"From my point of view we have to crack this, we can't allow it to continue."
These words were said by then-ACT chief minister and health minister Katy Gallagher in 2014.
She said this in response to a damning report which found staff shortages, "acute distress" of health workers, unrealistic workloads and limited training in the obstetrics and gynaecology unit at the Centenary Hospital for Women and Children.
The unit was at risk of losing its training accreditation.
The report was from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists which had reviewed the unit in September 2014 for training re-accreditation.
One visiting assessor reportedly described Canberra as "having the worst maternity training unit in Australia".
But nearly 10 years later, health authorities have not been able to "crack this" as a similarly damning report about the same unit was made public this week.
The college's draft report, seen by The Canberra Times, showed the unit is again at risk of losing training accreditation.
The review, based on a June 2023 visit, showed there are high workloads, "chronic understaffing" and high levels of burnout, while trainees reported being spoken to in a "disrespectful manner" and being given feedback in "inappropriate settings".
Trainees in obstetrics and gynaecology were unable to access clinical experience and opportunities to meet the training program's requirements and supervisors high workloads meant they were unable to spend much time with trainees.
The hospital has been given six months to turn around the situation and if that does not happen it will lose its training accreditation. There are 12 trainees in the unit and there are also seven senior resident medical officers and two junior medical officers who are receiving extra training.
In a unit already suffocating under staff shortages this would be absolutely dire.
But Health Minister Rachel Stephen-Smith has "no expectation" the unit will lose its training accreditation.
"I have no expectation that our training accreditation is at risk. Clearly the college has concerns and it's expressed those concerns," she said.
"The college has been really clear that they are committed to working with Canberra Health Services to ensure that training accreditation is maintained at the Centenary Hospital for Women and Children.
"They could not have been clearer with me, but their intention is to ensure that training, accreditation is maintained and that they will work collaboratively with Canberra Health Services to see that happen."
'Cyclical nature'
The college has imposed a range of conditions and recommendations on Canberra Health Services over the next six months, in order for the unit's training accreditation to be re-accredited.
These include a comprehensive plan to address workforce shortages, ensuring training supervisors have sufficient time to undertake their duties, supervisors having input on the rosters, staff must be supported to overcome burn out, the executive needs to engage in "meaningful dialogue" and there needs to be sufficient support for trainees after hours.
Ms Stephen-Smith said Canberra Health Services was focused on addressing wellbeing challenges and workforce challenges. She said the organisation had changed some structures and personnel within the unit.
A Canberra Health Services spokesman said there had been changes to rostering in the unit, including putting out the shifts earlier. The spokesman also said there had been recent recruitment efforts that were successful in securing senior staff specialists from overseas.
But there is little faith from employees that things will turn around, after all, the same issues have occurred for years and years.
One of the most damning observations from the college in its review of the unit was the hospital had "repeatedly been made aware of areas in which the training offered is insufficient".
"Engagement from the hospital to address training concerns has not been sufficient to this point," the draft review said.
It also found a "clear divide" between front-line medical staff and hospital executive and found "extreme escalation" was required to achieve any engagement from the senior level but, even then, "this was not seen to have any meaningful effect".
"Top-down communication is poor and there is no trust that concerns will be heard or acknowledged," the review said.
The Health Minister was asked this week how people could have confidence that things could change given the issues appeared to be systemic. She said issues were "cyclical".
"I think there is a level of cyclical nature to some of these things as well ... so if you look back [a decade ago] that we're talking about accreditation previously having been lost and the unit has really come up since that time," Ms Stephen-Smith said.
"There have been some recent challenges. There have been challenges around workforce and recruitment and retention and there have been some challenges around culture."
Ms Stephen-Smith also repeated the oft-used line that workforce shortages in the field were being experienced across the nation and, therefore, other units were having similar issues. She said this had been expressed to her by the college.
The college wrote, in a pre-budget submission to the Commonwealth, there were issues around training and upskilling in rural, regional and remote areas.
"Workforce maldistribution and the lack of consistent upskilling opportunities remain key barriers to enabling and maintaining safe and equitable maternity care in rural and remote areas," the submission said.
'Lack of staffing is at a crisis point'
Cultural issues in Canberra's maternity unit are never far away from the headlines.
Five years ago a group of midwives and senior nurses at the Centenary Hospital penned a damning letter, which prompted a parliamentary inquiry into maternity services in the ACT.
This letter said mothers and babies' lives were being put at risk by chronic overcrowding in the maternity unit. It claimed all areas of the maternity unit were consistently over capacity, there were daily over-bookings of labour inductions and there were not enough rooms in the postnatal ward to accommodate women after birth so women were forced to wait long period in the waiting area.
"It is frustrating and upsetting to feel so helpless in such a poorly managed and impossibly busy work environment, unable to provide the care we know we should and feeling consistently exhausted physically and emotionally. The negative effects on patients and staff are seen daily," the letter said.
"It is only a matter of time before there is an adverse outcome for a mother, baby or staff member.
"Some may say this has already been the case."
The report from the parliamentary inquiry called for there to be a greater focus on midwife-led care and a mandated staffing level of midwives and nurses.
But last year, a group of midwives told The Canberra Times issues had only worsened.
"I cannot stress enough that the lack of staffing is at a crisis point and so we're seeing more of those outcomes because we don't have the staff to prevent those things happening. We're seeing more drastic events," the midwives said.
"We are begging for help and have been begging for a really long time and it's just at a point where we are banging our heads against the wall and nobody's listening."
Staff in the unit were also deeply affected by the loss of obstetrician and gynaecologist Peter Scott, who had worked at Canberra Hospital for 20 years. Dr Scott died by suicide in June 2022.
The hospital's fetal medicine unit lost training accreditation in August 2022. The unit, which provides care for people with high-risk or complex pregnancies, suffered from sustained staffing pressures.
A number of senior staff from the unit have left or have gone on long-term leave and the unit has struggled to find replacement staff.
Health directors were warned earlier this year there was a "significant" risk to patient safety at the unit due to staffing shortages and there were fears they would be unable to provide a sustainable service for the first three months of the year.
But Ms Stephen-Smith has said the concerns did not eventuate as Canberra Health Services was able to establish strategies to cope with the shortages.
However, the college's review of gynaecology and obstetric make it clear this is not an issue isolated to the fetal medicine unit.
The fate of trainees in the maternity unit at Centenary Hospital for Women and Children will be decided in December.
Canberra Health Services has a lot of work to do to ensure it can maintain this accreditation and the college's draft review will be ringing alarm bells for authorities and for the government.
Ms Gallagher's comments that "we can't allow it to continue" ring true now just as much as they did nearly a decade ago.
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