"Option one requires the greatest change in service delivery, in recognition of the serious workforce sustainability issues confronting women's health services," they said.
They acknowledge that long-term sustainability meant significant change in providing acute services from a central hub.
"These changes are clearly a matter of considerable concern to patients, families and the wider community and stakeholders over the impact of the proposed arrangements," they said.
The second alternative, providing services at Wanganui Hospital within a regional framework, was relatively secure in the short-term but presented risks in the long-term if current trends in relation workforce issues continue.
"It relies heavily on the regional service to monitor and manage these risks [and] if adopted, there would remain a level of clinical risk in the long-term that would need to be acknowledged and accepted."
They said the third option was a variation on option two and looked to secure the staffing arrangements with an external contractor.
"This is likely to come at an additional cost and with a level of disconnection in relation to achieving a seamless single regional service," the report said.
The intention had been to develop a comprehensive service plan taking after receiving community feedback but two unexpected events enabled the development of two additional service options.
The first was a submission from an Auckland-based consultant O&G; proposing a contracted-out O&G; acute maternity and gynaecology service for Wanganui Hospital. The second was the imminent arrival of two O&G; consultants; one recruited many months ago and the other appointed from another DHB.
"Feedback confirmed that for most people who participated in the consultation, the proposal presented a level of risk, cost and inconvenience for patients, families and the wider community that was not acceptable," the report's authors said. "It was felt by many that the areas of concern could only be satisfied by continuing the provision of a full range of women's health services based in Wanganui."
They conclude by saying that "consistent with the original proposal," MidCentral DHB has been identified as the single provider to deliver the revised service arrangements, and to carry that risk in relation to continuity of service provision.
THE OPTIONS
Option 1: A regional women's health service with secondary maternity and gynaecology in-patient services provided from Palmerston North Hospital, supported by a single consultant O&G; roster
Option 2: A regional service with secondary maternity and gynaecology in-patient services provided from Wanganui and Palmerston North hospitals, supported by two consultant O&G; rosters provided by DHB-employed doctors
Option 3: A regional service with secondary maternity and gynaecology in-patient services provided from Wanganui and Palmerston North Hospitals, supported by two consultant O&G; rosters with Wanganui's doctors provided by way of a contracted third party, and MidCentral's provided by MDHB-employed doctors
To view the options go to www.wdhb.org.nz or www.midcentraldhb.govt.nz. To get a hard copy please contact WDHB office (06) 348 3393 or MidCentral DHB (06) 350-8945.
