omprehensive Workforce Information Report...DHB Midwifery Workforce Information Report - October...

Comprehensive Workforce

Information Report

The New Zealand District Health Boards’

Midwifery Workforce October 2018

DHB Midwifery Workforce Information Report - October 2018

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Document History

Date October 2018 (Revised edition which replaces the September 2018 version)

Author Kamini Pather, Workforce Specialist

With thanks and acknowledgement:

HWIP Data Extract Fen Zhou, Senior Analyst

Gema Ibanez, Senior Analyst

David Tayler, Senior Analyst

NMDS & NNPAC Extract Michael Rains, Principal Analyst

Shane Kerr, Business Intelligence Developer/Analyst

Ministry of Education Data Fazleen Rahiman, Workforce Analyst

Peter Maciver, Senior Analyst

Health Workforce New Zealand’s Forecasting Tool

Emmanuel Jo, Manager Analytics and Modelling, Ministry of Health

Data Extracts The Midwifery Council of New Zealand Immigration New Zealand, MBIE Ministry of Education

mailto:[email protected]

http://www.tas.health.nz/


Contents PURPOSE.................................................................................................................................... 7

KEY FINDINGS ............................................................................................................................ 8

MIDWIFERY IN NEW ZEALAND .................................................................................................. 14

OVERVIEW OF THE 20 DHBS’ MATERNITY SERVICES .................................................................. 16

HWIP INFORMATION ON THE DHB EMPLOYED MIDWIFERY WORKFORCE ................................. 19

A) OVERVIEW OF THE DHB MIDWIFERY WORKFORCE AS AT 31 DECEMBER 2017 ....................................... 21 1. The 20 DHBs’ Overall Midwifery Workforce Metrics ...................................................................................... 21 2. Midwifery Workforce Metrics by DHB Size ..................................................................................................... 21 3. Midwifery Workforce Metrics by DHB ............................................................................................................ 22 4. Change in Midwifery Workforce Metrics compared to 2016 by DHB ............................................................. 23

B) WORKFORCE SIZE ................................................................................................................... 24 1. Headcount ....................................................................................................................................................... 24

2. Contracted Full-time Equivalent (FTE) ............................................................................................................ 24

C) WORKFORCE DENSITY - FTE TO POPULATION RATIOS ...................................................................... 26 1. Overall DHB Midwifery FTE per 100,000 Fertile Female Population (15 to 49 years) of New Zealand .......... 26

2. Individual DHB Midwifery FTE per 100,000 Local Fertile Female Population (15 to 49 years) ....................... 27

D) WORKFORCE DISTRIBUTION ...................................................................................................... 28

E) WORKFORCE CONTRACTED AVAILABILITY & UTILISATION .................................................................. 30 1. Counting Staff Resources - Headcount vs Contracted FTE by DHB ................................................................. 30

2. Employment Status (Mean FTE) ...................................................................................................................... 30

3. Mean Hours Contracted .................................................................................................................................. 31

4. Mean Hours Paid ............................................................................................................................................. 32

5. Comparing Mean Hours Contracted to Mean Hours Paid .............................................................................. 33

F) WORKFORCE VACANCIES .......................................................................................................... 34 1. Overall Vacancy FTE and Vacancy Rates Reported by the 20 DHBs ................................................................ 34

2. A Snapshot of DHB Midwifery Vacancy FTE as at 31 December 2017 ............................................................ 34

G) WORKFORCE WELLNESS & MOBILITY INDICATORS .......................................................................... 36 1. Sick Leave ........................................................................................................................................................ 36

2. Annual Leave Balance to Entitlement Ratios .................................................................................................. 37

3. Annual Voluntary Turnover ............................................................................................................................. 38

4. Workforce Tenure ........................................................................................................................................... 39

H) WORKFORCE PROFILE .............................................................................................................. 41 1. Gender Profile ................................................................................................................................................. 41

2. Age Profile ....................................................................................................................................................... 41

3. Approaching Retirement Age (Over 55 years) ................................................................................................ 42

4. Workforce Diversity ........................................................................................................................................ 43 4.1 Overall Ethnicity of DHB Employed Midwives ........................................................................................................43

4.2 Ethnicity by DHB .....................................................................................................................................................45

4.3 Māori Representation ............................................................................................................................................46

OTHER INFORMATION RELATING TO THE DHB MIDWIFERY WORKFORCE .................................. 47

A) THE TRAINING PIPELINE – MIDWIFERY PRE-REGISTRATION EDUCATION PROGRAMMES ............................. 49 1. Completion of Midwifery Pre-registration Education Programmes................................................................ 49

2. Enrolment in Midwifery Pre-registration Education Programmes .................................................................. 51

3. Ethnicity of Completions and Enrolments ....................................................................................................... 52

B) MIDWIFERY COUNCIL DATA ...................................................................................................... 54


1. The New Zealand Midwifery Workforce ......................................................................................................... 54 2. New Registrations of Midwives in New Zealand ............................................................................................. 54

3. Return to Practice Programmes ...................................................................................................................... 55

C) IMMIGRATION NEW ZEALAND VISA APPROVAL DATA ...................................................................... 57

D) MIDWIFERY RELATED INFORMATION FROM THE NATIONAL MINIMUM DATASET (NMDS) & THE NATIONAL

NON-ADMITTED PATIENT COLLECTION (NNPAC) ............................................................................... 59 1. DHB Activity related to Labour and Birth ........................................................................................................ 60

1.1 DHB Labour and Birth Activity per 100,000 Fertile Female (15-49 year) Population .............................................61 1.2 DHB Labour and Birth Activity by Ethnicity ............................................................................................................61

2. Other DHB Maternity Activity outside Labour and Birth................................................................................. 63 2.1 Other DHB Maternity Activity per 100,000 Fertile Female (15-49 year) Population ..............................................65

2.2 Other DHB Maternity Activity by Ethnicity .............................................................................................................65

3. DHB Birth Activity by Type .............................................................................................................................. 67

4. Maternity Events to DHB Midwifery FTE Ratios .............................................................................................. 68

E) HEALTH WORKFORCE NEW ZEALAND’S FORECASTING MODEL ............................................................ 71

BIBLIOGRAPHY ......................................................................................................................... 73

APPENDICES ............................................................................................................................. 74

APPENDIX A - SUPPLEMENTARY INFORMATION ON HWIP DATA ............................................................. 74


List of Tables Table 1 - The 20 DHBs’ Overall Midwifery Workforce Metrics as at 31 December 2017 ......................................................................21 Table 2 - Midwifery Workforce Metrics by DHB Size as at 31 December 2017 .....................................................................................21 Table 3 - Change in Midwifery Workforce Metrics from 31 December 2016 by DHB Size ....................................................................21 Table 4 - Midwifery Workforce Metrics by DHB as at 31 December 2017 ............................................................................................22 Table 5 - Change in Midwifery Workforce Metrics compared to 2016 by DHB .....................................................................................23 Table 6 - Distribution of the Midwifery Workforce by DHB as at 31 December 2017 ...........................................................................29 Table 7 - Ethnicity of the DHB Midwifery Workforce by DHB as at 31 December 2017 ........................................................................45 Table 8 - Activity related to Labour and Birth undertaken by DHBs from 2009 to 2017 .......................................................................61 Table 9 - Snapshot of Activity related to Labour and Birth by DHB and Ethnicity in 2017 ....................................................................63 Table 10 - Other DHB Maternity Activity undertaken by DHBs from 2009 to 2017 ..............................................................................64 Table 11- Snapshot of Other DHB Maternity Activity by DHB and Ethnicity in 2017 .............................................................................66 Table 12 - DHB Birth Activity by Type from 2009 to 2017 .....................................................................................................................68 Table 13 - National DHB Midwifery FTE to Maternity Events Ratios .....................................................................................................69

List of Figures Figure 1 - DHB Midwifery Headcount from 31 December 2010 to 31 December 2017 ........................................................................24 Figure 2 - Change in the Midwifery Headcount by DHB - 31 December 2010 vs 31 December 2017 ...................................................24 Figure 3 - DHB Midwifery Contracted FTE from 31 December 2010 to 31 December 2017 ..................................................................25 Figure 4 - Change in the Midwifery Contracted FTE by DHB - 31 December 2010 vs 31 December 2017.............................................25 Figure 5 - Cumulative increase in DHB Midwifery FTE & the New Zealand Fertile Population (15 to 49 years) from 31 December 2010

to 31 December 2017 ............................................................................................................................................................................26 Figure 6 - DHB Midwifery FTE per 100,000 Fertile Population (15 to 49 years) of New Zealand from 31 December 2010 to 31

December 2017 .....................................................................................................................................................................................27 Figure 7 - Midwifery FTE per 100,000 Fertile Population (15 to 49 years) by DHB as at 31 December 2017 ........................................27 Figure 8 - Distribution of Midwifery Headcount & Contracted FTE by DHB as at 31 December 2017...................................................28 Figure 9 - Distribution of Midwives by Region as at 31 December 2017 ...............................................................................................29 Figure 10 - Distribution of Midwives by DHB Size as at 31 December 2017 ..........................................................................................29 Figure 11 - Distribution of % Headcount & % Contracted FTE for Midwifery by DHB as at 31 December 2017....................................29 Figure 12 - Midwifery Headcount vs Contracted FTE by DHB as at 31 December 2017 ........................................................................30 Figure 13 - DHB Midwifery Mean FTE from 31 December 2010 to 31 December 2017 ........................................................................31 Figure 14 - Midwifery Mean FTE by DHB as at 31 December 2017 .......................................................................................................31 Figure 15 - DHB Midwifery Mean Hours Contracted per head per week from 31 December 2014 to 31 December 2017 ...................31 Figure 16 - Midwifery Mean Hours Contracted per head per week by DHB as at 31 December 2017 ..................................................32 Figure 17 - DHB Midwifery Mean Hours Paid per head per week from 31 December 2014 to 31 December 2017..............................32 Figure 18 – Midwifery Mean Hours Paid per head per week by DHB as at 31 December 2017 ............................................................32 Figure 19 - Midwifery Mean Hours Contracted vs Mean Hours Paid per head per week by DHB as at 31 December 2017 .................33 Figure 20 - Difference between Mean Hours Paid and Mean Hours Contracted per head per week for Midwifery by DHB as at 31

December 2017 .....................................................................................................................................................................................33 Figure 21 - DHB Midwifery Vacancy FTE & Vacancy Rates from 30 September 2016 to 31 December 2017 ........................................34 Figure 22 - DHB Midwifery Vacancy FTE & Vacancy Rate by Region as at 31 December 2017 .............................................................34 Figure 23 - Midwifery Vacancy FTE & Vacancy Rates by DHB as at 31 December 2017 ........................................................................35 Figure 24 - Midwifery Vacancy FTE & Vacancy Rate by DHB Size as at 31 December 2017 ..................................................................35 Figure 25 - DHB Midwifery Annualised Mean Sick Leave Hours per FTE from 31 December 2014 to 31 December 2017 ...................36 Figure 26 - Midwifery Annualised Mean Sick Leave Hours per FTE by DHB from 31 December 2014 to 31 December 2017 ...............37 Figure 27 - Midwifery Annualised Mean Sick Leave Hours per FTE by DHB as at 31 December 2017 ...................................................37 Figure 28 - DHB Midwifery Annualised Mean Sick Leave Hours per FTE by Age as at 31 December 2017 ............................................37 Figure 29 - DHB Midwifery Mean Annual Leave Balance to Entitlement Ratios from 31 December 2014 to 31 December 2017 ........38 Figure 30 - Midwifery Mean Annual Leave Balance to Entitlement Ratios by DHB as at 31 December 2017 .......................................38 Figure 31 - DHB Midwifery Annual Voluntary Turnover Rate from 31 December 2010 to 31 December 2017 ....................................39 Figure 32 - Midwifery Annual Voluntary Turnover Rate by DHB as at 31 December 2017 ...................................................................39 Figure 33 - DHB Midwifery Mean Length of Service from 31 December 2010 to 31 December 2017 ..................................................40 Figure 34 - Midwifery Mean Length of Service by DHB as at 31 December 2017 .................................................................................40 Figure 35 - % Female within the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017 .....................................41 Figure 36 - DHB Midwifery Mean Age from 31 December 2010 to 31 December 2017 ........................................................................41


Figure 37 - Midwifery Mean Age by DHB as at 31 December 2017 .......................................................................................................42 Figure 38 - Age Distribution of the DHB Midwifery Workforce as at 31 December 2017 vs 31 December 2012 ..................................42 Figure 39 - Age Distribution of the DHB Midwifery Workforce as at 31 December 2017 vs 31 December 2012 ..................................42 Figure 40 - % Over 55 Years within the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017 ...........................43 Figure 41 - % over 55 Years within the DHB Midwifery Workforce by DHB as at 31 December 2017 ...................................................43 Figure 42 - Ethnicity of the DHB Midwifery Workforce as at 31 December 2017 .................................................................................44 Figure 43 - Ethnicity of the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017 ..............................................44 Figure 44 - Ethnic Proportionality of the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017.........................44 Figure 45 - Ethnicity of the DHB Midwifery Workforce by DHB as at 31 December 2017 .....................................................................45 Figure 46 - % Māori within the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017 .......................................46 Figure 47 - % Māori within the DHB Midwifery Workforce vs % Māori in Population from 31 December 2010 to 31 December 2017

...............................................................................................................................................................................................................46 Figure 48 - % Māori within the DHB Midwifery Workforce by DHB as at 31 December 2017 ...............................................................46 Figure 49 - Annual Completions of Midwifery Pre-registration Education Programmes in New Zealand from 2008 to 2016 ..............50 Figure 50 - Annual Completions of Midwifery Pre-registration Education Programmes by New Zealand Tertiary Education Provider

from 2008 to 2016 .................................................................................................................................................................................50 Figure 51 - All Completions of Midwifery Pre-registration Education Programmes in New Zealand by Tertiary Education Provider

from 2008 to 2016 .................................................................................................................................................................................50 Figure 52 - Annual Enrolments in Midwifery Pre-registration Education Programmes with a New Zealand Tertiary Education

Provider across all years of study from 2008 to 2017 ...........................................................................................................................51 Figure 53 - Annual Enrolments in Midwifery Pre-registration Education Programmes by New Zealand Tertiary Education Provider

across all years of study from 2008 to 2017 ..........................................................................................................................................51 Figure 54 - Commencements in Midwifery Pre-registration Education Programmes by New Zealand Tertiary Education Provider

across all years of study from 2008 to 2017 ..........................................................................................................................................51 Figure 55 - Ethnicity of all Completions of Midwifery Pre-registration Education Programmes in New Zealand from 2008 to 2016 ...52 Figure 56 - Ethnicity of Annual Completions of Midwifery Pre-registration Education Programmes from 2008 to 2016 .....................52 Figure 57 - Total Enrolments in a Bachelor of Midwifery or a Bachelor of Health Science (Midwifery) programme in New Zealand by

Ethnicity across all years of study from 2008 to 2017 ...........................................................................................................................52 Figure 58 - Headcount of Registered Midwives with Practising Certificates in New Zealand from 1 April 2010 and 31 March 2018 ...54 Figure 59 - Headcount of Midwives Registered from 1 April 2009 to 31 March 2018 ..........................................................................55 Figure 60 - New Zealand Graduates vs Internationally Qualified Midwives as a % of New Registrations from 1 April 2009 to 31 March

2018 .......................................................................................................................................................................................................55 Figure 61 - Completion Rates of Return to Practice Programmes between 2009/10 and 2017/18 ......................................................55 Figure 62 - Residence and Work Visa Approvals for Midwives from 1 July 2010 to 30 June 2018 ........................................................57 Figure 63 - Residence and Work Visa Approvals for Midwives by Country from 1 July 2010 to 30 June 2018 .....................................58 Figure 64 - DHB Labour and Birth Activity from 2009 to 2017 ..............................................................................................................60 Figure 65 - Labour and Birth Activity undertaken by Large DHBs from 2009 to 2017 ...........................................................................60 Figure 66 - Labour and Birth Activity undertaken by Medium Sized DHBs from 2009 to 2017 .............................................................60 Figure 67 - Labour and Birth Activity undertaken by Small DHBs from 2009 to 2017 ...........................................................................60 Figure 68 - DHB Activity related to Labour and Birth per 100,000 Fertile Female (15-49 year) Population from 2009 to 2017 ...........61 Figure 69 - DHB Activity related to Labour and Birth by Ethnicity from 2009 to 2017 ..........................................................................62 Figure 70 - DHB Activity related to Labour and Birth per 100,000 Fertile Female (15-49 year) Population by Ethnicity from 2009 to

2017 .......................................................................................................................................................................................................62 Figure 71 - Snapshot of Activity related to Labour and Birth by DHB and Ethnicity in 2017 .................................................................62 Figure 72 - Other DHB Maternity Activity from 2009 to 2017 ...............................................................................................................63 Figure 73 - Other DHB Maternity Activity undertaken by Large DHBs from 2009 to 2017 ....................................................................64 Figure 74 - Other DHB Maternity Activity undertaken by Medium Sized DHBs from 2009 to 2017 ......................................................64 Figure 75 - Other DHB Maternity Activity undertaken by Small DHBs from 2009 to 2017 ....................................................................64 Figure 76 - Other DHB Maternity Activity per 100,000 Fertile Female (15-49 year) Population from 2009 to 2017 ............................65 Figure 77 - Other DHB Maternity Activity by Ethnicity from 2009 to 2017 ...........................................................................................65 Figure 78 - Other DHB Maternity Activity per 100,000 Fertile Female (15-49 year) Population by Ethnicity from 2009 to 2017 .........66 Figure 79 - Snapshot of Other DHB Maternity Activity by DHB and Ethnicity in 2017 ...........................................................................66 Figure 80 - DHB Birth Activity by Type from 2009 to 2017 ....................................................................................................................67 Figure 81 - DHB Birth Activity by Type and Ethnicity from 2009 to 2017 ..............................................................................................67 Figure 82 - National DHB Midwifery FTE to Maternity Events Ratios ....................................................................................................69 Figure 83 - Ratio of Labour and Birth Events per FTE Midwife by DHB as at 31 December 2017 ..........................................................69 Figure 84 - Ratio of Other Maternity Events per FTE Midwife by DHB as at 31 December 2017 ..........................................................69 Figure 85 - Health Workforce New Zealand’s forecast midwifery workforce age distribution in 2018 and 2028 .................................71


Purpose

Workforce development is a key enabler for New Zealand’s District Health Boards (DHBs) and has a significant

impact on service delivery and outcomes.

The DHB midwifery workforce is under pressure nationally and is facing widespread workforce challenges.

There is a recognised lack of midwives nationally, problems with understaffed maternity units struggling to

meet demand for midwifery services, as well as difficulty retaining and recruiting midwives. There is

considerable midwifery workforce development activity underway nationally, aimed at addressing these

challenges. As a result, a range of related reports have been or are being produced. This report is a

complementary component in the development of a composite evidence base to inform future midwifery

workforce development and planning activity.

This report focuses on presenting a summary of quantitative workforce information relating specifically to

the 20 New Zealand DHBs’ midwifery workforce. The purpose of the report is to develop a comprehensive

quantitative understanding of the status of the DHB employed midwifery workforce - which can be used to

inform workforce development and planning activity, and to identify workforce pressures that may impact

on the capacity to deliver services.

The scope of this report deliberately excludes data relating to self-employed caseload midwives (Lead

Maternity Carers / LMCs). While there are clear interdependencies, self-employed LMCs comprise a distinct

and complex workforce - with marked differences from the DHB employed midwifery workforce. Many of

the patterns and trends identified in this report may apply to the wider midwifery workforce; however we

consider that efforts to develop a quantitative understanding of the self-employed LMC workforce warrants

a dedicated and specialist focus outside the remit of this report.

Data on DHB Employed Midwives

For the purposes of this report, data relating to DHB employed midwives is sourced from the Health

Workforce Information Programme (HWIP) and is for staff employed as fully qualified midwives from 31

December 2010 to 31 December 2017. The HWIP information is for all permanent and fixed term employees

and excludes those on long term leave, parental leave, leave without pay and those with zero contracted

hours (casuals). It should be noted that the DHB midwifery workforce is relatively small, so slight changes can

result in significant variation in trends.

The report includes analysis of some large and varied data sets to examine patterns, unknown correlations,

trends and other useful information relating to the DHB midwifery workforce. The report uses data from a

range of sources, including:

The Health Workforce Information Programme (HWIP);

The National Minimum Dataset (NMDS) - which is a national collection of public and private

hospital discharge information, including coded clinical data for inpatients and day patients;

The National Non-Admitted Patient Collection (NNPAC)) - which is a national collection of non-

admitted patient activity;

The Midwifery Council of New Zealand;

Immigration New Zealand;

Health Workforce New Zealand; and

The Ministry of Education.


Key Findings

The DHB Midwifery Workforce

The DHB Midwifery Workforce Profile Midwifery is an almost exclusively female, largely part-

time, ageing workforce; with increased sick leave,

reducing hours of work and an increasing number of

potential retirements. The high numbers of females

means that there are high levels of parental leave and

people not returning from parental leave, which impacts

on retention. Additionally, the Lead Maternity Carer

(LMC) role, which allows more flexibility, is often

perceived as more favourable than working in the

hospital setting. This workforce has very low levels of

diversity and severe under-representation of minority

ethnic groups.

An Aged Workforce The average age of DHB midwives nationally was

significantly high at 47.6 years in December 2017, and

has been around the same level since December 2010.

Six DHBs have midwifery workforces with average ages

below the national figure, while a further six DHBs have

midwifery workforces with average ages over 50 years.

Counties Manukau DHB’s midwifery workforce has the

lowest average age at 42.8 years, and Wairarapa DHB’s

midwifery workforce has the highest average age at 53

years.

Comparison of the age distribution of the overall DHB

midwifery workforce in December 2017 with December

2012; indicates that there has been a 26% increase in the

25 to 29 years age group and a 23% decrease in the 40 to

49 years age group. However, there has also been a 24%

increase in the 60 to 64 year old age group. Despite a

slight decrease since 2012, more than 70% of the DHB

midwifery workforce remains over 40 years old.

DHB Midwives Approaching Retirement Age The 20 DHBs need to prepare for the potential exit of a

significant proportion of midwives who are 10 years

away from the retirement age of 65 years. The

percentage of the national DHB midwifery workforce

over 55 years has been increasing since December 2011,

and was significantly high at 31.4% in December 2017.

Examination of individual DHB midwifery workforces

indicates significant differences in the percentage of

midwives over 55 years. Six DHBs have midwifery

workforces comprising of 40% or more midwives who are

over 55 years. Seven DHBs have midwifery workforces

with percentages over 55 years that are lower than the

national figure of 31.4%. Nearly half of Whanganui and

South Canterbury DHBs’ midwifery workforces comprise

midwives over 55 years. At around the 22% mark

Tairawhiti, Waikato and Lakes DHBs have the lowest

percentages of midwives over 55 years.

Lack of Workforce Diversity There is severe under representation of Pacific People,

Māori, and Asians within the national DHB midwifery

workforce. Only 0.6% of DHB midwives were Pacific, 7.2%

Māori and 3.8% Asian in December 2017. Ethnic

disproportionality and under representation of minority

ethnic groups within the DHB midwifery workforce have

been long standing issues.

These issues have worsened significantly for Pacific

People midwives over the long term. From December

2010 to December 2017, the headcount of Pacific People

midwives decreased by 53% to just 8 across the 20 DHBs;

resulting in the proportion of Pacific People in the DHB

midwifery workforce reducing from 1.7% to 0.6%.

The number of Asian midwives increased by 44% over the

same period to 49; however the proportion of Asians

within the DHB midwifery workforce remains at similar

levels to December 2010 (< 4%). There has also been a

shift in Māori representation within the DHB midwifery

workforce; with headcount increasing by 70% to 92 and

The workforce information in this report highlights a number of concerns regarding the New Zealand midwifery

workforce and confirms challenges signalled by stakeholders.

The DHB midwifery workforce is vulnerable and under pressure nationally, with service demand increasing in

complexity and acuity. Urgent action is needed to address severe national supply issues and the inadequate training

pipeline.

While a number of midwifery workforce related groups exist and activity is underway - the groups do not appear to

be well connected and there is little visibility of the activities being undertaken to address workforce challenges and

solutions. There is a need for a coordinated, cohesive, collaborative and visible national workforce development

approach for midwifery in New Zealand.


the proportion of Māori increasing to 7.2% from 5.4%

since December 2010.

There is continued ethnic disproportionality between the

DHB midwifery workforce and the fertile female (15 to 49

years) population of New Zealand.

Analysis of individual DHB midwifery workforces in

December 2017, revealed vast differences across the 20

DHBs in terms of workforce ethnic composition. Four

DHBs (South Canterbury, Wairarapa, West Coast and

Whanganui) did not employ any Māori midwives. Capital

& Coast, Counties Manukau and Waikato DHBs are the

only DHBs that employed Pacific People midwives. Only

50% of DHBs employed Asian midwives.

Māori Representation While there has been a slight increase in the proportion

of Māori within the national DHB midwifery workforce;

there is still significant under representation and

potential for the DHB midwifery workforce to better

reflect the Māori population.

Māori representation within the midwifery workforce

varies significantly at DHB level. Eleven DHBs had a lower

proportion of Māori within their midwifery workforce

than the national figure of 7.2% in December 2017. Four

of those DHBs (South Canterbury, Wairarapa, West Coast

and Whanganui) did not employ any Māori midwives in

December 2017. Tairawhiti (20%) and Taranaki (16.7%)

had the largest proportions of Māori within their

midwifery workforces.

A Shrinking Workforce The DHB midwifery workforce has been shrinking over time. Since 2010, the national workforce has diminished in headcount (-4.3%) and FTE (-2.6%); and in December 2017 comprised a headcount of 1,351 and 943.2 FTE. Over that period, the changes varied at DHB level and resulted in: 8 DHBs reducing their headcount, 10 DHBs increasing

their headcount, and no change in headcount for 2 DHBs; and

9 DHBs reducing their FTE and 11 DHBs increasing their FTE.

Reducing and Variable Workforce Density The DHB midwifery workforce has been shrinking, while

the population it serves is increasing. Comparison of the

national DHB midwifery FTE to the fertile female

population (15 to 49 years) of New Zealand, indicates

that there has been a significant reduction in overall

workforce density since December 2013. The fertile

female population has been experiencing a cumulative

increase since December 2013. Conversely, this trend is

not reflected in the DHB midwifery FTE, which has been

on a downward trajectory and has experienced a

cumulative decrease over the same period. There is

considerable variation between DHBs in terms of

workforce density. Small to medium DHBs with regional

/ rural populations appear to have higher midwifery FTE

per 100,000 local fertile female population compared to

larger DHBs with more densely populated urban centres.

Variable Workforce Distribution A high level comparison of the proportional distribution

of midwives employed by individual DHBs, in terms of

headcount and contracted FTE, indicates a rough

correlation in geographic distribution patterns with

minor variances of <1%. While all 20 DHBs employ

midwives, there is considerable variance between DHBs

in terms of individual workforce sizes. In December 2017,

the majority of DHB employed midwives worked for large

DHBs (64.8%); with medium and small DHBs employing

the remaining 23.1% and 12.1% respectively. Most DHB

employed midwives are based in the North Island, i.e.

1,080 (79.9%) in December 2017. The Northern Region

DHBs employ 38.3% of all DHB midwives; followed by the

Central Region (23.8%), the Southern Region (20.1%) and

the Midland Region (17.8%).

A Part-time Workforce The DHB midwifery workforce has the lowest Mean FTE

(0.70) of any DHB workforce, and is largely part-time with

midwives paid on average for 28.9 hours per week. The

largely part-time availability of the DHB midwifery

workforce is reflective of midwives being able to work as

Caseload / Core Midwives within the DHB setting while

also practising as self-employed Lead Maternity Carers

(LMCs) within the community. The DHB midwifery

workforce’s Mean FTE has not exceeded 0.70 since

December 2010. The Mean FTE of individual DHBs varies

significantly; with Hawke’s Bay DHB having the lowest

Mean FTE of 0.63 and South Canterbury having the

highest at 0.81 in December 2017. Nine DHBs (45%) had

a Mean FTE lower than the national average of 0.70.

Counting Resources - Headcount vs Contracted FTE All DHBs have a notably higher headcount compared to

contracted FTE figure. The gap varies depending on the

size of the DHB - larger urban DHBs appear to have larger

differences than the smaller more rural DHBs.

Workforce Availability - Mean hours contracted Nationally, mean hours contracted per head per week for the DHB midwifery workforce was 27.9 in December 2017 - it has remained at this level since December 2014. Analysis of individual DHB figures indicates significant disparity between DHBs in terms of the mean staff resources that were contracted to be available for productive work. Nine DHBs had mean hours contracted per head per week figures which were lower than the


national figure. Hawke’s Bay with 25.2 had the lowest

mean hours contracted per head per week and South

Canterbury had the highest at 32.4 hours.

Workforce Utilisation - Mean hours paid The national figure for mean hours paid per head per

week for the DHB midwifery workforce in December

2017 was 28.9. The national figure has fluctuated, but

remains at a similar level to the December 2014 figure.

Analysis of mean hours paid per head per week by DHB,

indicates that workforce utilisation varies between DHBs.

Only six DHBs had a mean hours paid per head per week

figure that was lower than the national figure.

Canterbury with 22.8 had the lowest mean hours paid

per head per week, while Counties Manukau had the

highest at 35.3.

Figures for mean hours contracted were compared to

mean hours paid per head per week by DHB, as an

indicator of workforce contracted availability vs actual

utilisation. Again, there is notable variance between

DHBs. The majority of DHBs (60%) have reported a mean

hours paid per head per week figure that is at least one

hour more than their mean hours contracted per head

per week figure in December 2017.

High Numbers of Midwifery Vacancies DHBs are carrying high numbers of midwifery vacancies;

with an overall lack of supply nationally and significant

problems recruiting midwives. 75% of DHBs reported

carrying midwifery vacancies in December 2017. This

equated to a national Vacancy FTE of 102.6 and Vacancy

Rate of 9.8% in December 2017 for the DHB midwifery

workforce.

Auckland and Counties Manukau DHBs had the highest

Vacancy FTE and Vacancy Rates in December 2017. Both

DHBs reported significantly higher individual Vacancy FTE

and Vacancy Rates compared to other DHBs. Their

combined Vacancy FTE of 58.9 represents 57.4% of the

national Vacancy FTE.

The majority (68%) of midwifery vacancies are in the

Northern Region DHBs, while the Central Region

reported the lowest midwifery Vacancy FTE at 3.6% of

the national figure. Large DHBs have a combined Vacancy

FTE of 89.8, which is 87.5% of the total Vacancy FTE

reported. Vacancy FTE reported by medium and small

DHBs represents 4.2% and 8.3% respectively of the

national total.

Workforce Wellness and Mobility Indicators

Sick Leave Useage Annualised sick leave patterns for DHB midwives indicates that in December 2017, midwives took 81.3

hours of sick leave on average per FTE for the year. This

was the second highest figure for all DHB workforces.

Average annualised sick leave patterns indicate

significant year on year increases in the national figure

for average sick leave hours taken per FTE by DHB

midwives since December 2014. When viewed

individually, there is considerable variance between

DHBs in terms of sick leave patterns. The majority of

DHBs have mirrored the national trend of high and

increasing average sick leave hours taken per FTE per

annum for midwives.

The average annualised sick leave hours per FTE taken by

midwives varies significantly between age groups.

Midwives over 60 years have the highest average sick

leave hours taken per FTE per annum.

Annual Leave Patterns The average annual leave balance to entitlement ratio for

the national DHB midwifery workforce has reduced

slightly - from 107% in December 2014 to 103% in

December 2017. This is the second highest for DHB

workforces.

In December 2017, there was considerable variance

across the 20 DHBs in terms of individual midwifery

workforce annual leave balance to entitlement ratios.

Eight DHBs had midwifery workforces with annual leave

balances that exceeded their annual leave entitlement.

Bay of Plenty (158.5%) and Counties Manukau (154.5%)

DHBs had the highest average annual leave balance to

entitlement ratios for midwives. Twelve DHBs had

midwifery workforces with average annual leave balance

to entitlement ratios lower than 100%.

Annual Voluntary Turnover The annual voluntary turnover rate for the national DHB

midwifery workforce has fluctuated since December

2010 - between 11.6% at its lowest in December 2014

and 14.8% at its highest in December 2012. In December

2017, the national annual voluntary turnover rate was

13.9%.

Annual voluntary turnover rates for individual DHB

midwifery workforces in December 2017, indicates a

pattern of extremes disparities. While two DHBs had a

0% annual voluntary turnover rate, four DHBs had rates

that exceeded 20%. The majority of DHBs (40%) have

annual voluntary turnover rates between 10 and 16%.

Workforce Tenure The average length of service for the national DHB

midwifery workforce was 7.8 years in December 2017,

and has remained around the same level since December

2010. In December 2017, all 20 individual DHB midwifery

workforces had average lengths of service that were


more than 5 years; with two DHBs exceeding 10 years.

Ten DHBs had mean lengths of service that were lower

than the national figure of 7.8 years.

Other information relating to the DHB

Midwifery Workforce

The Trainee Pipeline There are significant concerns around the very low

numbers of midwives generated by the New Zealand

midwifery trainee pipeline, being sufficient to meet

current and future need - due to the ageing workforce

demographic and increasing complexity of service

demand. Feedback from DHBs indicates that urgent

action is needed to address concerns around the trainee

pipeline; including an increase in the number of graduate

midwives, and consideration of postgraduate training

programmes for other health professionals leading to

registration as a midwife.

Over the long term, there have been very low numbers

of trainees completing midwifery pre-registration

programmes annually. Completion numbers for

midwifery pre-registration education programmes have

been low since 2008 - at 150 or less per annum. Since

2014, completion numbers have been decreasing,with

only 125 completions in 2016, which is the same as in

2009.

Completion rates for midwifery pre-registration

programmes are also concerning. Since 2008, there has

been a trend of increasing annual midwifery pre-

registration programme enrolment numbers across all

four tertiary education providers in New Zealand.

However, there is notable misalignment between

increased midwifery enrolment numbers and low

completion numbers - indicating a high attrition rate

within these midwifery pre-registration education

programmes. It would appear that a significant number

of students are not completing these programmes.

Additionally, there is a significant lack of ethnic diversity

within the midwifery trainee pipeline. Analysis of the

ethnicity of midwifery completions and enrolments,

indicates significant under representation of Asian,

Māori and Pacific People. There is particularly concerning

paucity around Pacific People completion numbers.

Despite significant increases in the number of Pacific

People enrolments across all years of study in midwifery

pre-registration education programmes; few appear to

be completing these programmes since 2008.

Registered Midwives in New Zealand In 2017, there were 3,210 registered midwives practising

in New Zealand - the majority (55%) of which were not

employed by DHBs, either permanently or on a fixed

term basis.

The midwifery workforce has been growing at a very low

rate; with the number of practising midwives in New

Zealand increasing by less than 8% (230) from 2010/11 to

2017/18. From 2011/12 the growth rate was 1% or less

per annum, however this increased to 2% in 2017/18.

The DHB employed midwifery workforce as a proportion

of all practising midwives in New Zealand, decreased

notably from 2010/11 to 2017/18. This correlates with a

decrease in the overall headcount of DHB employed

midwives over the same period.

New Registrations of Midwives in New Zealand From 2009 to 2018, there have been low and mostly

decreasing numbers of midwives added to the New

Zealand register. There were 187 midwives registered in

New Zealand in 2017/18, which is an increase from the

preceding three years.

The majority of new registrations are New Zealand

educated midwives, and in 2017/2018 this group

comprised 78% of all new registrations. The number of

New Zealand educated midwives has been low over the

long term (since 2009), and remained low at 146 in

2017/18.

The total number of Internationally Qualified Midwives

(IQMs) registered annually in New Zealand has decreased

significantly over a number of years, from 76 in 2009/10

to 41 in 2017/18. Over the same period, the proportion

of all IQMs fell from 37.6% of all new registrations to

22%.

Return to Practice Programmes There are very low numbers of midwives enrolling in

return to practice programmes, and completion rates

dropped significantly from 2009 to 2017. The number of

midwives participating in return to practice programmes

has decreased significantly over the long term (-80%

from 2009/10 to 2017/18), with only 7 participants in

2017/18. Additionally, the completion rate dropped from

89% in 2009/10 to 67% in 2016/17. However, in 2017/18

all 7 participants completed the programme.

Additionally, the completion rate has dropped from 89%

in 2009/10 to 67% in 2016/17. This is an untapped

potential source of experienced midwives.

Critical need for international recruitment of

experienced midwives Widespread national supply issues with the midwifery

workforce, low midwifery graduate numbers and high

numbers of unfilled vacancies over the long term; are


creating significant pressure across the 20 DHBs. These

pressures are unlikely to be alleviated without significant

international recruitment. It is certain that unless the

local midwifery workforce is supplemented with

experienced IQMs, DHBs will not be able to fill vacancies

over the long term and will struggle to ensure that the

midwifery workforce meets increasing service demand

needs.

There have been very low numbers of work and

residence visa approvals for midwives over the past 8

years. Both work and residence visa approval figures

have fluctuated over that period, but have remained at

less than 30 of each type per annum.

From 2013/14 work visa approvals began noticeably

declining below 20 per annum - this is likely to be due to

the removal of midwifery from Immigration New

Zealand’s (INZ’s) Long Term Skills Shortage List (LTSSL)

around the same time. Conversely, the recent inclusion

of the occupation ‘Midwife’ on INZ’s Immediate Skills

Shortage List (ISSL) appears to have resulted in a sudden increase to 27 visa approvals in 2017/18 (93% more than

2016/17).

Residence visa approvals have been declining since

2012/13, aside from a small anomalous surge in 2015/16.

If work visa approvals continue to increase, it is likely that

residence visa approvals will follow a similar trend.

The majority of internationally qualified midwives

granted visas to work in New Zealand were from the

United Kingdom, Ireland and other European countries.

Increasing Complexity of Service Demand

DHB Maternity Services Activity We have utilised information from the National

Minimum Dataset (NMDS) for admitted patients and the

National Non-Admitted Patient Collection (NNPAC) to

examine service delivery outputs relating to activities

that indicate the demand for DHB employed midwifery

services.

Feedback from stakeholders signalled that relying solely

on a count of actual births, would not reflect the activity

undertaken by or requiring some level of involvement

from midwives. The data used covers nine calendar years

up to and including 2017, and represents activity at DHB

owned facilities that have some input from DHB

employed midwives.

The use of service delivery data in workforce analysis is relatively new, and there have been some challenges. Service delivery data is intended to be indicative only and has some clear limitations – it may not reflect all the maternity activity outside of labour and birth undertaken by DHBs. It should be noted that DHBs may differ in how

they capture and record certain events - e.g. acute assessments and outpatient reviews.

Labour and Birth Activity Labour and birth activity undertaken by DHBs nationally

has decreased by 6%, but remained relatively stable at

over 53,000 events from 2009 to 2017.

At DHB level, there is significant variance between DHBs

depending on size and geographical location. Annually,

80% of DHB labour and birth activity is undertaken in the

North Island, with Northern Region DHBs accounting for

over 42%. The Central and Southern regions undertake

around 20% each of national activity, with the Midlands

region accounting for the remaining 18%. The seven large

DHBs undertake over 68% of all national labour and birth

activity, with medium and small DHBs undertaking

around 22% and 10% respectively.

Labour and birth activity undertaken nationally by DHBs

has decreased but remained relatively stable at around

5,000 events per 100,000 fertile female population from

2009 to 2017.

Over the same period, DHB labour and birth activity has

been increasing for Asians - in terms of actual events;

events as a proportion of all labour and birth activity

undertaken by DHBs; and events per 100,000 fertile

female population. Conversely, all other ethnic groups

have been experiencing decreases in terms of actual

events; events as a proportion of all labour and birth

activity undertaken by DHBs; and events per 100,000

fertile female population. The seven large DHBs are most

impacted by these trends.

Other DHB Maternity Activity outside Labour and Birth DHBs undertake a significant amount of ‘Other DHB

Maternity Activity’ that is outside labour and birth, and

which is likely to require midwifery involvement. This

includes pregnancy examinations, pregnancy

supervision, antenatal screening, postpartum care,

terminations, antenatal consults, postnatal consults,

pregnancy and parenting education, maternity foetal

medicine - multidisciplinary clinics, breastfeeding /

lactation clinics, maternity multidisciplinary non-

specialist clinics.

There has been some fluctuation and an overall decrease

in other DHB maternity activity undertaken nationally

from 2009 to 2017.

At DHB level, the trends for other DHB maternity activity mirror the trends identified with labour and birth activities undertaken by DHBs. There is significant variance between DHBs depending on size and geographical location. The majority of other DHB


maternity activity is undertaken in the North Island. DHBs

in the Northern region account for over 42% of national

other DHB maternity activity. The seven large DHBs

undertake over 68% of national other DHB maternity

activity.

Other DHB maternity activity undertaken nationally has

fluctuated between 14,800 and 18,000 events per

100,000 fertile female population from 2009 to 2017 –

resulting in an overall decrease.

Other DHB maternity activity has also been increasing

over the same period for Asians; in terms of actual

events; events as a proportion of all other DHB maternity

activity undertaken by DHBs; and events per 100,000

fertile female population. Conversely, all other ethnic

groups have been experiencing decreases in terms of

actual events; events as a proportion of all other DHB

maternity activity undertaken by DHBs; and events per

100,000 fertile female population. As with labour and

birth activity, the seven large DHBs are most impacted by

these trends.

DHB Birth Activity by Type Nationally, has been an overall decrease in births within

DHB settings from 2009 to 2017. However, there has

been a notable increase in caesarean sections

undertaken within DHB settings - both in the number of

events and as a proportion of all births.

From 2009 to 2017, there was a very significant increase

in caesarean sections and vaginal births for Asians - both

in terms of events and as a proportion of all births within

DHB settings. The number of Asians that birthed via

caesarean section increased by 105% (1,835); and the

number of vaginal births for Asians increased by 46%

(1,989) over that period.

From 2009 to 2017, there was also a 14% increase in

Māori and Pacific People birthing via caesarean section.

Vaginal births decreased for women classified as Māori,

Pacific People and ‘Other’ over the same period.

DHB Maternity Events to Midwifery FTE Ratios HWIP FTE data from 31 December 2010 to 2017, has

been used to calculate DHB maternity related events to

DHB midwifery FTE ratios.

Nationally, the ratio of labour and birth events per FTE of

DHB midwives has remained in the 50s. The ratio for

other DHB maternity events has fluctuated between 173

and 200 per FTE of DHB midwives.

At DHB level, there were extreme variances in the ratio

of maternity related events per FTE midwife as at 31

December 2017.

Health Workforce New Zealand’s Forecasting

Model Health Workforce New Zealand (HWNZ) has developed a

midwifery workforce supply and demand forecasting

model which considers the entire New Zealand

midwifery workforce, i.e. all midwives registered with

the New Zealand Midwifery Council.

The methodology used involves tracking individual

midwives’ annual practising certificate (APC) data for the

last 6 to 10 years to gather age or age-group specific exit

rates, full time equivalent (FTE) per headcount (HC)

ratios, and entry and re-entry distributions. The

forecasting model uses this data to calculate the likely

age distribution of the midwifery workforce in New

Zealand over the next 10 years, and then projects the

potential supply of midwives over that period.

In terms of demand, the model uses current age group,

ethnicity, DHB specific fertility rates, historic trends, and

the probability of having complex birthing events; to

forecast age group, ethnicity and DHB adjusted birthing

events for mothers for the next 10 years. It is intended

that the demand side of the model then be compared

with the supply side of the model.

HWNZ has updated the model in 2018 - to include more

information and features, aimed at enhancing the

model’s usefulness for future planning of the midwifery

workforce.


Midwifery in New Zealand

Midwives provide care and support to women, their partners and family/whānau during pregnancy, labour

and birth, and for six weeks following the birth. They also provide wellness and parenting information and

education for mothers and their families.

In New Zealand, midwives are health practitioners who practise under the Health Practitioners Competence

Assurance Act 2003, and are required to be registered with the Midwifery Council. Registered midwives are

legally required to hold a practising certificate issued by the Midwifery Council before they can practise.

Midwives may work as a self-employed caseload midwife (Lead Maternity Carer, LMC) or as an employed

core or caseload midwife. They can also work in other areas such as education, policy or advisory work. LMCs

are contracted through the Ministry of Health to provide complete maternity services to pregnant women.

Many midwives employed by DHBs work both part-time in the DHB setting and also as community based

LMC midwives.

Midwifery Scope of Practice The Midwifery Council specifies the Midwifery Scope of Practice, which is the legal definition of midwifery in

New Zealand, as follows:

A midwife works in partnership with women on her own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period up to six weeks, to facilitate births and to provide care for the new-born. A midwife understands, promotes and facilitates the physiological processes of pregnancy and childbirth, identifies complications that may arise in mother and baby, accesses appropriate medical assistance and implements emergency measures as necessary. When women require referral, a midwife provides midwifery care in collaboration with other health professionals. A midwife has an important role in health and wellness promotion and education for the woman, her family and the community. Midwifery practice involves informing and preparing the woman and her family for pregnancy, birth, breastfeeding and parenthood and includes certain aspects of women’s health, family planning and infant well-being. A midwife may practise in any setting, including the home, the community, hospitals or in any other maternity service. In all settings a midwife remains responsible and accountable for the care she provides.

Registration in New Zealand Midwives must be registered with and hold a practising certificate issued by the Midwifery Council. The

Midwifery Scope of Practice provides the broad boundaries of midwifery practice, and the Competencies for

Entry to the Register provide details of the skills, knowledge and attitudes expected of a midwife to work

within the Midwifery Scope of Practice.


The Midwifery Council assesses all applicants for registration to ensure that they satisfy the following

requirements: fitness for registration; qualifications; and competence to practise within the Midwifery Scope

of Practice.

The Council does not accept applications from internationally qualified new graduate midwives (except those

registering under the Trans-Tasman Mutual Recognition Act 1997), or from midwives whose skills are not

current. All applicants must show at least two years midwifery practice experience in the five years preceding

the application.

There is no connection between registration for midwives and registration for nurses or any other health

profession in New Zealand.

1. Registration Requirements for New Zealand midwifery graduates a) Completion of an approved Bachelor degree in Midwifery (minimum of 4800 hours four year degree

provided over three extended academic years) provided by an accredited educational provider in New Zealand; and

b) Demonstration of the Competencies for Entry to the Register of Midwives; and

c) Fitness for Registration - Applicants must be of good character and must not have any mental or physical condition that adversely affects their ability to practise as a midwife. Applicants must be able to communicate effectively and in written and spoken English; and

d) A pass in the National Midwifery Examination set by the Midwifery Council.

2. Registration Requirements for Registered midwives applying from all other countries a) Registration Outside of New Zealand - The Midwifery Council of New Zealand will only consider

applications from internationally qualified midwives who are or were registered with a registration authority that performs a similar function to the Council and in the same country in which they completed their midwifery education; and

b) Qualifications and Competence - Applicants’ Midwifery qualification, post registration midwifery practice (must be a minimum of two years post registration midwifery practice across the scope, within the immediate 5 years preceding application), post registration midwifery education, midwifery competence portfolio, and self-assessment against the New Zealand Competencies for Entry to the Register, when considered as a whole, must be deemed by the Council to be equivalent in content and competencies to the most recent New Zealand requirements for registration.

c) Fitness for Registration - Applicants must be of good character and must not have any mental or physical condition that adversely affects their ability to practise as a midwife. Applicants must be able to communicate effectively and in written and spoken English; and

a) Additionally, the Midwifery Council may require an applicant to:

1. Attain a pass in an Examination set by the Midwifery Council; and/or

2. Attain a pass in a clinical assessment specified by the Midwifery Council.

Annual Practising Certificates

Registered midwives are legally required to hold a practising certificate issued by the Midwifery Council

before they can practise. The Health Practitioners Competence Assurance Act requires the Midwifery Council

to satisfy itself that midwives are competent and fit to practise before issuing a practising certificate.

Practising certificates expire on 31 March each year.

Information sourced from The Midwifery Council of New Zealand and The New Zealand College of Midwives


Overview of the 20 DHBs’ Maternity Services

The Ministry of Health is responsible for setting the standards for maternity services in New Zealand. It has

in place specifications for the District Health Boards about the range of services and facilities each must

provide. Through the section 88 Maternity Services Notice, it also sets out the requirements for all LMCs.

DHB funded maternity services include primary, secondary and tertiary maternity care for pregnant women

and their babies until six weeks after the birth. These services support continuity of care and are delivered in

community, outpatient and inpatient settings at a range of facilities.

Maternity Facility Type

Midwifery Staffing

Description

Tertiary DHB employed

midwives

Tertiary maternity facilities are designed for women with complex maternity needs which require specialist multidisciplinary care. Well women may use these facilities in the absence of other maternity facilities in their area.

Secondary DHB employed

midwives

Secondary maternity facilities are designed for women and babies who experience complications and may require care from an obstetrician, anaesthetist, paediatrician as well as a midwife. Well women may use these facilities in the absence of other maternity facilities in their area.

Primary DHB employed midwives and LMC midwives

Primary maternity facilities are designed for well women who have no complications during pregnancy.

By DHB Tertiary Facilities Secondary Facilities Primary Facilities Tertiary care referrals

Auckland National Women's Hospital

Birthcare Auckland

Bay of Plenty

Tauranga Hospital Whakatane Hospital

Bethlehem Birthing Centre Murupara Community Health Centre and Birthing Centre Opotiki Community Health Centre

Waikato DHB

Canterbury Christchurch Women’s Hospital

Ashburton Hospital Chatham Islands Health Centre Darfield Hospital Kaikoura Hospital Lincoln Maternity Hospital Rangiora Hospital St George’s Hospital Waikari Hospital

Canterbury DHB

Capital & Coast Wellington Hospital Kenepuru Maternity Unit Paraparaumu Maternity Unit

Counties Manukau

Middlemore Hospital

Botany Downs Primary Birthing Unit Papakura Primary Birthing Unit Pukekohe Primary Birthing Unit

Hawke's Bay

Hawke’s Bay Hospital

Wairoa Hospital and Health Centre Capital & Coast DHB

Hutt Valley

Hutt Valley DHB Te Awakairangi Birthing Centre at

Melling Capital & Coast DHB


By DHB Tertiary Facilities Secondary Facilities Primary Facilities Tertiary care referrals

Lakes

Rotorua Hospital Taupo Maternity Unit Waikato DHB

MidCentral

Palmerston North Hospital

Dannevirke Rural Community Hospital Horowhenua Health Centre Barnados Te Papaioea Birthing Centre

Capital & Coast DHB

Nelson Marlborough

Nelson Hospital Wairau Hospital

Golden Bay Community Hospital Motueka Maternity Unit

Capital & Coast DHB

Northland

Whangarei Hospital Bay of Islands Hospital

Kaitaia Hospital Auckland DHB

South Canterbury

Timaru Hospital Canterbury

DHB

Southern Queen Mary Hospital

Southland Hospital Charlotte Jean Maternity Hospital Clutha Health First Hospital Gore Hospital Lakes District Hospital Lumsden Maternity Centre Oamaru Hospital Maternity Centre Winton Maternity & Health Centre

Tairawhiti

Gisborne Hospital Te Puia Springs Waikato DHB

Taranaki

Taranaki Base Hospital

Hawera Hospital Waikato DHB

Waikato Waikato Hospital Birth Care Huntly Pohlen Maternity River Ridge East Birth Centre Taumarunui Hospital Te Kuiti Hospital Thames Hospital Tokoroa Hospital Waihi Hospital Maternity Annexe Waterford Birth Centre

Wairarapa

Wairarapa Hospital Capital &

Coast DHB

Waitemata

North Shore Hospital Waitakere Hospital

Helensville Birthing Centre Warkworth Birthing Centre Wellsford Birthing Unit

Auckland DHB

West Coast

Greymouth Base Hospital

Kawatiri Birthing Unit Canterbury DHB

Whanganui

Whanganui Hospital Otaihape Health Centre

Waimarino Health Capital & Coast DHB

Information sourced from the Ministry of Health (https://www.health.govt.nz/your-health/pregnancy-and-

kids/services-and-support-during-pregnancy/where-give-birth/find-maternity-facilities-your-area)

https://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/where-give-birth/find-maternity-facilities-your-area

https://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/where-give-birth/find-maternity-facilities-your-area


HWIP Information on

the DHB Employed

Midwifery Workforce


a) Overview of the DHB Midwifery Workforce as at 31 December 2017

The DHB workforce information included is sourced from the Health Workforce Information Programme

(HWIP) and is for all staff employed in the occupation group 'Midwifery', and only includes staff employed as

fully qualified midwives. The information is for all permanent and fixed term employees and excludes those

on long term leave, parental leave, leave without pay and those with zero contracted hours. Where a

reporting date is used, the numbers are those who were employed on that end of quarter date, except for

turnover statistics which rely on counting those who terminated employment during the quarter.

Supplementary information relating to the HWIP data is included at Appendix A. It should be noted that the

DHB midwifery workforce is relatively small, so slight changes can result in significant variation in trends.

1. The 20 DHBs’ Overall Midwifery Workforce Metrics

Table 1 - The 20 DHBs’ Overall Midwifery Workforce Metrics as at 31 December 2017

2. Midwifery Workforce Metrics by DHB Size

Table 2 - Midwifery Workforce Metrics by DHB Size as at 31 December 2017

Table 3 - Change in Midwifery Workforce Metrics from 31 December 2016 by DHB Size

DHB Size Headcount FTE

FTE per

100,000 Fertile

Female

Population (15

to 49 years)

Mean FTE

Mean Hours

Contracted

per week per

head

Mean Hours

Paid per

week per

head

Mean

Length of

Service

Annual

Turnover Mean Age

% over 55

Years% Asian % Maori % Pacific % Other

Large 875 609.8 82.4 0.70 27.9 28.1 7.7 15.5% 46.7 29.1% 5.0% 6.3% 1.0% 87.7%

Medium 312 212.0 140.2 0.68 27.2 29.8 8.4 11.5% 49.0 35.8% 2.0% 8.5% 0.0% 89.5%

Small 164 121.3 123.7 0.74 29.6 31.6 7.5 10.0% 49.8 35.4% 0.7% 9.5% 0.0% 89.9%

Snapshot of the Midwifery Workforce by DHB Size as at 31 December 2017

DHB Size Headcount Contracted

FTE

FTE per

100,000 Fertile

Female

Population

(15 to 49

Mean FTE

Mean Hours

Contracted

per week per

head

Mean Hours

Paid per

week per

head

Mean

Length of

Service

Annual

Turnover Mean Age

% over 55


Large -0.7% 1.0% -0.9% 1.7% 2.0% 27.2% -3.3% -5.6% -0.4% 4.7% 11.3% 26.8% 12.1% -2.2%

Medium -4.3% -2.9% -3.6% 1.4% 1.7% 8.4% -6.5% 17.1% 0.3% 0.6% 25.3% 8.8% 0.0% -1.2%

Small 5.8% 6.6% 6.6% 0.7% 1.0% 3.2% -3.1% 15.4% 1.1% 5.4% -4.7% -11.1% 0.0% 1.4%

Midwifery Workforce - % Change from 31 December 2016 by DHB Size


3. Midwifery Workforce Metrics by DHB

Table 4 - Midwifery Workforce Metrics by DHB as at 31 December 2017

DHB HeadcountContracted

FTE

FTE per

100,000

Fertile

Female

Population (15 to 49 years)

Mean FTE

Mean Hours

Contracted

per week per

head

Mean Hours

Paid per

week per

head

Mean

Length of

Service

Annual

Voluntary

Turnover

Mean Age % over 55


Auckland 155 116.2 76.5 0.75 30.0 30.2 8.3 26.1% 48.2 32.3% 10.7% 4.0% 0.0% 85.3%

Bay of Plenty 54 39.0 80.4 0.72 28.9 32.9 9.0 6.1% 50.2 42.6% 3.8% 11.3% 0.0% 84.9%

Canterbury 129 83.3 65.6 0.65 25.8 22.8 9.2 8.0% 49.2 31.8% 1.7% 3.4% 0.0% 95.0%

Capital & Coast 112 78.2 94.6 0.70 27.9 23.9 6.7 12.9% 48.9 33.0% 1.9% 5.8% 3.9% 88.3%

Counties Manukau 157 115.0 82.2 0.73 29.3 35.3 6.6 12.5% 42.8 23.7% 7.7% 9.6% 1.9% 80.8%

Hawke's Bay 62 39.0 116.0 0.63 25.2 23.6 8.8 1.6% 47.3 27.4% 3.3% 8.3% 0.0% 88.3%

Hutt Valley 44 31.7 92.1 0.72 28.8 31.8 7.3 14.0% 49.4 34.1% 5.0% 2.5% 0.0% 92.5%

Lakes 41 30.5 127.9 0.74 29.8 31.9 6.2 3.0% 48.4 22.0% 0.0% 12.2% 0.0% 87.8%

MidCentral 64 42.7 107.5 0.67 26.7 31.2 8.4 10.3% 48.2 37.5% 0.0% 9.7% 0.0% 90.3%

Nelson Marlborough 41 27.3 94.8 0.67 26.7 30.3 7.8 13.2% 49.0 34.1% 0.0% 2.9% 0.0% 97.1%

Northland 47 32.2 94.3 0.69 27.4 30.4 8.3 25.1% 50.6 40.0% 0.0% 13.3% 0.0% 86.7%

South Canterbury 17 13.8 120.6 0.81 32.4 33.4 7.5 11.3% 51.2 47.1% 6.7% 0.0% 0.0% 93.3%

Southern 70 49.0 65.0 0.70 28.0 31.7 10.6 6.0% 47.5 30.0% 0.0% 4.7% 0.0% 95.3%

Tairawhiti 22 16.3 156.0 0.74 29.6 34.2 5.7 5.6% 45.6 22.7% 0.0% 20.0% 0.0% 80.0%

Taranaki 30 22.1 88.8 0.74 29.5 33.0 8.6 15.9% 49.0 43.3% 0.0% 16.7% 0.0% 83.3%

Waikato 93 62.7 66.7 0.67 27.0 25.4 6.7 14.5% 44.3 22.6% 4.3% 12.0% 1.1% 82.6%

Wairarapa 19 12.6 146.1 0.66 26.5 25.0 6.1 40.7% 53.0 42.1% 0.0% 0.0% 0.0% 100.0%

Waitemata 159 105.5 69.4 0.66 26.5 26.4 6.9 21.4% 46.8 29.6% 3.9% 5.2% 0.0% 90.8%

West Coast 14 9.4 148.4 0.67 26.9 31.8 9.6 0.0% 52.4 35.7% 0.0% 0.0% 0.0% 100.0%

Whanganui 21 16.7 132.5 0.80 31.8 30.5 10.6 0.0% 52.6 47.6% 0.0% 0.0% 0.0% 100.0%

Overall 1351 943.2 82.7 0.70 27.9 29.0 7.82 13.9% 47.6 31.4% 3.8% 7.2% 0.6% 88.4%

Snapshot of the Midwifery Workforce as at 31 December 2017 by DHB


4. Change in Midwifery Workforce Metrics compared to 2016 by DHB

Table 5 - Change in Midwifery Workforce Metrics compared to 2016 by DHB

DHB HeadcountContracted

FTE

FTE per 100,000

Fertile Female

Population

(15 to 49 years)

Mean FTE

Mean Hours

Contracted

per week per

head

Mean Hours

Paid per

week per

head

Mean

Length of

Service

Annual

Voluntary

Turnover

Mean Age % over 55


Auckland -3.7% -1.4% -4.5% 2.4% 2.7% 117.8% 4.6% 38.6% 2.4% 9.8% 0.3% 88.0% -100.0% -1.4%

Bay of Plenty 1.9% 2.9% 1.4% 1.0% 1.3% 14.4% -5.0% -38.2% -1.5% -1.9% 88.7% -19.1% 0.0% 1.1%

Canterbury -1.5% -3.6% -5.0% -2.1% -1.8% -1.4% -12.9% -8.9% 0.2% 12.5% 100.0% 33.3% 0.0% -1.7%

Capital & Coast -10.4% 4.3% 3.4% 16.4% 16.7% 17.0% -2.7% -52.9% -1.9% -4.0% 121.4% -5.1% 10.7% -1.3%

Counties Manukau 1.9% 0.4% -1.5% -1.5% -1.2% 25.8% -4.1% -39.9% -3.1% -1.9% -1.9% 83.9% 194.2% -6.4%

Hawke's Bay -4.6% -3.9% -4.0% 0.8% 1.1% -4.4% 0.3% -83.8% -0.2% 4.8% 5.0% 162.5% 0.0% -5.7%

Hutt Valley 12.8% 13.6% 13.3% 0.7% 1.0% 6.2% -16.0% -9.4% 1.7% -0.3% -10.0% -10.0% 0.0% 0.9%

Lakes 24.2% 24.0% 23.2% -0.2% 0.1% -3.1% -20.6% -17.3% 0.0% -19.5% 0.0% 0.6% 0.0% -0.1%

MidCentral -7.2% -4.1% -4.5% 3.3% 3.6% 20.9% -6.3% 100.0% -1.0% -4.2% 0.0% 62.1% 0.0% -3.9%

Nelson Marlborough -2.4% -10.2% -9.9% -8.0% -7.7% 0.2% -6.7% 163.2% 3.7% 2.4% 0.0% 8.6% 0.0% -0.2%

Northland -19.0% -12.9% -13.6% 7.5% 7.8% 8.9% -8.4% 86.0% 1.2% 6.7% 0.0% -20.0% 0.0% 4.0%

South Canterbury 0.0% -3.5% -2.7% -3.5% -3.2% -5.4% -4.3% -62.8% 1.8% 0.0% 6.7% 0.0% 0.0% -0.4%

Southern 2.9% 2.3% 1.6% -0.6% -0.4% 0.2% 7.6% -46.5% -0.1% -7.3% -100.0% -26.2% 0.0% 3.5%

Tairawhiti 4.8% 5.2% 4.8% 0.4% 0.7% 11.9% 2.6% 0.0% 0.4% 59.1% 0.0% -5.0% 0.0% 1.3%

Taranaki -9.1% -7.5% -7.7% 1.7% 2.0% 4.6% 21.4% 17.1% 3.8% 30.0% 0.0% -21.4% 0.0% 5.8%

Waikato 13.4% 16.9% 15.1% 3.1% 3.4% 28.7% -0.8% -11.1% -0.1% 8.9% -32.2% -22.3% 0.0% 5.6%

Wairarapa 18.8% 37.0% 36.7% 15.3% 15.6% 0.0% -32.9% 0.0% -4.7% -25.1% 0.0% 0.0% 0.0% 0.0%

Waitemata -0.6% -2.6% -4.7% -2.0% -1.7% 17.8% -7.6% 139.1% 0.6% 15.4% 200.0% 100.0% -100.0% -4.8%

West Coast 7.7% 9.3% 11.7% 1.5% 1.8% 44.5% 3.6% -100.0% 0.6% -7.1% 0.0% 0.0% 0.0% 0.0%

Whanganui -4.5% -6.2% -6.0% -1.7% -1.4% -2.1% 16.7% -100.0% 4.1% 49.7% 0.0% 0.0% 0.0% 0.0%

% Change from 31 December 2016 - Midwifery Workforce by DHB


b) Workforce Size

There has been a notable decrease in the overall size of the 20 DHBs’ midwifery workforce since 2010. The

20 DHBs reported an overall headcount of 1,351 and 943.2 FTE midwives as at 31 December 2017. Time

series analysis indicates an overall decrease of 4.3% in headcount and 2.6% in FTE since December 2010.

Over that period, the overall changes varied at DHB level and resulted in:

Headcount: 8 DHBs reducing their headcount, 10 DHBs increasing their headcount, and no change in headcount for 2 DHBs; and

FTE changes: 9 DHBs reducing their FTE and 11 DHBs increasing their FTE.

1. Headcount Headcount is an indicator of the size of the core workforce. It is the number of people employed at a point

in time, regardless of hours worked and other working arrangements or leave.

Figure 1 - DHB Midwifery Headcount from 31 December 2010 to 31 December 2017

Figure 2 - Change in the Midwifery Headcount by DHB - 31 December 2010 vs 31 December 2017

2. Contracted Full-time Equivalent (FTE) The combined FTE of DHB midwives increased by 1.6% from 2010 to 2011 and remained relative stable until

2014. Since 2014 there has been a significant decrease in overall FTE.


Contracted FTE is the number of active full-time equivalent employees (based on hours contracted for all full-

time and part-time employees) at a point in time. It is an indicator of staffing levels and the size of the core

workforce in terms of full-time equivalent employees, regardless of hours worked and other working

arrangements.

Figure 3 - DHB Midwifery Contracted FTE from 31 December 2010 to 31 December 2017

Figure 4 - Change in the Midwifery Contracted FTE by DHB - 31 December 2010 vs 31 December 2017

*** It should be noted that some DHBs also employ Registered Nurses in their maternity service areas. The

headcount and Contracted FTE information for those employees is not included in the HWIP data

reported in this report.


c) Workforce Density - FTE to Population Ratios

FTE to population ratios examine workforce density compared to population, e.g. per 100,000 population.

FTE numbers are based on contracted FTE figures. While FTE to population ratios can be useful in examining

workforce density trends nationally and between DHBs, they should be used cautiously and considered

within the wider health services context. These ratios are limited in that they do not take into account any

other variables, aside from population size. They do not consider factors such as population structure, service

demand, models of care, patterns of service and provider utilisation, epidemiology, health policies and socio-

demographic characteristics.

For the purposes of this report, DHB employed midwifery FTE numbers are compared to the fertile female

population (15 to 49 years) of New Zealand and individual DHB regions.

1. Overall DHB Midwifery FTE per 100,000 Fertile Female Population (15 to 49

years) of New Zealand Comparison of the overall DHB midwifery FTE to the fertile female population (15 to 49 years) of New Zealand

indicates that there has been a significant reduction in national level workforce density since December 2013.

The fertile female population has been experiencing a cumulative increase since December 2013. Conversely,

this trend is not reflected in the overall DHB midwifery FTE; which has experienced a cumulative decrease

over the same period.

From December 2010 to December 2013 there were slight increases in the DHB midwifery FTE per 100,000

fertile population in New Zealand. However, since 2013 the DHB midwifery workforce density has been

progressively decreasing. The December 2017 national density figure of 82.7 FTE DHB midwives per 100,000

fertile population is 11% lower than the 93.0 FTE figure in December 2013.

Figure 5 - Cumulative increase in DHB Midwifery FTE & the New Zealand Fertile Population (15 to 49 years) from 31 December 2010 to 31 December 2017


Figure 6 - DHB Midwifery FTE per 100,000 Fertile Population (15 to 49 years) of New Zealand from 31 December 2010 to 31 December 2017

2. Individual DHB Midwifery FTE per 100,000 Local Fertile Female Population (15

to 49 years) There is considerable variation between DHBs in terms of workforce density. Small to medium DHBs with

regional / rural populations appear to have higher midwifery FTE per 100,000 local fertile female population

compared to larger DHBs with more densely populated urban centres.

Figure 7 - Midwifery FTE per 100,000 Fertile Population (15 to 49 years) by DHB as at 31 December 2017

*** It should be noted that some DHBs also employ Registered Nurses in their maternity service areas. The

headcount and Contracted FTE information for those employees is not included in the HWIP data

reported in this report.


d) Workforce Distribution

Workforce distribution is the breakdown of headcount and contracted FTE by geographic location, and is also

presented as the percentage of total by location. It is useful for understanding a widespread workforce and

contextualising trends for different locations, regions or DHB sizes.

A high level comparison of the proportional distribution of midwives employed by individual DHBs, in terms

of headcount and Contracted FTE, indicates a rough correlation in geographical distribution patterns with

minor variances of <1%.

While all 20 DHBs employ midwives, there is considerable variance between DHBs in terms of individual

workforce sizes. In December 2017, the majority of DHB employed midwives worked for large DHBs (64.8%);

with medium and small DHBs employing the remaining 23.1% and 12.1% respectively.

Most DHB employed midwives are based in the North Island, i.e. 1,080 (79.9%) as at 31 December 2017. The

Northern Region DHBs employ 38.3% of all DHB midwives; followed by the Central Region (23.8%), the

Southern Region (20.1%) and the Midland Region (17.8%).

Figure 8 - Distribution of Midwifery Headcount & Contracted FTE by DHB as at 31 December 2017


Figure 9 - Distribution of Midwives by Region as at 31 December 2017

Figure 10 - Distribution of Midwives by DHB Size as at 31 December 2017

Figure 11 - Distribution of % Headcount & % Contracted FTE for Midwifery by DHB as at 31 December 2017

Table 6 - Distribution of the Midwifery Workforce by DHB as at 31 December 2017

DHB Headcount % of Total Headcount Contracted FTE% of Overall Contracted

FTE

Auckland 155 11.5% 116.2 12.3%

Bay of Plenty 54 4.0% 39.0 4.1%

Canterbury 129 9.5% 83.3 8.8%

Capital & Coast 112 8.3% 78.2 8.3%

Counties Manukau 157 11.6% 115.0 12.2%

Hawke's Bay 62 4.6% 39.0 4.1%

Hutt Valley 44 3.3% 31.7 3.4%

Lakes 41 3.0% 30.5 3.2%

MidCentral 64 4.7% 42.7 4.5%

Nelson Marlborough 41 3.0% 27.3 2.9%

Northland 47 3.5% 32.2 3.4%

South Canterbury 17 1.3% 13.8 1.5%

Southern 70 5.2% 49.0 5.2%

Tairawhiti 22 1.6% 16.3 1.7%

Taranaki 30 2.2% 22.1 2.3%

Waikato 93 6.9% 62.7 6.6%

Wairarapa 19 1.4% 12.6 1.3%

Waitemata 159 11.8% 105.5 11.2%

West Coast 14 1.0% 9.4 1.0%

Whanganui 21 1.6% 16.7 1.8%

Total 1351 100% 943.2 100%

Distribution of the Midwifery Workforce as at 31 December 2017 by DHB


e) Workforce Contracted Availability & Utilisation

The contracted availability and utilisation of workforce resources can be measured in a number of different

ways, including:

Counting potential staff resources using available headcount and contracted FTE;

Using Mean FTE as an indicator of the overall part time status of a workforce;

Examining mean hours contracted per head per week as an indicator of workforce contracted

availability, as this represents the mean staff resource that was potentially available for productive

work;

Examining mean hours paid per head per week as an indicator of workforce utilisation, as this

represents the mean staff resource that was actually used for productive work; and

Comparing mean hours contracted to mean hours paid per head per week, as an indicator of

workforce contracted availability vs actual utilisation.

The availability of the DHB midwifery workforce is largely part-time, which is reflective of midwives being

able to work as Caseload / Core Midwives within the DHB setting while also practising as self-employed Lead

Maternity Carers (LMCs) within the community.

1. Counting Staff Resources - Headcount vs Contracted FTE by DHB All DHBs have a notably higher headcount compared to contracted FTE figure. The gap between headcount

and contracted FTE varies between DHBs - depending on the size of the DHB. The larger urban DHBs appear

to have larger differences than the smaller more rural DHBs.

Figure 12 - Midwifery Headcount vs Contracted FTE by DHB as at 31 December 2017

2. Employment Status (Mean FTE) Mean FTE is calculated by dividing the total contracted FTE by the actual number of employees who make up

that figure - i.e. headcount. This is only an average, so it does not model the ratio of fulltime to part time

employees. Neither does it indicate ‘how’ part time employees are.


In December 2017, the DHB midwifery workforce had an overall Mean FTE of 0.70. The Mean FTE has not

exceeded 0.70 since December 2010. The Mean FTE of individual DHBs varies significantly with Hawke’s Bay

DHB having the lowest Mean FTE of 0.63 and South Canterbury having the highest at 0.81 in December 2017.

Nine DHBs (45%) had a Mean FTE lower than the national average of 0.70.

Figure 13 - DHB Midwifery Mean FTE from 31 December 2010 to 31 December 2017

Figure 14 - Midwifery Mean FTE by DHB as at 31 December 2017

3. Mean Hours Contracted Nationally, mean hours contracted per head per week for the DHB midwifery workforce was 27.9 and has

remained at this level since December 2014. Analysis of individual DHB figures as at 31 December 2017,

indicates significant disparity between DHBs in terms of the mean staff resources that were contracted to be

available for productive work. Nine DHBs had mean hours contracted per head per week figures which were

lower than the national figure. Hawke’s Bay with 25.2 had the lowest mean hours contracted per head per

week and South Canterbury had the highest at 32.4 hours.

Figure 15 - DHB Midwifery Mean Hours Contracted per head per week from 31 December 2014 to 31 December 2017


Figure 16 - Midwifery Mean Hours Contracted per head per week by DHB as at 31 December 2017

4. Mean Hours Paid The national mean hours paid per head per week for the DHB midwifery workforce as at 31 December 2017

was 28.9. The national mean hours paid per head per week has fluctuated but remains at a similar level to

the December 2014 figure.

Analysis of mean hours paid per head per week by DHB as at 31 December 2017, indicates that workforce

utilisation also varied between DHBs. Only six DHBs had a mean hours paid per head per week figure that

was lower than the national figure. Canterbury with 22.8 had the lowest mean hours paid per head per week,

while Counties Manukau had the highest at 35.3.

Figure 17 - DHB Midwifery Mean Hours Paid per head per week from 31 December 2014 to 31 December 2017

Figure 18 – Midwifery Mean Hours Paid per head per week by DHB as at 31 December 2017


5. Comparing Mean Hours Contracted to Mean Hours Paid Figures for mean hours contracted were compared to mean hours paid per head per week by DHB as at 31

December 2017, as an indicator of workforce contracted availability vs actual utilisation. Again, there is

notable variance between DHBs. The majority of DHBs (60%) have reported a mean hours paid per head per

week figure that is at least one hour more than their mean hours contracted per head per week figure in

December 2017.

Figure 19 - Midwifery Mean Hours Contracted vs Mean Hours Paid per head per week by DHB as at 31 December 2017

Figure 20 - Difference between Mean Hours Paid and Mean Hours Contracted per head per week for Midwifery by DHB as at 31 December 2017


f) Workforce Vacancies

75% (15) of the 20 DHBs reported carrying midwifery vacancies as at 31 December 2017. This equated to a

national Vacancy FTE of 102.6 and vacancy rate of 9.8% as at 31 December 2017 for the DHB midwifery

workforce, based on the reported contracted FTE of 943.2 at the time.

Analysis of vacancy information reported by the 20 DHBs, indicates that:

The national DHB midwifery Vacancy FTE reported has fluctuated since late 2016, with vacancy rates of around 9% for most of 2017.

Auckland and Counties Manukau DHBs had the highest Vacancy FTE and vacancy rates on 31 December 2017. Both DHBs reported significantly higher individual Vacancy FTE and vacancy rates compared to other DHBs. Their combined Vacancy FTE of 58.9 represents 57.4% of the national Vacancy FTE.

The majority (68%) of midwifery vacancies reported are in the Northern Region; while the Central Region reported the lowest midwifery Vacancy FTE at 3.6% of the national figure.

Large DHBs have a combined Vacancy FTE of 89.8, which is 87.5% of the total Vacancy FTE reported. Vacancy FTE reported by medium and small DHBs represents 4.2% and 8.3% respectively of the national total.

1. Overall Vacancy FTE and Vacancy Rates Reported by the 20 DHBs Figure 21 - DHB Midwifery Vacancy FTE & Vacancy Rates from 30 September 2016 to 31 December 2017

2. A Snapshot of DHB Midwifery Vacancy FTE as at 31 December 2017 Figure 22 - DHB Midwifery Vacancy FTE & Vacancy Rate by Region as at 31 December 2017


Figure 23 - Midwifery Vacancy FTE & Vacancy Rates by DHB as at 31 December 2017

Figure 24 - Midwifery Vacancy FTE & Vacancy Rate by DHB Size as at 31 December 2017

Caveats:

The vacancy information included, is based on DHBs reporting the Full Time Equivalent (FTE) values of contracted FTE and vacancies unfilled, on the last day of a reporting quarter for the period 30 September 2016 to 31 December 2017.

The information is for all permanent and fixed term employees and excludes casuals, locums and any employees on long term leave, including parental leave.


g) Workforce Wellness & Mobility Indicators

1. Sick Leave Sick leave usage is a useful indicator of workforce morale and wellness. Both high and low levels of sick leave

can be of concern. Significantly low levels of sick leave could indicate presenteeism, i.e. employees turning

up to work despite poor health.

The 20 DHBs’ health workforce sick leave usage is calculated and reported using average annualised sick

leave hours per full-time equivalent employee (FTE).

It should be noted that average annualised sick leave hours per FTE is a broad indicator, which provides basic

high level information that can help to identify particular problem areas in terms of workforce group, service

or function. However, it does not signal situations that may consist of a small number of people absent for

long periods or a large number absent for short periods. Therefore, there could be situations where sick leave

usage may appear to be relatively stable over time even though the number of staff absent may be increasing

and the duration of absence falling and vice versa.

Annualised sick leave patterns for DHB midwives indicates:

In December 2017, DHB midwives took 81.3 hours of sick leave on average per FTE for the year. This was the second highest figure for all DHB workforces.

Average annualised sick leave patterns indicate significant year on year increases in the overall average sick leave hours taken per FTE by DHB midwives since December 2014.

When viewed individually, there is considerable variance between DHBs in terms of sick leave patterns. The majority of DHBs have mirrored the national trend of high and increasing average sick leave hours taken per FTE per annum for midwives.

The average annualised sick leave hours per FTE taken by midwives varies significantly between age groups. Midwives over 60 years have the highest average sick leave hours taken per FTE per annum.

Figure 25 - DHB Midwifery Annualised Mean Sick Leave Hours per FTE from 31 December 2014 to 31 December 2017


Figure 26 - Midwifery Annualised Mean Sick Leave Hours per FTE by DHB from 31 December 2014 to 31 December 2017

Figure 27 - Midwifery Annualised Mean Sick Leave Hours per FTE by DHB as at 31 December 2017

Figure 28 - DHB Midwifery Annualised Mean Sick Leave Hours per FTE by Age as at 31 December 2017

2. Annual Leave Balance to Entitlement Ratios Annual leave balance to entitlement ratios is another useful indicator of workforce morale and wellness.

Similar to the measurement of sick leave usage, it should be noted that annual leave balance to entitlement

ratios are broad indicators, which provide basic high level information that can help to identify particular


problem areas in terms of workforce group, service or function. However, they do not highlight individual

situations that may skew the overall measure.

The average annual leave balance to entitlement ratio for the overall DHB midwifery workforce has reduced

slightly from 107% in December 2014 to 103% in December 2017.

In December 2017, there was considerable variance across the 20 DHBs in terms of individual midwifery

workforce annual leave balance to entitlement ratios. Eight DHBs had midwifery workforces with annual

leave balances that exceed their annual leave entitlement. Bay of Plenty (158.5%) and Counties Manukau

(154.5%) DHBs had the highest average annual leave balance to entitlement ratios for midwives. Twelve DHBs

had midwifery workforces with average annual leave balance to entitlement ratios lower than 100%.

Figure 29 - DHB Midwifery Mean Annual Leave Balance to Entitlement Ratios from 31 December 2014 to 31 December 2017

The bars in Figure 26 represent the ratios of annual leave balance to annual leave entitlement for each DHB

as at 31 December 2017. A value of 100% means that on average the annual leave balance equals the annual

leave entitlement.

Figure 30 - Midwifery Mean Annual Leave Balance to Entitlement Ratios by DHB as at 31 December 2017

3. Annual Voluntary Turnover Annual voluntary turnover is a useful indicator of workforce wellness and mobility. It is calculated by dividing

the number of positions terminated over the period being measured, by the mean number of positions


employed at each of the reporting quarters over the reporting period. Excludes those staff with zero

contracted hours, those on fixed-term contracts, and those not classified as ‘voluntary resignations’.

The annual voluntary turnover rate for the overall DHB midwifery workforce has fluctuated since December

2010 - between 11.6% at its lowest in December 2014 and 14.8% at its highest in December 2012.

Annual voluntary turnover rates for individual DHB midwifery workforces, indicates a pattern of extremes

disparities. While two DHBs had a 0% annual voluntary turnover rate, four DHBs had rates that exceeded

20%. The majority of DHBs (40%) have annual voluntary turnover rates between 10 and 16%.

Figure 31 - DHB Midwifery Annual Voluntary Turnover Rate from 31 December 2010 to 31 December 2017

Figure 32 - Midwifery Annual Voluntary Turnover Rate by DHB as at 31 December 2017

4. Workforce Tenure Workforce tenure is measured using the mean length of service for the total number of ongoing employees

at the end of the period measured. It is a useful way of gauging workforce stability and mobility.

The mean length of service for the overall DHB midwifery workforce was 7.8 years as at 31 December 2017,

and has remained around the same level since December 2010.

In December 2017, all 20 individual DHB midwifery workforces had mean lengths of service that were more

than 5 years - with two DHBs exceeding 10 years. Ten DHBs had mean lengths of service that were lower

than the national average of 7.8 years.


Figure 33 - DHB Midwifery Mean Length of Service from 31 December 2010 to 31 December 2017

Figure 34 - Midwifery Mean Length of Service by DHB as at 31 December 2017


h) Workforce Profile

1. Gender Profile The DHB midwifery workforce is almost exclusively female.

Figure 35 - % Female within the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017

2. Age Profile The national average age of DHB midwives was significantly high at 47.6 years in December 2017, and has

been at the same level since December 2010.

Six DHBs have midwifery workforces with average ages below the national figure, while a further six DHBs

have midwifery workforces with average ages over 50 years. Counties Manukau DHB’s midwifery workforce

has the lowest average age at 42.8 years, and Wairarapa DHB’s midwifery workforce has the highest average

age at 53 years.

Comparison of the age distribution of the overall DHB midwifery workforce in December 2017 with December

2012; indicates that there has been a 26% increase in the 25 to 29 years age group and a 23% decrease in the

40 to 49 years age group. However, there has also been a 24% increase in the 60 to 64 year old age group.

Despite a slight decrease since 2012, more than 70% of the DHB midwifery workforce remains over 40 years

old.

Figure 36 - DHB Midwifery Mean Age from 31 December 2010 to 31 December 2017


Figure 37 - Midwifery Mean Age by DHB as at 31 December 2017

Figure 38 - Age Distribution of the DHB Midwifery Workforce as at 31 December 2017 vs 31 December 2012

Figure 39 - Age Distribution of the DHB Midwifery Workforce as at 31 December 2017 vs 31 December 2012

3. Approaching Retirement Age (Over 55 years) Monitoring the number of employees in the age range considered to be approaching retirement (over 55

years) as a percentage of overall headcount, is useful for assessing the potential risk posed by likely age

retirements and the associated loss of institutional knowledge, skills and experience.

The percentage of the overall DHB midwifery workforce over 55 years has been increasing since December

2011, and was significantly high at 31.4% in December 2017.


Examination of individual DHB midwifery workforces indicates significant differences in the percentage of

midwives over 55 years. Six DHBs have midwifery workforces comprising of 40% or more midwives who are

over 55 years. Seven DHBs have midwifery workforces with percentages over 55 years that are lower than

the national figure of 31.4%. Nearly half of Whanganui and South Canterbury DHBs’ midwifery workforces

comprise midwives over 55 years. At around the 22% mark Tairawhiti, Waikato and Lakes DHBs have the

lowest percentages of midwives over 55 years.

Figure 40 - % Over 55 Years within the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017

Figure 41 - % over 55 Years within the DHB Midwifery Workforce by DHB as at 31 December 2017

4. Workforce Diversity

There is severe under representation of Pacific People, Māori, and Asians within the DHB midwifery

workforce. Only 0.6% of DHB midwives were Pacific, 7.2% Māori and 3.8% Asian as at 31 December 2017.

The majority of DHB midwives (88.4%) are categorised as ‘Other Ethnicity’, which is a group amalgamation

of all ethnicities that do not fall into the groups Asian, Māori and Pacific Peoples.

4.1 Overall Ethnicity of DHB Employed Midwives Ethnic disproportionality and under representation of minority ethnic groups within the DHB midwifery

workforce have been long standing issues. These issues have worsened significantly for Pacific People

midwives over the long term. From December 2010 to December 2017, the headcount of Pacific People

midwives decreased by 53% to just 8 across the 20 DHBs; resulting in the proportion of Pacific People in the

DHB midwifery workforce reducing from 1.7% to 0.6%. The number of Asian midwives increased by 44% over


the same period to 49; however the proportion of Asians within the DHB midwifery workforce remains at

similar levels to December 2010 (< 4%). There has been a slight shift in Māori representation within the DHB

midwifery workforce; with headcount increasing by 70% to 92 and the proportion of Māori increasing to 7.2%

from 5.4% since December 2010. There is continued ethnic disportionality between the DHB midwifery

workforce and the fertile female (15 to 49 years) population of New Zealand.

Figure 42 - Ethnicity of the DHB Midwifery Workforce as at 31 December 2017

Figure 43 - Ethnicity of the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017

Figure 44 - Ethnic Proportionality of the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017


4.2 Ethnicity by DHB Analysis of individual DHB midwifery workforces as at 31 December 2017, revealed vast differences across

the 20 DHBs in terms of workforce ethnic composition. Four DHBs (South Canterbury, Wairarapa, West Coast

and Whanganui) did not employ any Māori midwives. Capital & Coast, Counties Manukau and Waikato DHBs

are the only DHBs that employed Pacific People midwives. Only 50% of DHBs employed Asian midwives.

Figure 45 - Ethnicity of the DHB Midwifery Workforce by DHB as at 31 December 2017

Table 7 - Ethnicity of the DHB Midwifery Workforce by DHB as at 31 December 2017

DHB Asian Māori Pacific Other % Asian % Māori % Pacific % Other

Auckland 16 6 128 11% 4% 85%

Bay of Plenty 2 6 45 4% 11% 85%

Canterbury 2 4 113 2% 3% 95%

Capital & Coast 2 6 4 91 2% 6% 4% 88%

Counties Manukau 12 15 3 126 8% 10% 2% 81%

Hawke's Bay 2 5 53 3% 8% 88%

Hutt Valley 2 1 37 5% 3% 93%

Lakes 5 36 12% 88%

MidCentral 6 56 10% 90%

Nelson Marlborough 1 34 3% 97%

Northland 6 39 13% 87%

South Canterbury 1 14 7% 93%

Southern 3 61 5% 95%

Tairawhiti 4 16 20% 80%

Taranaki 5 25 17% 83%

Waikato 4 11 1 76 4% 12% 1% 83%

Wairarapa 13 100%

Waitemata 6 8 139 4% 5% 91%

West Coast 8 100%

Whanganui 21 100%


4.3 Māori Representation There has been a slight shift in Māori representation within the overall DHB midwifery workforce, with the

proportion of Māori increasing from 5.4% to 7.2% between December 2010 and December 2017. However,

there is still significant under representation and potential for the DHB midwifery workforce to better reflect

the Māori Population.

Māori representation within the midwifery workforce varies significantly at DHB level. In December 2017,

eleven DHBs had a lower proportion of Māori within their midwifery workforce than the national figure of

7.2%. Four of those DHBs (South Canterbury, Wairarapa, West Coast and Whanganui) did not employ any

Māori midwives in December 2017. Tairawhiti (20%) and Taranaki (16.7%) had the largest proportions of

Māori within their midwifery workforces.

Figure 46 - % Māori within the DHB Midwifery Workforce from 31 December 2010 to 31 December 2017

Figure 47 - % Māori within the DHB Midwifery Workforce vs % Māori in Population from 31 December 2010 to 31 December 2017

Figure 48 - % Māori within the DHB Midwifery Workforce by DHB as at 31 December 2017


Other Information

Relating to the DHB

Midwifery Workforce


a) The Training Pipeline – Midwifery Pre-registration Education Programmes

Midwifery pre-registration education programmes are four-year bachelor degree programmes completed

over an extended three year programme - three trimesters of 45 weeks per year (as opposed to the more

traditional university 32 weeks semester). They result in the completion of a Bachelor of Midwifery or a

Bachelor of Health Science (Midwifery) degree. There are currently four Midwifery pre-registration

programmes in New Zealand. These are offered by Ara Institute of Canterbury (ARA), Auckland University of

Technology (AUT), Otago Polytechnic and Waikato Institute of Technology (Wintec). These programmes are

designed to prepare students for registration and practice as a midwife in New Zealand.

Indicative information sourced from the Ministry of Education, indicates that:

Completion numbers for midwifery pre-registration education programmes have been notably low since 2008 - at around 150 or less per annum. Since 2014, completion numbers have been decreasing,with only 125 completions in 2016, which is the same as in 2009.

The majority of completions are from AUT. Massey University stopped offering midwifery pre-registration education programmes in 2012. Completion numbers have fluctuated across all four remaining tertiary education providers from 2008 to 2016, resulting in a decrease in the overall number of midwifery pre-registration education programme completions.

Annual midwifery pre-registration programme enrolment numbers across all years of study have increased since 2008. 730 students were enrolled across all years of study in 2017 which is 27% higher than the 2008 figure of 575. This trend of increasing enrolment numbers reflects increases in enrolment numbers across all four tertiary education providers. However, the most significant increase has been in AUT’s enrolment numbers, which is 73% higher than the 2008 figure of 205. An examination of annual commencements (i.e. students who first start this qualification) indicates small increases between 2008 and 2017.

There is misalignment between increased midwifery enrolment numbers and low completion numbers, indicating a high attrition rate within midwifery pre-registration education programmes. It would appear that a significant number of students are not completing these programmes.

Analysis of the ethnicity of midwifery completions and enrolments, indicates significant under representation of Pacific People, Māori and Asian. There is particularly concerning paucity around Pacific People completion numbers. Despite significant increases in the number of Pacific People enrolments across all years of study in midwifery pre-registration education programmes, few appear to be completing these programmes since 2008.

*** It should be noted that the Ministry of Education has advised that the data provided is indicative, as all values including totals, are rounded to the nearest 5 to protect the privacy of individuals.

1. Completion of Midwifery Pre-registration Education Programmes Annual completion figures for midwifery pre-registration education programmes have been notably low

since 2008 - at 150 or less per annum. The exception to this trend was an anomalous increase to 160 in 2011.

Since 2014, completion numbers have been decreasing, with only 125 in 2016 - which is the same number as

in 2009.


Massey University stopped offering midwifery pre-registration education programmes in 2012. Completion

numbers have fluctuated across all four remaining tertiary education providers from 2008 to 2016, resulting

in a decrease in the overall number of midwifery pre-registration education programme completions.

1,220 people completed midwifery pre-registration education programmes in New Zealand from 2008 to

2016. The majority of completions were from AUT (415 / 34%) followed by Wintec (270 / 22%) and Otago

Polytechnic (250 / 21%). Ara produced the fewest completions (160 / 13% ) over the same period. Massey

University produced 125 (10%) from 2008 to 2012, after which it stopped offering midwifery pre-registration

education programmes.

Figure 49 - Annual Completions of Midwifery Pre-registration Education Programmes in New Zealand from 2008 to 2016

Figure 50 - Annual Completions of Midwifery Pre-registration Education Programmes by New Zealand Tertiary Education Provider from 2008 to 2016

Figure 51 - All Completions of Midwifery Pre-registration Education Programmes in New Zealand by Tertiary Education Provider from 2008 to 2016


2. Enrolment in Midwifery Pre-registration Education Programmes Annual enrolment numbers for midwifery pre-registration education programmes across all years of study

have increased since 2008. The 2017 overall enrolment figure across all years of study was 730, which is 27%

higher than the 2008 figure of 575.

All four current tertiary education providers have higher annual enrolment numbers for midwifery pre-

registration education programmes across all years of study than in 2008. The most significant increase has

been in AUT’s enrolment numbers. An examination of annual commencements (i.e. students who first start

this qualification) indicates relatively small increases between 2008 and 2017.

Figure 52 - Annual Enrolments in Midwifery Pre-registration Education Programmes with a New Zealand Tertiary Education Provider across all years of study from 2008 to 2017

Figure 53 - Annual Enrolments in Midwifery Pre-registration Education Programmes by New Zealand Tertiary Education Provider across all years of study from 2008 to 2017

Figure 54 - Commencements in Midwifery Pre-registration Education Programmes by New Zealand Tertiary Education Provider across all years of study from 2008 to 2017


3. Ethnicity of Completions and Enrolments Analysis of reported ethnicity information on people who completed midwifery pre-registration education programmes in New Zealand from 2008 to 2016, indicates significant under representation of minority ethnic groups, i.e. Asian, Māori and Pacific People. There is a particularly severe paucity of Pacific People completing midwifery pre-registration education programmes, with approximately 25 completions from 2008 to 2016. Analysis by ethnicity of annual enrolment numbers for midwifery pre-registration education programmes across all years of study, indicates under representation of minority ethnic groups, i.e. Asian, Māori and Pacific People. This under representation persists despite significant year on year increases in minority ethnic group representation during the period 2008 to 2016. It should be noted that people are counted in each ethnic group they identify with, so they may be counted multiple times. All values, including totals, are rounded to the nearest 5 to protect the privacy of individuals. Therefore, totals do not equal the sum of each group and proportional calculations will have an unspecified margin of error.

Figure 55 - Ethnicity of all Completions of Midwifery Pre-registration Education Programmes in New Zealand from 2008 to 2016

Figure 56 - Ethnicity of Annual Completions of Midwifery Pre-registration Education Programmes from 2008 to 2016

Figure 57 - Total Enrolments in a Bachelor of Midwifery or a Bachelor of Health Science (Midwifery) programme in New Zealand by Ethnicity across all years of study from 2008 to 2017


Caveats:

Information included in this section was sourced from the Ministry of Education in August 2018, and looks at students enrolled in a Bachelor of Health Science (Midwifery) or Bachelor of Midwifery study programme.

Data excludes all non-formal learning and on-job industry training; and includes domestic and international students.

The Ministry of Education has advised that the data provided has been revised, and may differ from previously published figures.

The Ministry of Education has also advised that all values including totals, are rounded to the nearest 5 to protect the privacy of individuals, so the sum of individual counts may not add to the total.

Ethnicity: People are counted in each ethnic group they identify with, so the totals do not equal the sum of each category and proportional calculations will have an unspecified margin of error. People whose ethnic group(s) is unknown will be included in the totals but not in the individual categories.

Completion caveats: Completion data for 2016 is indicative, as completions may be reported through the following year. The completion year reflects when a student met the requirements to complete the qualification, rather than when the degree was conferred.

Enrolment caveats: Enrolment numbers reflect students enrolled at any time during the year with a tertiary education provider in formal qualifications of greater than 0.03 EFTS (more than one week's full-time duration). Specific cohorts are not evident from this dataset.

Commencements: Students who changed tertiary education providers will count as a commencement even though it might not be their first year pursuing the degree.


b) Midwifery Council Data

1. The New Zealand Midwifery Workforce For the year to 31 March 2018, there were 3,210 registered midwives practising in New Zealand - the majority

(55%) of which were not employed by DHBs, either permanently or on a fixed term basis. Data identifying

DHB employed midwives excludes those on long term leave, parental leave, leave without pay and those

with zero contracted hours (casuals).

It should be noted that HWIP sourced data is pay derived and differs from information collected via the

Midwifery Council of New Zealand’s annual workforce surveys. Data reported from those surveys indicates

that the majority of practising midwives (approximately 56%) state that their employer is a DHB.

The number of registered midwives practising in New Zealand increased by less than 8% (230) from 2010/11

to 2017/18. From 2011/12 the growth rate was 1% or less per annum, however this increased to 2% in

2017/18.

The DHB employed midwifery workforce as a proportion of all practising midwives in New Zealand, decreased

notably from 2010/11 to 2017/18. This correlates with a decrease in the overall headcount of DHB employed

midwives over the same period.

Figure 58 - Headcount of Registered Midwives with Practising Certificates in New Zealand from 1 April 2010 and 31 March 2018

2. New Registrations of Midwives in New Zealand From 2009 to 2018, there have been low and mostly decreasing numbers of midwives added to the New

Zealand register. There were 187 midwives registered in New Zealand in 2017/18, which is an increase from

the preceding three years.

The majority of new registrations are New Zealand educated midwives, and in 2017/2018 this group

comprised 78% of all new registrations. The number of New Zealand educated midwives has been low over

the long term (since 2009), and remained low at 146 in 2017/18.


The total number of Internationally Qualified Midwives (IQMs) registered annually in New Zealand has

decreased significantly over a number of years, from 76 in 2009/10 to 41 in 2017/18. Over the same period,

the proportion of all IQMs fell from 37.6% of all new registrations to 22%.

Figure 59 - Headcount of Midwives Registered from 1 April 2009 to 31 March 2018

Figure 60 - New Zealand Graduates vs Internationally Qualified Midwives as a % of New Registrations from 1 April 2009 to 31 March 2018

3. Return to Practice Programmes There are very low numbers of midwives enrolling in return to practice programmes, and completion rates

dropped significantly from 2009 to 2017. The number of midwives participating in return to practice

programmes has decreased significantly over the long term (-80% from 2009/10 to 2017/18), with only 7

participants in 2017/18. Additionally, the completion rate dropped from 89% in 2009/10 to 67% in 2016/17.

However, in 2017/18 all 7 participants completed the programme.

Figure 61 - Completion Rates of Return to Practice Programmes between 2009/10 and 2017/18


Caveats:

Data included in this section is sourced from the Midwifery Council of New Zealand’s Annual Report for the year to 31 March 2017. (https://www.midwiferycouncil.health.nz/sites/default/files/sitedownloads/Annual%20Report%20Midwifery%20Council%202017%20Final.pdf)

The Midwifery Council has provided additional data for the year to 31 March 2018.

HWIP information on DHB employed midwives is for all permanent and fixed term employees and excludes casuals, locums and any employees on long term leave, including parental leave. Data from 31 March of each year is used to make a comparison with the Midwifery Council data.

https://www.midwiferycouncil.health.nz/sites/default/files/sitedownloads/Annual%20Report%20Midwifery%20Council%202017%20Final.pdf

https://www.midwiferycouncil.health.nz/sites/default/files/sitedownloads/Annual%20Report%20Midwifery%20Council%202017%20Final.pdf


c) Immigration New Zealand Visa Approval Data

A priority for the 20 DHBs is ensuring that they have a health workforce that meets the needs of the

communities they serve. This means ensuring that DHBs have an appropriate supply of labour in the right

places with the right skills and at the right time. Widespread national supply issues with the midwifery

workforce, low midwifery graduate numbers and high numbers of unfilled vacancies over the long term; are

creating significant pressure across the 20 DHBs. These pressures are unlikely to be alleviated without

significant international recruitment. It is certain that unless the local midwifery workforce is supplemented

with experienced internationally qualified midwives, DHBs will not be able to fill vacancies over the long term

and will struggle to ensure that the midwifery workforce meets increasing service demand.

Information provided by the Ministry of Business, Innovation and Employment’s (MBIE’s) Immigration New

Zealand indicates very low numbers of work and residence visa approvals for midwives between 1 July 2010

and 30 June 2018. Both work and residence visa approval figures have fluctuated over that period, but have

remained at less than 30 of each type per annum.

From 2013/14 work visa approvals began noticeably declining below 20 per annum, however in 2017/18

there was a sudden increase to 27 (93% more than 2016/17). This is likely to be due to the inclusion of

midwifery as an occupation on Immigration New Zealand’s Immediate Skill Shortage List in early 2018.

Residence visa approvals have been declining since 2012/13, aside from a small anomalous surge in 2015/16.

If work visa approvals continue to increase, it is likely that residence visa approvals will also follow a similar

trend.

Between 1 July 2010 and 30 June 2018 the majority of internationally qualified midwives granted visas to

work in New Zealand were from the United Kingdom, Ireland and other European countries.

Figure 62 - Residence and Work Visa Approvals for Midwives from 1 July 2010 to 30 June 2018


Figure 63 - Residence and Work Visa Approvals for Midwives by Country from 1 July 2010 to 30 June 2018

*** Due to privacy considerations, from 2017-18 country level information is no longer available, so the 2017-18 figure

is a total ‘Not Identified’ figure.


d) Midwifery Related Information from the National Minimum Dataset (NMDS) & the National Non-Admitted Patient Collection (NNPAC)

We have utilised information from the National Minimum Dataset (NMDS) for admitted patients and the

National Non-Admitted Patient Collection (NNPAC) to examine service delivery outputs relating to activities

that indicate the demand for DHB employed midwifery services. The data used covers nine calendar years

up to and including 2017, and represents activity at DHB owned facilities that have some input from DHB

employed midwives.

Data Sources The NMDS is a national collection of public and private hospital discharge information, including clinical

information, for inpatients and day patients. The NMDS provides statistical information, reports, and

analyses about the trends in the delivery of hospital inpatient and day-patient health services both nationally

and on a provider basis.

The NNPAC information includes event-based purchase units that relate to medical and surgical outpatient

events and emergency department events. This includes information on the type of service provided and the

health specialty involved. NNPAC provides national consistent data on non-admitted patient (outpatient and

emergency department) activity.

Service Delivery Output Data Feedback from stakeholders signalled that relying solely on a count of actual births, would not reflect the

activity undertaken by or requiring some level of involvement from midwives. Hence, the use of service

delivery events in addition to actual births as a high level indicator of demand.

Service delivery output data within NMDS and NNPAC is generated at DHB level and includes key outputs

from routine reporting on the services and care offered and the treatments administered. This event based

data is useful in providing volume, time and seasonal trend analyses. However, the size, facilities and type of

services offered by DHBs may vary considerably and affect comparisons. Additionally, for a range of reasons,

populations may not necessarily use the services within their own geographical DHB area. It should also be

noted that DHBs may differ in how they capture and record certain events - e.g. acute assessments and

outpatient reviews. Therefore, the data may not reflect all the maternity activity outside of labour and birth

undertaken by DHBs. Comparisons of DHB information in relation to local populations should be used

cautiously.

Service delivery data from NMDS and NPAC data is not intended to be definitive. This information is intended

to be indicative, and involves event based purchase units rather than a count of births – except where the

term ‘birth activity’ is specified. A single birth may involve multiple service delivery events of various

configurations in relation to ‘Labour and Birth Activity’ or ‘Other Maternity Activity’.

Service delivery outputs are limited in that they provide no information on:

The status and quality of service delivery;

Specific service provision arrangements and models of care;

Variation in the distribution of health services; and

Differences in the use of services by different populations.


1. DHB Activity related to Labour and Birth Labour and birth activity undertaken by DHBs nationally has decreased by 6%, but remained relatively stable

at over 53,000 events from 2009 to 2017. At a DHB level, there is significant variance between DHBs

depending on size and geographical location. Annually, 80% of DHB labour and birth activity is undertaken in

the North Island. DHBs in the Northern region account for over 42% of national labour and birth activity. The

Central and Southern regions undertake around 20% each of national activity, with the Midlands region

accounting for the remaining 18%. The seven large DHBs undertake over 68% of all national labour and birth

activity, with medium and small DHBs undertaking around 22% and 10% respectively.

Figure 64 - DHB Labour and Birth Activity from 2009 to 2017

Figure 65 - Labour and Birth Activity undertaken by Large DHBs from 2009 to 2017

Figure 66 - Labour and Birth Activity undertaken by Medium Sized DHBs from 2009 to 2017

Figure 67 - Labour and Birth Activity undertaken by Small DHBs from 2009 to 2017


Table 8 - Activity related to Labour and Birth undertaken by DHBs from 2009 to 2017

1.1 DHB Labour and Birth Activity per 100,000 Fertile Female (15-49 year) Population Labour and birth activity undertaken nationally by DHBs has decreased but remained relatively stable at

around 5,000 events per 100,000 fertile female population from 2009 to 2017.

Figure 68 - DHB Activity related to Labour and Birth per 100,000 Fertile Female (15-49 year) Population from 2009 to 2017

1.2 DHB Labour and Birth Activity by Ethnicity From 2009 to 2017, DHB labour and birth activity has been increasing for Asians - in terms of actual events;

events as a proportion of all labour and birth activity undertaken by DHBs; and events per 100,000 fertile

female population. Conversely, over the same period all other ethnic groups have been experiencing

decreases in terms of events; events as a proportion of all labour and birth activity undertaken by DHBs; and

events per 100,000 fertile female population. The seven large DHBs are most impacted by these trends.

DHB of Service 2009 2010 2011 2012 2013 2014 2015 2016 2017

Auckland 7,580 7,579 7,388 7,604 7,111 7,335 6,877 7,177 6,789

Bay of Plenty 2,744 2,787 2,678 2,752 2,536 2,605 2,364 2,423 2,565

Canterbury 5,920 5,919 5,610 5,752 5,609 5,533 5,667 5,624 5,603

Capital & Coast 3,871 3,790 3,824 3,803 3,581 3,556 3,558 3,512 3,567

Counties Manukau 7,783 7,811 7,970 7,969 7,367 7,282 7,180 7,162 7,034

Hawke's Bay 2,335 2,253 2,137 2,166 2,040 1,959 1,855 1,947 1,999

Hutt Valley 2,186 2,143 1,963 1,976 1,841 1,784 1,864 1,867 1,845

Lakes 1,595 1,525 1,512 1,447 1,361 1,368 1,428 1,461 1,477

MidCentral 2,064 2,196 2,151 2,042 1,987 1,976 1,952 1,917 1,937

Nelson Marlborough 1,538 1,536 1,525 1,360 1,421 1,276 1,282 1,399 1,247

Northland 1,926 2,079 1,992 1,964 1,815 1,799 1,804 1,925 1,928

South Canterbury 612 617 540 595 585 612 588 601 586

Southern 3,126 3,093 3,062 3,117 2,915 2,870 2,925 2,897 2,976

Tairawhiti 588 696 678 677 651 622 661 669 627

Taranaki 1,418 1,406 1,395 1,379 1,373 1,366 1,441 1,350 1,319

Waikato 3,824 3,827 3,753 3,939 3,836 3,849 3,771 3,745 3,808

Wairarapa 510 492 493 475 455 429 400 411 481

Waitemata 6,632 6,737 6,574 6,883 6,654 6,860 6,621 6,856 6,664

West Coast 322 290 303 298 280 270 249 242 267

Whanganui 747 758 696 740 690 670 699 698 743

Total 57,321 57,534 56,244 56,938 54,108 54,021 53,186 53,883 53,462


Figure 69 - DHB Activity related to Labour and Birth by Ethnicity from 2009 to 2017

Figure 70 - DHB Activity related to Labour and Birth per 100,000 Fertile Female (15-49 year) Population by Ethnicity from 2009 to 2017

Figure 71 - Snapshot of Activity related to Labour and Birth by DHB and Ethnicity in 2017


Table 9 - Snapshot of Activity related to Labour and Birth by DHB and Ethnicity in 2017

2. Other DHB Maternity Activity outside Labour and Birth DHBs undertake a significant amount of maternity activity that is outside labour and birth, and which is likely

to require midwifery involvement. This includes pregnancy examinations, pregnancy supervision, antenatal

screening, postpartum care, terminations, antenatal consults, postnatal consults, pregnancy and parenting

education, maternity foetal medicine - multidisciplinary clinics, breastfeeding / lactation clinics, maternity

multidisciplinary non-specialist clinics. For the purpose of this report, we refer to the grouping of those

activities as ‘Other DHB Maternity Activity’. It should be noted that this event data is indicative only, as DHBs

may differ in how they capture and record certain events - e.g. acute assessments and outpatient reviews.

There has been some fluctuation and an overall decrease in other DHB maternity activity undertaken

nationally from 2009 to 2017. At DHB level, the trends for other DHB maternity activity mirror the trends

identified with labour and birth activities undertaken by DHBs. There is significant variance between DHBs

depending on size and geographical location. The majority of other DHB maternity activity is undertaken in

the North Island. DHBs in the Northern region account for over 42% of national other DHB maternity activity.

The seven large DHBs undertake over 68% of all national other DHB maternity activity.

Figure 72 - Other DHB Maternity Activity from 2009 to 2017

DHB of Service Asian Māori Other Pacific Total

Auckland 2,427 422 3,227 713 6,789

Bay of Plenty 238 864 1,396 67 2,565

Canterbury 823 530 3,997 253 5,603

Capital & Coast 632 497 2,129 309 3,567

Counties Manukau 1,568 1,547 1,491 2,428 7,034

Hawke's Bay 128 761 975 135 1,999

Hutt Valley 309 377 995 164 1,845

Lakes 128 714 595 40 1,477

MidCentral 185 415 1,260 77 1,937

Nelson Marlborough 98 177 938 34 1,247

Northland 97 905 871 55 1,928

South Canterbury 41 60 479 6 586

Southern 265 295 2,329 87 2,976

Tairawhiti 16 399 197 15 627

Taranaki 87 343 872 17 1,319

Waikato 517 1,081 2,047 163 3,808

Wairarapa 25 112 332 12 481

Waitemata 2,187 786 3,032 659 6,664

West Coast 15 41 210 1 267

Whanganui 38 291 377 37 743

Total 9,824 10,617 27,749 5,272 53,462


Figure 73 - Other DHB Maternity Activity undertaken by Large DHBs from 2009 to 2017

Figure 74 - Other DHB Maternity Activity undertaken by Medium Sized DHBs from 2009 to 2017

Figure 75 - Other DHB Maternity Activity undertaken by Small DHBs from 2009 to 2017

Table 10 - Other DHB Maternity Activity undertaken by DHBs from 2009 to 2017

DHB of Service 2009 2010 2011 2012 2013 2014 2015 2016 2017

Auckland 36,585 36,967 37,243 35,394 31,561 35,890 31,686 33,638 33,112

Bay of Plenty 3,266 3,528 3,865 3,961 3,781 3,869 3,415 3,397 3,550

Canterbury 13,235 14,462 14,771 14,858 13,815 13,606 13,665 13,734 14,407

Capital & Coast 16,280 17,711 17,774 17,490 15,508 12,967 14,733 16,114 16,994

Counties Manukau 47,144 43,924 46,105 52,977 50,158 49,196 37,256 43,545 47,811

Hawke's Bay 6,589 9,941 9,999 7,222 6,667 6,637 8,730 7,950 7,507

Hutt Valley 5,411 8,072 11,198 10,527 9,660 8,949 8,706 7,792 9,036

Lakes 1,979 1,862 1,864 1,761 2,978 3,315 2,737 2,874 2,747

MidCentral 3,639 5,485 4,997 4,718 4,637 4,183 4,339 3,928 3,721

Nelson Marlborough 1,601 1,617 1,596 1,445 1,428 1,318 1,292 1,408 1,269

Northland 16,629 13,668 10,085 10,888 8,598 8,141 8,689 9,090 8,066

South Canterbury 830 861 764 860 977 859 799 823 799

Southern 9,090 8,539 7,647 7,865 5,825 5,396 5,564 5,749 6,002

Tairawhiti 810 744 849 966 899 898 813 789 786

Taranaki 3,979 4,176 4,681 4,132 3,593 2,917 2,823 2,846 2,807

Waikato 5,060 4,936 4,743 5,131 4,709 4,535 4,315 4,411 5,713

Wairarapa 529 526 527 512 481 478 773 738 1,135

Waitemata 7,264 7,302 7,166 7,360 7,585 9,239 11,128 12,980 11,650

West Coast 1,882 2,984 2,182 1,392 2,851 2,431 542 334 337

Whanganui 6,960 7,441 3,650 867 745 756 741 775 889

Total 188,762 194,746 191,706 190,326 176,456 175,580 162,746 172,915 178,338


2.1 Other DHB Maternity Activity per 100,000 Fertile Female (15-49 year) Population Other DHB maternity activity undertaken nationally has fluctuated between 14,800 and 18,000 events per

100,000 fertile female population from 2009 to 2017 - resulting in an overall decrease.

Figure 76 - Other DHB Maternity Activity per 100,000 Fertile Female (15-49 year) Population from 2009 to 2017

2.2 Other DHB Maternity Activity by Ethnicity From 2009 to 2017, other DHB maternity activity has been increasing for Asians - in terms of actual events;

events as a proportion of all other DHB maternity activity undertaken by DHBs; and events per 100,000 fertile

female population. Conversely, over the same period all other ethnic groups have been experiencing

decreases in terms of actual events; events as a proportion of all other DHB maternity activity undertaken by

DHBs; and events per 100,000 fertile female population. The seven large DHBs are most impacted by these

trends.

Figure 77 - Other DHB Maternity Activity by Ethnicity from 2009 to 2017


Figure 78 - Other DHB Maternity Activity per 100,000 Fertile Female (15-49 year) Population by Ethnicity from 2009 to 2017

Figure 79 - Snapshot of Other DHB Maternity Activity by DHB and Ethnicity in 2017

Table 11- Snapshot of Other DHB Maternity Activity by DHB and Ethnicity in 2017

DHB of Service Asian Māori Other Pacific Total

Counties Manukau 12,119 10,672 8,893 16,127 47,811

Auckland 12,187 2,869 11,971 6,085 33,112

Capital & Coast 3,410 2,673 9,274 1,637 16,994

Canterbury 2,087 1,442 10,203 675 14,407

Waitemata 3,452 1,626 5,268 1,304 11,650

Hutt Valley 1,446 2,119 4,744 727 9,036

Northland 403 3,719 3,645 299 8,066

Hawke's Bay 235 4,231 2,660 381 7,507

Southern 633 560 4,643 166 6,002

Waikato 649 1,679 3,175 210 5,713

MidCentral 370 971 2,232 148 3,721

Bay of Plenty 286 1,354 1,821 89 3,550

Taranaki 168 740 1,874 25 2,807

Lakes 225 1,172 1,275 75 2,747

Nelson Marlborough 95 248 887 39 1,269

Wairarapa 53 252 809 21 1,135

Whanganui 36 356 442 55 889

South Canterbury 49 102 637 11 799

Tairawhiti 23 488 260 15 786

West Coast 16 55 257 9 337

Total 37,942 37,328 74,970 28,098 178,338


3. DHB Birth Activity by Type Nationally, there has been an overall decrease in births within DHB settings from 2009 to 2017. However,

there has been a notable increase in caesarean sections undertaken within DHB settings; both in the number

of events and as a proportion of overall births.

From 2009 to 2017, there was a very significant increase in caesarean sections and vaginal births for Asians,

both in terms of events and as a proportion of all births within DHB settings. The number of Asians that

birthed via caesarean section increased by 105% (1,835); and the number of vaginal births for Asians

increased by 46% (1,989) over that period.

There has also been a 14% increase in Māori and Pacific People birthing via caesarean section over the same

period. Vaginal births decreased across all ethnic groups bar Asian from 2009 to 2017.

Figure 80 - DHB Birth Activity by Type from 2009 to 2017

Figure 81- DHB Birth Activity by Type and Ethnicity from 2009 to 2017


Table 12 - DHB Birth Activity by Type from 2009 to 2017

4. Maternity Events to DHB Midwifery FTE Ratios HWIP FTE data from 31 December 2010 to 2017, has been used to calculate DHB maternity related events

to DHB midwifery FTE ratios.

Nationally, the ratio of labour and birth events per FTE of DHB midwives has remained in the 50s. The ratio

for other DHB maternity events has fluctuated between 173 and 200 per FTE of DHB midwives. At DHB

level, there were extreme variances in the ratio of maternity related events per FTE midwife as at 31

December 2017.

DHB of Service Delivery Type 2009 2010 2011 2012 2013 2014 2015 2016 2017

Caesarean Section 2,365 2,467 2,418 2,563 2,469 2,563 2,452 2,602 2701

Vaginal Birth 5,215 5,112 4,970 5,041 4,642 4,772 4,425 4,575 4088

Caesarean Section 647 678 621 633 630 653 651 679 760

Vaginal Birth 2,097 2,109 2,057 2,119 1,906 1,952 1,713 1,744 1805


Vaginal Birth 4,055 4,157 3,899 4,126 3,860 3,974 4,048 3,963 3927


Vaginal Birth 2,807 2,660 2,638 2,625 2,446 2,420 2,479 2,364 2444


Vaginal Birth 6,445 6,360 6,459 6,240 5,654 5,595 5,504 5,382 5092


Vaginal Birth 1,770 1,716 1,654 1,601 1,528 1,464 1,386 1,435 1513


Vaginal Birth 1,555 1,578 1,439 1,479 1,354 1,321 1,289 1,263 1231


Vaginal Birth 1,220 1,168 1,182 1,092 1,018 1,019 1,103 1,049 1102


Vaginal Birth 1,461 1,594 1,588 1,470 1,407 1,401 1,405 1,321 1380


Vaginal Birth 1,094 1,090 1,096 952 983 888 886 994 842


Vaginal Birth 1,634 1,739 1,658 1,654 1,514 1,507 1,523 1,579 1578


Vaginal Birth 461 451 406 441 452 459 450 462 438

Caesarean Section 1,029 974 984 991 958 932 861 888 917

Vaginal Birth 2,097 2,119 2,078 2,126 1,957 1,938 2,064 2,009 2059


Vaginal Birth 512 544 543 550 519 466 517 530 500


Vaginal Birth 1,081 1,053 1,073 999 1,020 1,008 1,064 1,026 975

Caesarean Section 976 937 1,029 990 971 940 957 971 1156

Vaginal Birth 2,848 2,890 2,724 2,949 2,865 2,909 2,814 2,774 2652


Vaginal Birth 335 339 346 335 315 311 270 289 349


Vaginal Birth 4,821 4,985 4,916 4,893 4,731 4,863 4,745 4,806 4463


Vaginal Birth 243 228 231 205 199 193 174 167 183


Vaginal Birth 620 603 577 608 592 566 587 567 603

Caesarean Section 14,950 15,039 14,710 15,433 15,146 14,995 14,740 15,584 16,238

Vaginal Birth 42,371 42,495 41,534 41,505 38,962 39,026 38,446 38,299 37,224

Auckland

Canterbury

Bay of Plenty

Total

Capital & Coast

Counties Manukau

Hawke's Bay

Hutt Valley

Lakes

Whanganui

MidCentral

Nelson Marlborough

Northland

South Canterbury

Southern

Tairawhiti

Taranaki

Waikato

Wairarapa

Waitemata

West Coast


Figure 82 - National DHB Midwifery FTE to Maternity Events Ratios

Table 13 - National DHB Midwifery FTE to Maternity Events Ratios

Figure 83 - Ratio of Labour and Birth Events per FTE Midwife by DHB as at 31 December 2017

Figure 84 - Ratio of Other Maternity Events per FTE Midwife by DHB as at 31 December 2017

2010 2011 2012 2013 2014 2015 2016 2017

DHB Midwives Contracted FTE as at 31 December 968.0 982.0 986.4 996.0 986.9 937.1 935.7 943.2

DHB Labour and Delivery Events per FTE Midwife 59.4 57.3 57.7 54.3 54.7 56.8 57.6 56.7

Other DHB Maternity Events per FTE Midwife 201.2 195.2 192.9 177.2 177.9 173.7 184.8 189.1


Caveats:

Data related to ectopic pregnancies and first trimester terminations of pregnancy have been excluded. Otherwise we include all admitted patient data from DHB agencies and DHB-owned facilities whether provided as secondary or primary maternity, in addition to second trimester terminations of pregnancy.

“Primary Maternity” means provided at a primary maternity facility. These events are identified as: EITHER their purchase Unit in NMDS is W10.01

OR their Purchase Unit in NMDS is EXCLU and the health specialty code is one of {P60,

P61, P70, P71}

OR the DRG is one of O05Z or O63Z and the clinical coding identifies the event s second

trimester.

NNPAC events were those with the Purchase Units: W01007, Antenatal Consults

W01008, Postnatal Consults

W01011, Pregnancy and Parenting Education

W03008, Maternity foetal medicine - multidisciplinary clinics

W03010, Breastfeeding / lactation clinic

W03011, Maternity multidisciplinary non-specialist clinic

S30009, 2nd Trimester Surgical ToP

The definitions of tertiary, secondary, and primary maternity facilities are consistent with the service specifications for DHB-funded maternity services in 2018.

Standard census demographic data from StatsNZ is used to allow for linking to population groups.


e) Health Workforce New Zealand’s Forecasting Model

Health Workforce New Zealand (HWNZ) has developed a midwifery workforce supply and demand

forecasting model which considers the entire New Zealand midwifery workforce, i.e. all midwives registered

with the New Zealand Midwifery Council.

The methodology used involves tracking individual midwives’ annual practising certificate (APC) data for the

last 6 to 10 years to gather age or age-group specific exit rates, full time equivalent (FTE) per headcount (HC)

ratios, and entry and re-entry distributions. These parameters are used with an in-house developed dynamic

modelling algorithm to forecast future midwifery workforce size and supply in New Zealand. As a result, the

model calculates the likely age distribution of the midwifery workforce over the next 10 years, and projects

the potential supply of midwives over that period.

In terms of demand, the model uses current age group, ethnicity, DHB specific fertility rates, historic trends,

and the probability of having complex birthing events; to forecast age group, ethnicity and DHB adjusted

birthing events for mothers for the next 10 years. The demand side of the model can then be compared with

the supply side of the model. The graph below presents a snapshot of information forecast by HWNZ’s model.

Figure 85 - Health Workforce New Zealand’s forecast midwifery workforce age distribution in 2018 and 2028

HWNZ has updated the previous model to include more information to enhance the model’s usefulness for

future planning of the midwifery workforce.

New features introduced in the 2018 Midwifery model, include:

Splitting Entry into New Entry and Re-Entry - to estimate how many new trainees need to be trained;

Mothers’ age groups, ethnicities, the DHB specific case-weight of mothers’ birthing events, and

babies’ neonate events - to reflect the growing number of complex birthing and neonate events that

require core midwifery resources;

Mothers’ age groups, ethnicities, the DHB specific utilisation of LMC services - to reflect LMC

workload more accurately; and


Geographic display of the distribution of core midwives by facility and of LMC midwives attending

facilities, compared with distribution of women likely to experience birthing events, and their closest

primary (if any) and secondary/tertiary birthing facilities - to identify under-resourced areas.

Geographic distribution analysis is supported by the collection of birthing facility data from the

Midwifery Council of New Zealand and the New Zealand College of Midwives.


Bibliography

Australian Public Service (2012) Strategic Workforce Analysis and Reporting Guide.

Ball J.A., Washbrook M. & The Royal College of Midwives (2018) Birthrate Plus Report. Retrieved from https://www.rcm.org.uk/sites/default/files/Birthrate%20Plus%20Report_1.pdf

Galloway, J (2018) Shortage of rural midwives amid concerns they are not paid enough. Retrieved from https://www.stuff.co.nz/business/farming/101874933/shortage-of-rural-midwives-amid-concerns-they-are-not-paid-enough

Henry, D (2018) Midwifery in 'crisis' with pregnant women unable to find lead maternity carers. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11997502

Meier, C. (2018) Thousands of women unable to find midwife for Christmas holiday births. Retrieved from http://www.stuff.co.nz/life-style/parenting/pregnancy/101473747/Thousands-of-women-unable-to-find-midwife-for-Christmas-holiday-births

Ministry of Health (2018) Health Workforce New Zealand Annual Report to the Minister of Health: 1 July 2016 to 30 June 2017. Retrieved from https://www.health.govt.nz/publication/health-workforce-new-

zealand-annual-report-minister-health-1-july-2016-30-june-2017

Ministry of Health (2014) Find maternity facilities in your area. Retrieved from http://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/where-give-birth/find-maternity-facilities-your-area

Ministry of Health (2014) Maternity service specifications - Current service specifications for DHB-funded maternity services. Retrieved from https://nsfl.health.govt.nz/service-specifications/current-service-

specifications/maternity-service-specifications

Ministry of Health (2017) Midwifery Strategic Advisory Group. Retrieved from https://www.health.govt.nz/our-work/health-workforce/health-workforce-taskforces/midwifery-strategic-advisory-group

The New Zealand College of Midwives (2018) New Zealand Midwifery. Retrieved from https://www.midwife.org.nz/midwives/midwifery-in-new-zealand

The Midwifery Council of New Zealand (2017) Annual Report to March 2017. Retrieved from https://www.midwiferycouncil.health.nz/about-us/publications/annual-report-march-2017

The Midwifery Council of New Zealand (2016) 2016 Midwifery Workforce Survey. Retrieved from https://www.midwiferycouncil.health.nz/about-us/publications/midwifery-workforce-survey-2016

The Midwifery Council of New Zealand (2010) Midwifery (Scope of Practice and qualifications) Notice 2010. Retrieved from https://www.midwiferycouncil.health.nz/sites/default/files/for-

midwives/Gazette%20Notice%202010%20-scope%20%26%20quals%20new%20form.pdf

The Midwifery Council of New Zealand (2011) Midwifery Workforce Report Updated 2010. Retrieved from https://www.midwiferycouncil.health.nz/sites/default/files/site-downloads/Midwifery%20Workforce%20Report%20%20updated%202010%20final.compressed%20new%20website.pdf

Warhurst, L (2018) Struggle for midwives as demand booms. Retrieved from https://www.newshub.co.nz/home/health/2018/02/struggle-for-midwives-as-demand-booms.html

World Health Organization (2016) Global strategic directions for strengthening nursing and midwifery 2016–2020

World Health Organization (2016) Health Service Delivery. Retrieved from http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_section1_web.pdf

https://www.rcm.org.uk/sites/default/files/Birthrate%20Plus%20Report_1.pdf

https://www.stuff.co.nz/business/farming/101874933/shortage-of-rural-midwives-amid-concerns-they-are-not-paid-enough

https://www.stuff.co.nz/business/farming/101874933/shortage-of-rural-midwives-amid-concerns-they-are-not-paid-enough

https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11997502

http://www.stuff.co.nz/life-style/parenting/pregnancy/101473747/Thousands-of-women-unable-to-find-midwife-for-Christmas-holiday-births

http://www.stuff.co.nz/life-style/parenting/pregnancy/101473747/Thousands-of-women-unable-to-find-midwife-for-Christmas-holiday-births

https://www.health.govt.nz/publication/health-workforce-new-zealand-annual-report-minister-health-1-july-2016-30-june-2017

https://www.health.govt.nz/publication/health-workforce-new-zealand-annual-report-minister-health-1-july-2016-30-june-2017

http://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/where-give-birth/find-maternity-facilities-your-area

http://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/where-give-birth/find-maternity-facilities-your-area

https://nsfl.health.govt.nz/service-specifications/current-service-specifications/maternity-service-specifications

https://nsfl.health.govt.nz/service-specifications/current-service-specifications/maternity-service-specifications

https://www.health.govt.nz/our-work/health-workforce/health-workforce-taskforces/midwifery-strategic-advisory-group

https://www.health.govt.nz/our-work/health-workforce/health-workforce-taskforces/midwifery-strategic-advisory-group

https://www.midwife.org.nz/midwives/midwifery-in-new-zealand

https://www.midwiferycouncil.health.nz/about-us/publications/annual-report-march-2017

https://www.midwiferycouncil.health.nz/about-us/publications/midwifery-workforce-survey-2016

https://www.midwiferycouncil.health.nz/sites/default/files/for-midwives/Gazette%20Notice%202010%20-scope%20%26%20quals%20new%20form.pdf

https://www.midwiferycouncil.health.nz/sites/default/files/for-midwives/Gazette%20Notice%202010%20-scope%20%26%20quals%20new%20form.pdf

https://www.midwiferycouncil.health.nz/sites/default/files/site-downloads/Midwifery%20Workforce%20Report%20%20updated%202010%20final.compressed%20new%20website.pdf



https://www.newshub.co.nz/home/health/2018/02/struggle-for-midwives-as-demand-booms.html

http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_section1_web.pdf


Appendices

Appendix A - Supplementary Information on HWIP Data

HWIP Data Extract

The DHB workforce information included in this report is sourced from the Health Workforce Information

Programme (HWIP) and is for all staff employed as at 31 December 2017 in the occupation group 'Midwifery',

and only includes staff employed as fully qualified midwives. The HWIP information is for all permanent and

fixed term employees and excludes those on long term leave, parental leave, leave without pay and those

with zero contracted hours (casual). Where a reporting date is used, the numbers are those who were

employed on that end of quarter date, except for turnover statistics which rely on counting those who

terminated employment during the quarter. It should be noted that the DHB midwifery workforce is relatively

small, so slight changes can result in significant variation in trends.

The HWIP has been capturing and reporting DHB employed workforce demographic data since 2006. The

data collected is supported by an agreed data standard and code sets. Information from the HWIP is used to

inform strategic and operational workforce analysis, development and planning. Every quarter, analysts in

the 20 DHBs submit workforce data for inclusion in the HWIP. Comprehensive data completeness and quality

checks are run, before the information is loaded into the HWIP database. While every effort has been made

to ensure the report is correct, this extract relies upon the quality of the data supplied. Consideration must

be given to the fact that the data is extracted from multiple systems within the DHBs.

Key Definitions

a) Annual Turnover

Voluntary annual turnover is calculated by dividing the number of positions terminated over the period

being measured, by the mean number of positions employed at each of the reporting quarters over the

reporting period. Excludes those staff with zero contracted hours, those on fixed-term contracts, and

those not classified as ‘voluntary resignations’.

b) Other Ethnicity

Is a group amalgamation of all ethnicities that do not fall into the groups Asian, Māori and Pacific People.

c) Vacancy Data

The HWIP began capturing DHB vacancy FTE data in September 2016, to accommodate increased

interest and need for this information. This quarterly reporting measure, uses the agreed vacancy

definition below, enabling accurate and consistent reporting of vacancy levels across the 20 DHBs.

Vacancy information is based on DHBs reporting the Full Time Equivalent (FTE) values of contracted FTE

and vacancies unfilled, on the last day of a reporting quarter. The information is for all permanent and

fixed term employees and excludes casuals, locums and any employees on long term leave, including

parental leave.


Vacancy Definitions

Vacancy FTE An unfilled position that has funding allocated and will be actively recruited for within the next six months. It is a permanent position that is part of the FTE allocation (if applicable). Where a vacancy exists, it remains a vacancy when temporarily filled.

Contracted FTE

Contracted FTE uses the number of hours that an employee is contracted to work, based on a 2086 hour annual contract representing a full-time equivalent employee. The contracted FTE definition used here allows a comparison to be made across DHBs and occupations through a universal standard.

Overall FTE This is the sum of all contracted FTE figures for all the vacancies covered under the job title or ANZSCO codes.

FTE Allocations & Funding Application

The way that certain DHBs operate their services means that they have the flexibility to determine FTEs and do not have pre-determined FTE allocations (excluding Management/Administration staff which have an FTE cap in all DHBs). In these instances a vacancy exists where a permanent FTE position has been identified as necessary to deliver services and the position has not been permanently filled.

Calculations

a) Vacancy Rate

The Vacancy Rate (VR) measures Vacancy FTE (unfilled positions) as a percentage of the FTE allocation

for a workforce at the end of a quarter. The FTE allocation for a workforce is the sum of the Contracted

FTE (occupied positions) and Vacancy FTE at the end of a quarter.

The Vacancy Rate (VR) is calculated as follows: 𝐕𝐑 =𝐕𝐚𝐜𝐚𝐧𝐜𝐲 𝐅𝐓𝐄

(𝐂𝐨𝐧𝐭𝐫𝐚𝐜𝐭𝐞𝐝 𝐅𝐓𝐄+𝐕𝐚𝐜𝐚𝐧𝐜𝐲 𝐅𝐓𝐄) × 𝟏𝟎𝟎

b) Calculations involving sex exclude the few employees with an unreported sex.

c) Calculations involving ethnicity exclude employees with an unknown ethnicity.

d) Averages are shown as mean unless otherwise stated.

e) Percentage of employees over 55 years old is a year to date calculation to smooth out quarterly variation

occurring due to the way ages are calculated in HWIP using birth year.

Technical Notes

a) The data is extracted directly from the central repository (HWS) of all HWIP data, except population data

which has been supplied by Statistics New Zealand.

b) Excludes staff with zero contracted hours and those on long term leave (where paid Employment Status

= '4', '5' or '6' in HWIP).

c) Only staff employed on the reporting dates (quarter end dates) are included - except those used for

leaving/turnover calculations.

d) All FTE figures are contracted FTE (2086 hours per annum).

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