The Health Minister took the same line as Prime Minister Jacinda Ardern, in blaming the previous National Government for the maternity services crisis.
"We are scaling up our medical workforces. I was certainly very clear in Opposition that the $2.4 billion that the previous Government stripped out of the health system has a real impact on the delivery of services. And as a Government we have ambition to build up those workforces over time. You can't unfortunately magic up specialists overnight. They take, in many cases, a decade to train.
"We set aside $2.45 billion in our first two Budgets for capital facilities - which is more than twice what the previous Government put aside in their whole nine years...we are signalling clearly that we are investing more, and they [DHBs] should invest in more staff so we can upskill and make sure that we are providing the health services that the public need and deserve."
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National's health spokesman Michael Woodhouse has said such statements are a "cop out", and DHBs were struggling under very small operational funding increases: "To blame the previous Government for the situation they find themselves in is actually quite insulting."
A Herald investigation has found maternity care for South Aucklanders fell below safe standards, as services struggled to cope with big increases in the number of pregnancies needing more care and monitoring.
Changes have been made or are under way, after a damning internal review found an 11-bed shortfall for maternity services, and linked a lack of resources to a death in 2016/17, and another two in 2017/18. Cases include:
• A newborn died after a delayed diagnosis of pneumonia. Monitoring equipment wasn't easily locatable, and there were major communication and documentation problems as staff struggled with double the number of induction of labours than normal.
• A baby was stillborn after a breakdown in the co-ordination of a woman's care, limited caesarean surgical slots and no allocation to a senior doctor.
• Health risk factors for baby and mother weren't properly picked up as a lack of doctors and midwives struggled with high workload. The child was stillborn.
DHB reports say substandard care "resulted in" or "led to" deaths, but a spokeswoman said those were summary descriptions of complex cases with a range of factors. Further details weren't released for privacy reasons, including more information about patients' health conditions.
After the review, the DHB launched one-year and three-year work programmes. Changes include a new maternity assessment clinic and more midwife, nursing and support staff roles, including senior positions.
Some women with babies in the neonatal unit will move in phases to another ward, freeing up 22 beds on the maternity floor. A new women's health building is about five years away.
Like other DHBs, Counties Manukau has little spare money and competing demands. Last month the Auditor-General noted the worsening financial position of DHBs, writing: "In just a few years, we have seen one or two DHBs experiencing financial difficulties to almost all of them budgeting for deficits [and many struggling to achieve those budgets]."
More than a third of Counties Manukau residents are among the country's most socio-economically deprived. That poverty, combined with related factors like rising obesity rates, has helped put enormous pressure on the DHB services.
As well as Middlemore, there are birthing units in Botany Downs, Papakura and Pukekohe. Births within the district have dropped to about 18 a day, but cases are increasingly complex.
From 2014-2017 women turning up in labour "unbooked" and with no antenatal care rose from 88 to 118 a year, for example, and 245 more women had caesareans. More than one in 10 pregnant women now have diabetes.
