Source: PMMRC, Tenth Annual Report, 2016, p85, Table 1.52 Improving rates of consent is desirable as a post-mortem is a valuable mechanism to identify accurate cause of death, identify disorders with implications for counselling and monitoring of future pregnancies, and assist in the grieving process by enhancing parental understanding of events surrounding the death. PMMRC reported that, in 2014, of the 255 post-mortems completed there was data on the usefulness of the post-mortem available for 212 (83%) of cases. The data showed that in: 123 cases (58%) the post-mortem confirmed the clinical diagnosis 32 cases (15%) the post-mortem changed the diagnosis and resulted in altered counselling to parents for future pregnancies 35 cases (17%) additional information was gained but did not change the diagnosis 22 cases (10%) the post-mortem was inconclusive. Estimating the number of post-mortems required to achieve a goal ‘rate’ depends on the number of birth rates and the number and rate of perinatal deaths, which are expected to remain relatively stable in the short term. Achieving the rate will depend upon improving rates of family or whānau consent. Birth rates Statistics New Zealand reports on live births in New Zealand, and reported that in 2015 live births increased, to 61,038. This followed declining in the preceding four years. Statistics New Zealand has modelled birth rates between 2016 and 2033, factoring in projected fertility rates and migration. Based on their conclusions, birth rates are projected to increase between 2016 and 2026, then flatten before gradually reducing to 2033. The expectation is that in the five years between 2016 and 2021, the number of live births will increase by an average of 600 per annum. Figure 4: Live birth rates Source: Statistics New Zealand, October 2015 for financial years ending June 2016 - 2033 Post-mortem rates A post-mortem is one of three potential strategies identified as optimal investigation of death, and remains the gold standard investigation. The other types of investigation include karyotype to confirm chromosomal abnormality or clinical examination/investigations (including MRI). Perinatal post-mortem has utility in confirming clinical diagnosis, contributing to new information about the cause of death and associated factors. The information is important as it may: accurately identify cause of death and exclude some causes of death
Model 3: Fee-for-service The Service calculates a fee for activity, and enters into an MOU, or contract, with external funders for the delivery of the Service on the of an invoice for services provided Advantages Considerations Status quo Fees can be set to cost of service Flexible and responsive to changes in demand and cost Invoice can be to either referring DHB or DHB of domicile. Administration costs sit with Service Requires MOU to be agreed by hosts, and all referrers Cost may be considered a deterrent to referral May be different cost and fee structures across the Service providers Services provided for the local population generally not invoiced, ie, a calculation required to set DHB ‘base’ funding Referring DHBs have limited visibility over forecast costs. Model 4: Mixed model A lead DHB receives a programme fee to support delivery of national service components, with activity funded through IDFs or fee-for-service Advantages Considerations Recognises ‘national’ components of the Service, while retaining responsiveness to demand driven activity. As with top slice, would require GM agreement to establishment and any future increases Administration costs associated with arrangements sit with Service Requires MOU to be agreed by hosts, and all referrers Cost may be considered a deterrent to referral Referring DHBs have limited visibility over forecast costs Funding to Host DHB.
BDM – Births, Deaths and Marriages Registry CHL – Canterbury Health Laboratories CT – Computed Tomography DHB - District Health Board FIM – Fetal and Infant Mortality FTE – Full time equivalent GM – General Manager GST – Goods and Services Tax HWNZ – Health Workforce New Zealand IDF – Inter-district flows IPPA – International Paediatric Pathology Association IT – Information technology KPI – Key performance indicator LMC – lead maternity MOU – Memorandum-of-understanding MRI – Magnetic Resonance Imaging NEHR – National Electronic Health Record NHB – National Health Board NMDS – National Minimum Dataset – National Non-Admitted Patients Collection NPPS – National Perinatal Pathology Service PBFF – Population Based Funding Formula - Perinatal and Maternal Mortality Review Committee SCL – Southern Community Laboratories Appendices
2018/19 $245,000 Continuation of the Service Programme Funding to the lead DHB: Logistics for Governance Clinical leader – 0.1 FTE Service Coordinator – 1.0 FTE Administrative support – 0.5 FTE Develop a training package and resources for referrers, which will involve: Convening an Advisory Group Conducting focus groups/meetings with stakeholders Develop resources Consultation An implementation approach $5,000 $30,000 $110,000 $25,000 $100,000 2019/20 and beyond $140,000 Continuation of the Service Programme Funding: Logistics for Governance Clinical leader – 0.1 FTE Service Coordinator – 0.6 FTE Administrative support – 0.5 FTE Training and support – delivery of training programmes at least twice per annum $3,000 $30,000 $70,000 $25,000 $12,000 Total (3 years) $512,500