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Improving women’s gynaecological health at CM Health
MARY BURR
General Manager
Gynaecological Services at CM Health provides acute and planned general medical and surgical gynaecology management, minimal access surgery and non-tertiary cancer services, urogynaecology (including urodynamics, colposcopy, hysteroscopy and contraception), and manages early pregnancy complications and loss services.
Our data shows that our activities are increasing year on year. In addition, we know there is unmet need in our community. While our highest priority is to provide expert and timely care for critically or acutely unwell women, and for those with life threatening conditions such as cancer, many women also suffer from less urgent but debilitating and restrictive conditions that impact on their lives and those of their whaanau. At present, we are unable to provide treatment for all these women. Other women are experiencing considerable delays in their surgical management, due to the number of patients we are servicing and limited resources, particularly related to theatre access at Middlemore Hospital.
The Ministry of Health’s Faster Cancer Treatment timeframe targets are also currently being affected by delays in diagnostic procedures, such as pipelle, hysteroscopy, ultrasound scan and magnetic resonance imaging to exclude cancer. During 2020, we gained funding to complete some diagnostic procedures in the primary care setting. This will provide earlier diagnosis of benign disease, and some cancers, and reduce the number of patients on the cancer pathway.
CM Health has substantially higher rates of endometrial cancer than the rest of New Zealand (driven by obesity and related comorbidities) and our mortality rates are not decreasing when compared to the rest of the country. Pacific women are over represented in the endometrial cancer group. Work continues to understand and address these issues. Obesity increases the likelihood of many gynaecological conditions. It also complicates surgery, when this is required, by increasing theatre time (making it physically more demanding and requiring longer more complex surgeries), increasing post-operative complications and requiring longer post-operative recovery times. This impact of obesity and comorbidities on gynaecological capacity is a huge area of concern for the Women’s Health service, and has been identified as a risk in the CM Health Corporate Risk Register.
We continue to advocate for more theatre access, particularly at Middlemore Hospital, in order to avoid delays for surgery and the exclusion of some women from having surgical treatment at all. We also work to ensure appropriate training opportunities are available for our future specialists. Other measures to address capacity include outsourcing some cases and recruiting more gynaecologists. Outsourcing surgery has improved delays, and we have recently secured a contract to accommodate women with higher body mass indexes.
Our perinatal loss service provides support for women and whaanau who have experienced a perinatal loss. We have carried out significant work to design an holistic service for this important activity, including appointing a clinical nurse specialist to complement the work led by our perinatal midwife specialist. Our goal is that every woman will receive appropriate counselling and support throughout and after pregnancy loss.
Health equity
Maaori and Pacific women are over represented in gynaecological first specialist assessment and surgery data. This is partially due to the obesity levels and related comorbidities in these populations. But it is also about the barriers these women face in seeking medical advice and care early.
Gynaecological Services is focused on breaking these barriers down further and providing equity of access, continuing to work together with women to ensure priority populations are prioritised for care.
