The College of Midwives met with the Ministry of Health this week in its continuing quest for pay equity.

After the Ministry of Health’s co-design funding model project with the College last year, which calculated that a fair gross income for a self-employed midwife should be $241,000 for a caseload of about 40 births a year, the Ministry last month released the recommendation that the income of self-employed midwives should at least double.

At present a midwife has a gross income before business expenses and tax of about $100,000 for a caseload of 40 births, with no paid back-up and no recognition for being on call and the often long and unsociable hours.

In 2015 it was calculated that the average taxable income of a midwife working as a lead maternity carer (LMC) was $53,728. Midwives and mothers marched on Parliament this year calling for a decent income to stop overworked midwives leaving the profession.

Last week it was made public that the Ministry recommended against the Minister of Health accepting the new co-design funding model, which the Ministry had helped to develop, saying it would cost $353m a year – up $237m on the current cost ­– and was “unlikely to be affordable” in either the short or long term.

Frustrated at  the Ministry’s stand ­– and May’s Budget falling far short of what the co-design project had recommended ­– the College of Midwives met last week with Minister of Health Dr David Clark, followed by a meeting on Monday with the Ministry of Health.

College deputy chief executive Alison Eddy said Monday’s meeting helped to clarify a few points, including a timeline for developing a new funding contract, which members would be updated on shortly.

She said the Ministry indicated that many of the elements of the negotiated co-design model that the Ministry was happy to look at fitting into a new contract arrangement. The issues were more about the dollar amounts not the components of the proposed new blended funding model.

Eddy said a focus of the co-design had been to provide more income certainty for midwives, who faced income unpredictability, particularly if the caseload included a high number of women who ended up having elective caesareans or miscarried and did not receive a full course of chargeable midwifery care. The co-design blending payment model had sought a base payment in recognition of ongoing business operation costs faced by a midwife (such as their midwifery rooms, car, insurance and professional development costs) as well as a compensation payment for being on call, which was described as an under-recognised but critical component of the community midwife role.

Started by court challenge

The co-design project was triggered by the College’s 2015 historic pay equity claim under the Bill of Rights Act. That legal challenge led to mediation with the Ministry of Health in 2016 and an agreement in May 2017 to withdraw the court action in return for a 2 per cent funding increase and the Ministry agreeing to co-design a new funding model to resolve the College’s longstanding concerns about pay equity for self-employed LMC midwives.

The co-design project between the College and the Ministry of Health was completed in November year including its recommendation that $241,000 was a fair gross income for a full-time LMC midwife.

Recent information released under the Official Information Act showed that co-design partners the Ministry of Health not only recommended against the Minister of Health accepting the funding model as it was unaffordable but also because it was concerned that there would be significant flow-on pay relativity effects that would impact on DHBs and other providers of maternity services.

The result was that the Government’s first Budget in May did not mention the co-design model, and the $103.6m midwifery package in the Budget included only an 8.9 per cent fee increase for LMC fees, which left community midwives ‘underwhelmed’ and frustrated.

Clark said after meeting with the College of Midwives last week that the Budget was “a start” towards making midwifery more sustainable and it had always been clear that “we can’t fix everything in one go”. He also said the College left him in no doubt that the midwifery workforce feels it has been neglected and faced real concerns about pay, turnover, retention and the sustainability of rural midwifery.

“They [College] made clear their strong and clear expectation that real progress was needed,” said Clark, who is due to meet with the College again in late October.

Meanwhile the College-aligned midwifery union MERAS, which represents 85 per cent of the district health board employed midwives, is recommending its members reject a DHB pay offer as it fails to recognise their base claim for a pay differential over nurses.

MERAS co-leaders Caroline Conroy and Jill Oven told DHB midwives that based on the co-design calculations an experienced, full-time DHB core midwife should be earning about $130,000 a year. This is $30,000 more than if they accepted the DHB pay offer, which would see them earn about $100,000 ($70,000 in base pay plus about an extra $30,000 in over-time, penal rates for unsociable hours, leave entitlements and on-call allowances etc).

Community Midwifery Funding Co-design project findings:

  • LMC midwives currently deliver on average 53 contact, non-contact and travel hours per woman over the course of care (from early pregnancy to six weeks postpartum) and carry an average caseload of 47 women per year.
  • If 40 hours per week is used as a benchmark for 1 FTE, midwives currently work on average 1.25 FTE with some working upwards of 2 FTE, excluding on-call expectations.

Community Midwifery Funding Co-design project recommendations:

  • 1 FTE (fulltime equivalent) is set at an average of 54 hours per course of care and an average of 40 births per year (2,160 hours per year, 42 hours per week excluding on call time and urgent call outs).
  • Additional time and travel, recognising the need some women have for additional midwifery care, is compensated over and above a straightforward case of 48 hours, in increments, up to twice a straightforward case (96 hours).
  • One-quarter of the population is likely to require some additional time and travel and 5 per cent of the population is likely to require significantly more time and travel.
  • Fair and reasonable remuneration for the scope of the work, in the context of the history of this role and in comparison to other roles with similar responsibility, risk and working conditions is $170,000 per annum per FTE, excluding on call and operating costs.
  • Fair and reasonable remuneration for the unique on call expectations is $30,000 per annum. This includes compensation for time on call and call outs.
  • Fair and reasonable operating costs are $41,000 per annum.
  • This means a total gross income of $241,000 for a 1 FTE workload.
  • Other factors to support the sustainability of the workforce are urgently progressed including a national locum service, recruitment and retention incentives, and separate payments for single service episodes, including miscarriage care and second midwife birth attendance.

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