Sydney Local Health District Women’s Health Service Plan

Mission and Goals

The Sydney Local Health District aims to achieve excellence in the healthcare services for all community residents. Its mission is to ensure that the community has adequate access opportunities to best quality patient-centred care services. It works towards promoting evidenced-based, efficient, culturally appropriate and timely treatment (Sydney Local Health District, 2017). It is supported by extremely skilled, accountable and committed staff. A plethora of research, technologies and education supports the organization.

This report will outline a health service plan for women and gynaecological health services. The primary aim of the women’s health service plan will be to improve the wellbeing and health of women who experience poor health in the community. The health service plan will address a range of preventive services for women without affecting the health quality standards. It will also offer free medical, nursing, nutrition and counselling services to the women who are vulnerable in the region. The service will identify women who face difficulty in accessing healthcare opportunities due to the effect of cultural or language barriers, substance abuse, mental issues, violence or sexual identity issues.

Emergence of health service planning since the past decade represents a major progress and has introduced an entirely new avenue of opportunities that work to improve the quality, quantity and effectiveness of environmental and personal health care. The methods that are used in healthcare planning lead to a more effective involvement of constituency, when compared to previous methods. Healthcare planning functions to develop a comprehensive administrative mechanism (Lewis, 2015). This mechanism ensures sound health program operation. The planning, reform and performance form an integrated cycle that depends on a variety internal and external influences and stakeholders.

The service plan will provide several strategies and high direction level for the development, reform and investment related to the service. Proper planning will be needed to built the delivery models or meet the needs of the target population. The reforms, values, processes and behaviours will be taken into account during its implementation (Fahey & Shenassa, 2013). It will help in keeping a track of the positive effects or improvements in patient outcome. Moreover, effective budget management and staff retention will play an essential role in the planning.

Social and demographic data from the Women’s Health, Neonatal services of the Sydney Local Health District are needed to support the health service planning in the target population. The SLHD comprises of 8 local government areas namely, Burwood, Ashfield, Canada Bay, Canterbury, Leichhardt, part of City of Sydney, Strathfield and Marrickville. The current population of the district is around 582,100 and is expected to reach 642,000 by 2021 (Sydney Local Health District, 2017). The population has shown significant increase of 16.7% since 2001-2011. This increase creates a pressure on the health of women and neonates across the community. The population projection for all the areas is estimated to be from 531,624 in 2006 to 725,751 in 2036 (Appendix 1). A significant increase in the number of neonates was observed during 2005-2010 (Sydney Local Health District, 2017). There were an additional 1800 births every year. The total births in 2005 were 86,589, which showed a huge increase to 95,918 in 2010. A large increase in the birth rate has been observed in Marrickville and Canterbury (Appendix 2). Moreover, demographic data analysis suggest that the presence of 145,823 women in 2011, who were aged between 15 to 44 years. The highest proportion of women belonged to the 20-24 year age group (50.3%) (Appendix 3).

Emergence of Health Service Planning

The needs assessment will include an analysis that will be based on the benchmarks for newborn and maternal care readiness. The need assessment will act as an effort that will focus on the critical issues that need attention in the district. It will be thoughtfully designed and will identify the characteristics and needs of the women and neonates living in the community. A survey instrument, containing close ended questions will be created. These questions will focus on maternal health. The instrument will be tested on the target group.  It will involve training of women volunteers as survey administrators (Tamrat & Kachnowski, 2012). Thorough training will be provided on issue sensitivity, definition of relevant terminologies and protocols for the administration of the survey. Data from the clinical stream indicate that efficient obstetric services are provided by the Canterbury and the RPA maternity, neonatal and gynecological service. RPA accounts for about 5,500 births per year and the Canterbury hospital services helped in 1700 births in the year 2012 (Sydney Local Health District, 2017). However, less maternity and neonatal services are available at Concord and Balmain. Although, Concord gynaecological service addresses menopause, emergency situation and gynaecological surgeries, no such provisions are available at Balmain. The data showed a huge prevalence of teenage pregnancy among the women (49.4%). Teenage parents and their children are vulnerable to poor health outcomes. It is associated with socially excluded and deprived young people. Low self-esteem, poor family relationships and unhappiness at schools act as risk factors. This creates serious consequences on women health and wellbeing (Craine et al., 2014).

Career prospects and higher education get limited. Therefore, the need is to provide means of early pregnancy avoidance to young women. This will contribute to reducing social exclusion and inequalities. The health service plan will make well published sexual health advices and contraceptives available to young people. It will lay a high strong focus on building target interventions for the target population who are at a risk. Substance misuse and reproductive health education needs to be made accessible for the youth. The need assessment will also investigate the factors that contribute to perinatal death. It will evaluate the role of antenatal and perinatal care, maternal age, marital status, chronic maternal disease, social factors, immigration and tobacco consumption on perinatal mortality (Yasmin, Kumar & Parihar, 2014). Low birth rate is the most common factor responsible for perinatal death. It occurs due to congenital malformations, teenage pregnancy, poor socio-economic background, plural pregnancy, smoking and drinking. The need assessment will therefore help in developing strategies to increase awareness on high risk pregnancies. It will provide the scope to promote referral pathways that will help in reducing neonatal mortality.

• RPA Hospital- It is a tertiary referral obstetric service and contributes to more than 5,500 births per year. The clinical stream includes 7 departments such as high and low risk obstetrics, infertility, neonatology, benign gynaecology and ultrasound wards. The Neonatal Intensive Care and Women’s Health ambulatory care service caters for 1,000 and 55,000 admissions, every year. There are several maternity care models. The maternity inpatient service contains 83 beds (11 for delivery ward, 13 for birth centre, 54 postnatal and 15 antenatal) (Sydney Local Health District, 2017). There exist provisions for lactation and parent education, midwivery practice, infertility service and early pregnancy assessment services. 4 gynaecological beds, 12 high dependency, 10 ventilated and 12 special care cots are available (Appendix 4).
• Canterbury Hospital- A level 4 obstetric service caters to medium and low risk obstetrics. There were 1700 births in 2012. 14,600 admissions of ambulatory care service occur per year. Low risk midwifery case models of care exist. The maternity service has 6 bedded birthing units, 22 bedded antenatal or postnatal ward, and special care nursery with 8 beds, emergency services, lactation services, and elective surgery ad midwifery practices.
• Concord Hospital- It has outpatient clinics, emergency services and provisions for benign gynaecological surgery (Appendix 5).
• Balmian Hospital- It does not have any maternity, gynaecological or neonatal service.

Service Strategies and Implementation

Maternity services in Sydney Local Health District have shown an increase in birth rates over past 10 years. Maximum increase has been observed in the RPA hospital. A data analysis of patient outflow for maternity services in beddays 2010-11 show maximum outflow to other SLHD hospitals (77% for antenatal services, 68.3% for vaginal delivery, 64.4% for postnatal services and 60.1% for caesarean delivery services). Outflow to private hospitals was highest for caesarean delivery (Appendix 6). Lowest outflow was observed to other states for all 4 services. SWSLHD, overseas and SESLHD showed maximum inflow for maternity services (Sydney Local Health District, 2017).

A state-wide catchment would be needed for effective implementation and success of the healthcare plan. Of the 8 local government areas, Concord and Balmian hospitals donot show access to good maternal, neonatal or gynaecological health services. Therefore, the health service plan needs to be applied to these regions to provide good healthcare opportunities to the women residents. Another area of priority is Aboriginal health. There are several disparities in pregnancy related outcomes among Aboriginals. The reverse catchment area would be South Western Sydney Local Health District and South Eastern Sydney Local Health District since, there is less patient outflow to these 2 regions.

The RPAH gynecological services contain specialists and generalists. Appointment should be made on the basis of predominance in practicing operative gynaecology.  

• There are 3 gynaecologists at present in RPAH, on call for emergency services. 1 is involved in elective operating lists and will retire in 5 years. Another has elective operating lists if a vacancy arises.  No on site gynaecology registrar is present for most of the week.
• Inadequate floor space in RPAH neonatology and obstetrics services needs to be addressed.
• Absence of defined budget to replace neonatal intensive care equipment is another issue.
• Voluntary efforts of the staff, donors, parent s and charities sustain the units.
• More than 1200 cases of monitoring outpatient fetal heart rate are performed in RPAH birth units.

Future services include expansion of neonatology and obstetric services at RPA hospital. The bed numbers and floor space needs should be increased. An increase in midwifery staffing and neonatal and medical nurse practitioners would be required (Yelland et al., 2013). Administrative and neonatal ambulatory services will be relocated to separate region. The future services would also include expansion of obstetric facility with respect to staffing and space at Canterbury Hospital.

Role delineation will determine that safety standards, staff profile are adequate to ensure safe clinical services. No major changes are planned for the next 5 years (Appendix 7).

Thus, it can be concluded that there is a need to expand women’s health and neonatology services over the next 5 years. There has been a huge increase in birth rates, with 7,000 births in 2011 at RPAH and Canterbury Hospital. This led to expansion of the facility at RPAH. The recommendations are stated below:

• Establishment of gynaecological day stays at Canterbury or RPA hospital
• Consolidation of gynaecological data at RPAH for including Concord and Cantebury facilities.
• Development of Walk in women assessment care in RPAH.
• Development of day stay unit at Canterbury hospital.

Their effective implementation will work towards producing a better environment for clinical practice.

References

American College of Obstetricians and Gynecologists. (2014). Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. Obstet Gynecol, 123, 693-711.

Craine, N., Midgley, C., Zou, L., Evans, H., Whitaker, R., & Lyons, M. (2014). Elevated teenage conception risk amongst looked after children; a national audit. Public Health, 128(7), 668-670.

Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.

Fahey, J. O., & Shenassa, E. (2013). Understanding and meeting the needs of women in the postpartum period: the perinatal maternal health promotion model. Journal of Midwifery & Women’s Health, 58(6), 613-621.

Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.

Sydney Local Health District. (2017). Women’s Health, Neonatology and Paediatrics Clinical Stream Position Paper. Retrieved 21 October 2017, from https://www.slhd.nsw.gov.au/planning/pdf/Womens_Health_Neonatology_and_Paediatrics_Clinical_Stream_Position_Paper.pdf

Tamrat, T., & Kachnowski, S. (2012). Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world. Maternal and child health journal, 16(5), 1092-1101.

ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., … & Renfrew, M. J. (2014). Improvement of maternal and newborn health through midwifery. The Lancet, 384(9949), 1226-1235.

Yasmin, G., Kumar, A., & Parihar, B. (2014). Teenage pregnancy-Its impact on maternal and fetal outcome. International Journal of Scientific Study, 1(6), 9-13.

Yelland, A., Winter, C., Draycott, T., & Fox, R. (2013). Midwifery staffing needs; patterns of variation in demand and capacity, and their possible effects. Bjog: An International Journal of Obstetrics and Gynaecology, 120, 472-473.

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