I seek leave to make a brief explanation before asking the Minister for Aboriginal Affairs and Reconciliation, representing the Minister for Health, a question about services for premature babies.
The Hon. J.M.A. LENSINK: It was reported in The Advertiser of 23 September 2003 that in South Australia the incidence of premature birth (which is defined as babies born 37 weeks) has increased by 15 per cent, based on figures from the Pregnancy Outcome Unit of the Department of Human Services, and it is predicted that this trend will continue. Premature babies require highly specialised care due to the risk of lung immaturity, bleeding in the brain and infection. Therefore, this raises the important issue of the need for neonatal intensive care and other services that are proven to successfully improve the survival rate of premature babies. As the rate of premature babies is predicted to increase, the burden on the health system in that area is also set to increase. My questions to the minister are:
1. What is the government doing to ensure that our hospitals have adequate neonatal equipment?
2. What will the government do to ensure sufficient doctors and nurses are trained in delivering premature babies, especially in the light of the current rate of exit of doctors from the medical profession?
3. Will there be sufficient hospital places to cater for the increase in premature births, especially since babies can be in hospital for as long as three months?
4. As premature babies have a high risk of health problems, as mentioned previously, what support and counselling services will be available to parents to cater for the potential increase in complications?
The PRESIDENT: Order! I have drawn the Hon. Terry Cameron’s attention to standing orders 163 and 164. I am not doing so for practice. I suggest that he read those two standing orders and comply with them in future, please.
The Hon. T.G. Cameron: I will if everyone else has to.
The PRESIDENT: Order!
The Hon. T.G. ROBERTS (Minister for Aboriginal Affairs and Reconciliation): I will refer those important questions to the Minister for Health in another place and bring back a reply.
Tuesday 2 December 2003
In reply to Hon. J.M.A. LENSINK (22 October).
The Hon. T.G. ROBERTS: The Minister for Health has provided the following information:
1. The Pregnancy Outcome Unit reported a 15 per cent increase in the number of premature births over the fifteen-year period 1986—2001, where a pre-term baby is one less than 37 completed weeks of gestation.
Health issues facing premature babies include lung immaturity, bleeding in the brain and infection, but most babies escape experiencing long-term complications of these conditions.
An equipment allowance is included in the budget provided to every public hospital. Each hospital decides how to allocate their equipment funds based on priority for clinical need and replacement of inferior/superseded equipment.
In addition to the equipment allowance to individual hospitals, the DHS Medical Equipment Program provides a centrally funded annual program for purchasing major or particularly expensive pieces of equipment (eg. a neonatal cot or ventilator, with the most recent style of ventilator costing $48 000). Hospitals place bids for items late each calendar year for the next financial year. Each hospital prioritises their item/s against a common scale. Most priority 1 and 2 items are purchased, for example a $172 000 neonatal unit monitoring system has just recently been approved for Flinders Medical Centre.
2. There is an Australia-wide shortage of neonatologists and registrars relative to current and projected staffing demands. The high workload and lower remuneration than private practice, are disincentives for working in the public hospital system.
A new Enterprise Agreement for salaried medical practitioners has recently been agreed with the SA Medical Officers Association and is subject to approval in the SA Industrial Relations Commission. The increased remuneration coupled with some improvements in work conditions (eg. special teaching and research opportunities) in the new Agreement will go some way to attracting more trainees to highly specialised medical areas such as neonatology.
There is also an Australia-wide shortage of midwives. The DHS has developed The South Australian Nursing&Midwifery Recruitment and Retention Strategic Directions Plan 2002-05 and established a Midwifery Advisory Committee to address the recommendations from the plan. The Committee will be reviewing all issues related to midwifery, including workforce issues and links to nurse practitioners.
3. The projected increase in premature births should be considered within the context of the declining birthrate in South Australia. Pregnancy Outcome Unit data for the five calendar years 1997 to 2001 show that the number of births in SA has decreased by 970 or 5.2 per cent (from 18 674 in 1997 to 17 704 in 2001).
Planning for neonatal beds is based on the projected births in South Australia and those from towns/cities in the border areas generating inflows to SA. The two Level 3 Neonatal Intensive Care Units (NICUs), located at the Women’s and Children’s Hospital (WCH) and at Flinders Medical Centre (FMC), cater for the whole of South Australia including receiving premature babies from private hospitals.
The 1999 Metropolitan Clinical Services Planning Study review of obstetric and neonatal services in South Australia reported the projected neonatal bed requirement for 2006, with estimated projected births of 18 270 for SA, to be 26 Level 3 NICU cots. There are 28 beds currently available. It is worth noting that the 2001 actual birthrate for SA (17 704 births) was already less than the projected number for 2006 (18 270).
The estimated number of Level 2 cots (high and low dependency) required in metropolitan hospitals, including cots in private hospitals, in 2006 is around 60, assuming a 30 per cent inflow from rural areas.
Level 2 high and low dependency care is provided at the WCH, FMC and the Lyell McEwin Health Service.
Currently there are 83 Level 2 cots in the public hospital system.
These cots are of world class standard for neonatal care. There are sufficient to cater for the projected increase in premature births and the often lengthy stay of pre-term babies.
4. Hospitals have a number of strategies to assist parents of premature babies, not all of whom have complications following their birth. The gestational age of the baby is a significant factor in terms of complications, with babies born after 31 weeks having a 95 per cent survival rate and fewer complications.
At both FMC and the WCH, parents of premature babies are able to speak with a doctor every day, if they wish, in relation to the care of their baby. The primary nurse caring for an individual baby is also able to discuss with parents the care, treatment and management of their baby. A hospital social worker is available to work closely with NICU staff and parents, as needed.
FMC has a Parent Support Group for parents of premature babies that meets fortnightly. Clinicians (speech therapist, physiotherapist) attend this group to provide information to parents on how to care for and manage their baby after they go home. Parents of children who were premature also attend the group to share their experiences with new parents and to talk about the strategies they used in coping with their premature baby.
At the WCH, the social worker sees all mothers of premature babies and formally meets with parents once a week. The Growth Development Coordinator (audit program) follows up the baby’s progress after discharge from hospital, with the child’s growth and development being followed for seven years. There are weekly coffee mornings for parents of premature babies which provide information and education. Parents have access to other clinicians involved in their baby’s care, for example the physiotherapist, mental heath worker and speech therapist.