WA's women's, newborn and children's model remains a "major missed opportunity", doctors say

On 9 September, the same day the WA Government announced a new dedicated Women and Babies Health Service, the Australian Medical Association (WA) said the state government’s decision not to deliver genuine tri-location of tertiary adult, paediatric, obstetric and neonatal services “remains a major missed opportunity for Western Australian families”.

AMA (WA) President Dr Kyle Hoath welcomed the creation of a dedicated Women and Babies Health Service, saying clearer accountability across women’s, newborn and children’s health services had the potential to improve coordination and continuity of care.

“Bringing women’s, newborn and children’s health services together under a single Health Service Provider has the potential to improve coordination across services that are currently delivered through different sites and organisational structures,” Hoath said. “Patients should experience one health system, not a collection of organisational boundaries.” However, Hoath also said: “A new Health Service Provider may improve coordination, but it cannot reproduce the clinical advantages of having tertiary adult, paediatric, obstetric and neonatal services located together.”

The AMA (WA) said it has consistently advocated for a tri-located model and maintains that clinical requirements should determine the location of the Women and Babies Hospital, adding that it remains concerned that mothers, babies and specialist teams will continue to be spread across multiple sites.

“World-class maternity care means tertiary adult, paediatric, obstetric and neonatal services located together. That is not what Western Australia will have under the current model,” Hoath said.

“Infrastructure and workforce constraints may help explain the government’s decision, but they do not overturn the clinical advantages of tri-location,” Hoath said. “A mother should not have to choose between receiving proper postnatal care and being close to a critically ill baby.”

Hoath also said: “The government’s own report acknowledges that tri-location remains the best way of delivering these services,” saying that the state government’s own consultation process confirmed clinicians preferred a comprehensive tertiary maternity service at the QEII Medical Centre.

The state government’s announcement of improved transfer arrangements and enhanced paediatric capability at Fiona Stanley Hospital was acknowledged by Hoath, yet he also said mitigation measures should not be confused with solving the underlying problem.

“A dedicated neonatal transfer service is important and we welcome that investment,” Hoath said. “But a transfer is still a transfer. The proposed mitigations are necessary, but they do not replicate the benefits of immediate physical proximity between specialist teams.”

The AMA (WA) said it would closely scrutinise the implementation of the state government’s proposed safeguards, including neonatal transfer arrangements, paediatric services, postnatal support and clinical governance frameworks.

The AMA (WA) also used its statement to urge the state government to keep open a pathway for future maternity services at the QEII Medical Centre precinct. “What we’re asking for is a genuine commitment to continue exploring what can be achieved at QEII in the future,” Hoath said.

“The government has recognised the constraints of today. What we have not yet seen is a commitment to solve this problem for the next generation of Western Australian families.”

Additional maternity capacity in Perth’s northern suburbs was supported by the AMA (WA); however, it was also said that the proposed expansion of Osborne Park Hospital must be backed by appropriate emergency pathways, specialist support services, workforce planning and clinical governance.

“More maternity capacity is important, but increased capacity must also be safe capacity,” Hoath said. “Every commitment must have funding, staff, a deadline and an accountable clinical leader.”

Image: AMA (WA) President Dr Kyle Hoath at a press conference. Source: AMA (WA)