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Jacinda Ardern has pointed to "consistent underfunding" under the last Government after baby deaths at Middlemore were linked to problems like not enough staff.

That's been denounced as an insulting cop out by National's health spokesman Michael Woodhouse, who accused the Government of dropping the ball on midwifery conditions.

Counties Manukau DHB has taken urgent steps to improve maternity services after problems like lack of staff and bed space contributed to the recent death or stillbirth of three babies. Resourcing problems were also a factor in other incidents where patients were seriously harmed.

Speaking at her post-Cabinet press conference, the Prime Minister wouldn't say what steps might be taken over strained South Auckland maternity services, given she hadn't been briefed.


"We absolutely generally know that we have had consistent underfunding in our health system. We have had record investments in Budget 2018 and 2019," Ardern said.

"Even though these are ultimately matters for DHBs, where there are workforce challenges we have stepped in. Again, I would like to see some of the specific information around what is happening in South Auckland before I make too much further comment."

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Woodhouse said DHBs had been given very little operational funding increase in this year's Budget, and the Government had also failed to secure adequate remuneration for midwives.

"To blame the previous Government for the situation they find themselves in is actually quite insulting."

A Herald investigation has found maternity care for South Aucklanders fell below safe standards, as services struggled to cope with big increases in the number of pregnancies needing more care and monitoring.

Changes have been made or are underway, after a damning internal review found an 11-bed shortfall for maternity services, and linked a lack of resources to a death in 2016/17, and another two in 2017/18. Cases include:

• A newborn died after a delayed diagnosis of pneumonia. Monitoring equipment wasn't easily locatable, and there were major communication and documentation problems as staff struggled with double the number of induction of labours than normal.


• A baby was stillborn after a breakdown in the coordination of a woman's care, limited caesarean surgical slots and no allocation to a senior doctor.

• Health risk factors for baby and mother weren't properly picked up as a lack of doctors and midwives struggled with high workload. The child was stillborn.

DHB reports say substandard care "resulted in" or "led to" deaths, but a spokeswoman said those were summary descriptions of complex cases with a range of factors. Further details weren't released for privacy reasons, including more information about patients' health conditions.

After the review, the DHB launched one-year and three-year work programmes. Changes include a new maternity assessment clinic and more midwife, nursing and support staff roles, including senior positions.

Some women with babies in the neonatal unit will move in phases to another ward, freeing up 22 beds on the maternity floor. A new women's health building is about five years away.

South Auckland maternity services have struggled with demand. Photo / Dean Purcell
South Auckland maternity services have struggled with demand. Photo / Dean Purcell

Like other DHBs, Counties Manukau has little spare money and competing demands. Last month the Auditor-General noted the worsening financial position of DHBs, writing: "In just a few years, we have seen one or two DHBs experiencing financial difficulties to almost all of them budgeting for deficits (and many struggling to achieve those budgets)."

More than a third of Counties Manukau residents are among the country's most socioeconomically deprived. That poverty, combined with related factors like rising obesity rates, has helped put enormous pressure on the DHB and led to cases of so-called "postcode healthcare", when treatment is harder to get than in other DHBs, including up the motorway in Auckland.

Cases detailed as part of the Herald's Fair Care series include an 11-year-old who went blind in one eye after her case was lost amidst a backlog waiting for eye services, and a retiree who had to stop driving because of a cataract that would have been removed if she lived within Auckland DHB boundaries. Half of all South Auckland children referred for specialist care for painful skin conditions are declined.
Clinicians have appealed to Health Minister David Clark for help, and there has been concern Counties misses out on funding because the Census doesn't capture its true population, given some people's wariness of admitting to living in rental properties that are overcrowded.

Asked if the DHB gets enough funding to provide maternity services, a spokeswoman said it "continues to work with the Ministry of Health with regards to appropriate funding for all of our community, including those with complex needs, across all services provided by the DHB".