, the SDHB says it will be establishing stronger project management structures, reshaping midwifery leadership roles and looking at opportunities to expand telemedicine and optimise payments to lead midwives.

SDHB chief executive Chris Fleming said the health board accepted the findings that the SDHB did not adequately anticipate or plan for the scope of changes required by ensuring it had sufficiently robust project management structures in place. 

"We particularly acknowledge that the transition to a hub in Lumsden has been a concern for the rural Southland community, and there was more we could have done to ensure this change went more smoothly.”

“We cannot solve these challenges alone, and appreciate the efforts of the stakeholder group chaired by Gore mayor Tracy Hicks and including LMC midwives, a GP, New Zealand College of Midwives, Ministry of Health and Gore Health that has been meeting in Gore and working collaboratively in the interests of women in the Northern Southland community. I especially wish to acknowledge the role of Gore Health in enabling the work of the Lumsden and Te Anau Maternal and Child Hub coordinators, who are making a difference in building the networks and supports that are needed.” 

“We thank everyone who participated in the reviews, especially the women who were interviewed about their experiences. We accept the outcomes of the reviews, and are committed to working to build a sustainable and equitable primary maternity system across our whole district.”