Safety and quality goals for health care

A consultation paper on the Australian Safety and Quality Goals for Health Care has been released for comment. The website for the commission is http://www.safetyandquality.gov.au/

APMA is preparing a response, in which we will apply the draft goals to our area of interest - private midwifery, particularly at the primary maternity care level. We are seeking to have private midwifery practice seen as a standard option in Australian health care, just as general medical practitioners (GPs) are. Submissions will be published at the commission’s website, and hopefully we will say something that can be carried forward into the final consultation paper, which then should be used to influence government policy.  (It's optimism that keeps some people moving forward!)

The three draft goals are  
1. Safety of care: That people receive their health care without experiencing harm. Initial priorities are to:
• reduce harm from adverse medicines events and improve quality use of medicines
• reduce harm from healthcare associated infections through effective infection control and antimicrobial stewardship.  
2. Appropriateness of care: That people receive appropriate, evidence-based care. Initial priorities are for:
• people living with type 2 diabetes
• people with acute coronary syndrome or stroke.  
3. Partnering with patients and consumers: That there are effective partnerships between patients, consumers and healthcare providers and organisations at all levels of healthcare provision, planning and evaluation.

APMA will seek to inform the commission about the failure of health care reform in maternity care – that the government’s reforms have been obstructed; that no midwives have clinical privileges in hospitals; that there is no indemnity insurance product for midwives attending births privately in the woman’s home; that midwives experience considerable difficulties applying the collaboration rules when hospitals are keen not to collaborate in a way that the determination sets out ...

APMA will seek to make strong presentations on each of these draft goals, as applied to maternity care. Our focus will be on the majority of women; well women with uncomplicated pregnancies, for whom the midwife is the agreed appropriate primary care provider, who collaborates with medical/hospital services as the need arises.

Here are a few initial comments, which readers may wish to think about in preparing your own responses or submissions:
1. Safety of care in maternity includes promoting and protecting natural processes in birth. We need to come out strongly in criticism of mainstream maternity care with unacceptably high rates of induction and the consequences; rates of caesarean; long term morbidity from unnecessary caesarean surgery. We need to give references and show statistics of how private midwifery provides safety and effectiveness in primary maternity care. Medicines and microbes are also matters of great importance in the promotion of unmedicated childbirth, and keeping mother and baby together after birth.
2. Appropriateness of care, with evidence based care, is also a topic about which we can wax lyrical.
3. Partnering with 'patients' (is a woman who is pregnant, who is receiving maternity care, a 'patient'?  Does that word not suggest that some form of illness exists?) and consumers is a key (definitional) aspect of midwifery. I heard a lecture by a well-respected professor of Law and Medicine, who pointed out that there is no legal or ethical expectation of partnership between a doctor and a patient. This, in her opinion, was a major difference between midwifery and medicine.



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