How many more maternity units would go?

(34 Posts)
mulberrybush Mon 05-Aug-13 15:13:53

The administrators for Mid staffs have delivered their recommendations, and it is worse than we expected.
The two main units that will be affected if the proposals go through are Maternity and Paediatrics.
The reason for closing down the maternity ward at the hospital was that it currently delivers only 1700 babies a year, rather than the 2500 that the experts think justify a consultant led unit.
So it would be too big for a midwife led unit and too small for a consultant led unit.
The maternity unit here has a very good record, with an impressively low number of C sections.

The argument for closing this appears to be financial, though it is presented as a "potential future safety risk".

I have always feared that if the recommendations for Stafford go through this will be the start of downgrades throughout the country. I looked up a sight giving the numbers of births per hospital in 2011, and it would seem, looking at that as if another 20-25 maternity units could be on the hit list.

In Stafford the community is fighting hard against these proposals, as we start the consultation period tomorrow.

Would it bother you to lose your maternity unit? Should we all meekly accept that the experts know best? Do we need national debate on this?

mulberrybush Mon 12-Aug-13 00:28:09

Oh - sorry! The TSA are the "Trust Special Administrators". They were set up by Monitor, which is the financial regulator for Foundation Trusts, after their CPT or contingency planning team reported that the trust was "Financially and Clinically unsustainable"

"Sustainability" is the key word in all of this. They are looking at the trust not so much in terms of its current performance, but if it appears to be sustainable for the medium to long term. It doesn't, but there are many more hospitals where the same applies.

The funding hospital trusts receive, for the level of demand that they face is insufficient.

Quodlibet Sat 10-Aug-13 19:55:48

What is a TSA please OP?

mulberrybush Sat 10-Aug-13 19:06:26

The TSA would say that their recommendations were driven by the fact that no organisation bid to run maternity and the CCG do not propose to commission it.

The Clinicians would say that they would not now setting up a "new consultant led service" and this would count as a new service despite the fact that it is an established and successful unit - unless there was a minimum of 2500 births a year. because it would need 2500 to give them the level of consultant cover - 10 consultants - they see as desirable for the future, (despite the fact that almost no service has it now)

I think it is valid to ask the question - what is driving this "clinically led" decision, and I think it has to revolve around a changed perception of risk and safety. - which is what may threaten other units.

I do not know if the clinicians take a particularly cautious view of Stafford - perhaps because of the extraordinary level of litigation that was stimulated here by the combination of the No win no fee lawyers, the campaign group and the press.

I do not know if the clinicians are particularly nervous about maternity in view of the Morecombe bay campaigners and the very high level of damages that can be payable in the case of maternity errors.

I do know that if the recommendations are allowed to stand that many ordinary women will be denied the option of seeing maternity as a simple natural part of their lives, and also that the continuity with community based support, which will be delivered at Stafford, pre and post birth is bound to be weaker.

The TSA are I think intended to give a steer on integration and community services. They say and I agree that they have really not got to grips with this at all. All the conversations remain to be had.

LaVolcan Sat 10-Aug-13 10:16:33

So maternity care could collapse completely then in Stafford, and if this model is perpetrated throughout the country we might end up with a few regional super hospitals? What is happening with the Community Services or is that outside the remit of the TSA?

They seem to have completely bought the idea that maternity care equals high risk obstetrics. The nearest comparison I could make would be if everyone with high blood pressure was referred to a specialist stroke unit, just in case.

mulberrybush Sat 10-Aug-13 00:07:36

it is getting to the co-ordinated planning part that seems to be so difficult. It is clear that with the pressures on the health service, demographic challenge etc. that there is a need for things to be done differently.

The TSA process here is the first of its kind. I perhaps naively expected that there would be a total review of the needs and the services, here and in the surrounding hospitals in order to work out how the services meet the needs of the population and what savings or improvements if any could be made.

It hasn't been even remotely like that. The TSA sought for expression of interests from organisations that wanted to bid to run all or part of a service. It is noticeable that none of them bid to run maternity, and that the CCG indicated that it would not commission a maternity unit.

The TSA process has - in my view, and the view of most of the other people closely involved in watching the process, been pretty disastrous, and there are messages going back to Westminster to strongly suggest that no other community should be put through this.

The maddening thing about it is that we are now really 1 year into the process, and most of it has been conducted in conditions of commercial confidentiality, so the conversations one needs to build a co-ordinated service simply cannot take place.

We are now stuck in a process that will grind on until 31st December, and is very unlikely to produce a result that anyone is happy with!

It really is a mess, and I really really hope that no other community has to suffer this.

blondieminx Fri 09-Aug-13 19:15:40

Watching this thread with interest, here in Colchester the Hospital Trust and CCG are looking at reconfiguring services here and one of the options being looked at was to close one of the MLU's.

YY we need a national debate but it is blindingly obvious that maternity and parents are a very low priority for this government, as the failure to recruit extra midwives and the new childcare "improvements" show. sad

LaVolcan Fri 09-Aug-13 18:49:45

Rhianna - yes and no.

I am not a midwife. My own midwife when I had my son said that very often things do not change suddenly from low risk to high risk and that it was her job to be alert to potential problems. Obviously with a cord prolapse or an abruption an emergency could suddenly arise.

OK so CLUs are important - I don't think that anyone has said they are not, but what of the woman who gets into hospital but the staff are so run ragged that she and her partner are left in a room to get on with it? Who is keeping an eye on what is happening to her? Or worse the woman who gets turned away because the unit she is booked into is too busy? How much support is there at the roadside if/when an emergency happens?

This is exactly the situation that mulberrybush is trying to alert us to - that if we have a few super CLUs a significant number of women will in practice end up with nothing.

Quodlibet Fri 09-Aug-13 18:21:32

Yes LaVolcan - and we should pay attention to David Cameron only last week using the expression 'bailing out A and E' as if funding a struggling health service is somehow equivalent to the bank bailout. That is an intentional use of the phrase.

Rhianna1980 Fri 09-Aug-13 18:20:27

Levolcan
While I do agree agree with you on the need for giving more personalised treatment for women etc and that high risk women's care has improved in the last few years, I don't agree with you on the fact that we should go back to basics with maternity care. It is proven that giving birth can suddenly change from low risk to high risk in few minutes - matter of life and death. CLU are as important as MLU. They work and compliment each other.

Quodlibet Fri 09-Aug-13 18:19:18

The thing is it's not about a lack of health fusing to spend. Last year £2bn was underspent by the NHS and returned to the Treasury (so 1/5 of the amount Rihanna is saying goes on foreign aid). The problem is how the money is organised and spent, and how services are commissioned, which is only going to get more fractured with the Health as Social Care Act. There doesn't seem to be any overview - though people assume there must be - between closing a 'clinically unsustainable' unit and the equivalent services being readily available elsewhere. Look at London where something like eleven A and E units are under threat. There isn't a magic alternative A and E service if those go - the reality is that other units will be dangerously overrun.

LaVolcan Fri 09-Aug-13 18:05:28

I don't think we really spend all that much on foreign aid. We could ask instead why did we bail out the bankers to the tune of a few billion and why should the NHS bear the brunt of those costs?

However, what I feel is really needed, and just won't happen because there is no co-ordinated planning going on, is something on the lines mulberrybush suggested:
There is maybe a case for screening out those people identified as high risk, to go to the "super hospitals", whilst allowing the majority to have a much more natural and personal service in familiar surroundings.
It's this second bit which is definitely falling by the wayside. We need to have some sort of debate as to what basic entitlement to maternity care is necessary for all women. I just don't see that happening. My own feeling is that things have probably improved for women with high risk pregnancies but for the average woman things have gone been going steadily backwards over the last ten years or so.

mulberrybush Fri 09-Aug-13 17:57:32

Was seeing some stats on maternal deaths in this country and in Africa. Cant remember the figures, but the difference was pretty shocking. The commentary made the point that a tiny number of deaths here may result from medical error, but that compares with the many hundreds of deaths occurring in Africa because there is no medical support.

One of the big problems that we have here is that most people would like more to be spent on health, care, education and many other important things, but it is pretty rare for a political party to have the courage to go to the polls saying "we are going to increase taxes". At some point that may be the only realistic option, but I do not know if people are ready for it yet.

Rhianna1980 Fri 09-Aug-13 17:30:35

I did say keeping a fraction of the foreign aid not all of it.

Also , when the times are hard surely you spend money to look after your own country first before helping others?

SunnyIntervals Fri 09-Aug-13 17:22:25

But how many people would die in the developing world?

Rhianna1980 Fri 09-Aug-13 17:20:01

A billion pound a month in aid is sent to foreign countries while they are trying to save few thousand pounds here and there in the NHS and closing down maternity services like OP's.

How many state of the art hospitals and schools etc would we be able to build every year if we kept a fraction of this foreign aid?

mulberrybush Fri 09-Aug-13 13:28:25

Just thinking SunnyIntervals. maybe people just don't "get" something so significant as a maternity unit closing down. They will assume that it has to be for a very good reason, and they show a touching faith in expert opinion.

When the TSA did its presentation to the public they kept on harping about the way that they had gone to the Academy of Medical Royal colleges, and how all their proposals had been signed off by them.

What I felt is that there is actually quite a lot of difference between the experts, especially on maternity, and I would have liked to see the support for local options actually made clear to the public who will respond to the consultation.

The royal colleges know that the finances are stacked against them, and they are protecting their professions in the best way they can, by voting for centralisation. To me this feels as if it is pulling us in the opposite direction to the other big imperative, which is to develop seamless, integrated care, with close cooperation between primary, secondary and community care.

The government have played a blinder in delegating decisions to the "independent, expert, clinicians". Great in theory - but the decisions these people make is inevitably determined by the treasury and government policy.

So when maternity units are closed, it is hoped we will see that it is nothing to do with government policy and we can be quite certain that it is all for our own good!

LaVolcan Fri 09-Aug-13 11:58:04

I think one of the problems is that women have an idealised picture of CLUs presented to them, and only the medical considerations are discussed - how if/when it goes wrong, the Consultant will be on tap; if they want an epidural they will just have to ask and it will be produced. There seems to be little mention of how good midwifery from a known attendant can prevent problems arising.

I know that the above was the case when I was having my children. I was told I had 'got' to have a Consultant, if it went wrong he was the best. Yes, fine, I believe he genuinely was, but really, how good is a name on your notes? It is the people who actually attend you who matter.

The sad thing will be that people won't realise what they have lost until it has gone. Fairly locally to me Chipping Norton MLU was closed last year to deliveries. It has now reopened, but I wonder if the damage has been done and that women will automatically go elsewhere? The nearest alternative is Banbury CLU which only does 1500 deliveries, so that has also been under threat. (I am not sure what the position is at the moment). Meanwhile, earlier this year, the JR in Oxford has had to close its doors at least once. So how much support do you get when driving round trying to find a hospital which can take you?

Sorry, bit of a rant there.

MiaowTheCat Fri 09-Aug-13 11:51:46

I'd be delighted if our very local maternity unit closed - the way they treated us was so appalling. Logistically it's never likely to though (we regularly have local hospitals closed to new admissions as they're so full on the labour ward) - but it does need a large rocket up its arse regarding patient care.

SunnyIntervals Fri 09-Aug-13 11:42:30

What is very sad is the level of interest in intrusive bounty ladies when compared to this:

Pressed into signing up for bounty? A scandal!

Losing your maternity unit? Silence sad

mulberrybush Fri 09-Aug-13 09:43:43

Thanks for those who have taken the trouble to post on this. I agree. It is very hard to get people to understand the level of the threat.

I am well past child bearing age now. but I know that when I had my baby it was important to feel that I knew were I was going, had seen round the unit, met some of the midwives, and knew about their approach to the birth.

I was 40 when I had my (surprise) baby, after waiting 12 years. and knew that there was a real danger that I would be treated as high risk and subjected to more intervention tnan I wanted. It was important to me that the hospital gave me enough support to deliver naturally.

Had a meeting last night with the MP who is being very proactive in trying to find a way through the threats to our services, I think he rightly identifies that it is about our perception of risk.

Having a child is not risk free, we all know that, and we know that there are a range of different risks.

What we are being asked to do in Stafford is to increase our risk, from access and travelling time, in order to decrease risk for the hopefully small number who may need some complex intervention, that can only be delivered in a "super hospital" with all the kit.

I hope that some kind of middle way can be found. There is maybe a case for screening out those people identified as high risk, to go to the "super hospitals", whilst allowing the majority to have a much more natural and personal service in familiar surroundings.

People need to be aware that if their unit does under 2500 births a year it will be regarded as "financially unsustainable" for a consultant led unit, (there are around 20 consultant led units in this position).

The guideline for a "clinically sustainable" unit of around 2500 births would be a staff of 10 consultants, to maintain consultant cover for a specified number of hours. Currently only around 18% of maternity units are meeting this kind of level of cover.

Rhianna1980 Tue 06-Aug-13 19:04:44

Yep
Probably also because not all ppl affected come on this forum to voice their concerns. Also, People reading the news will feel bad for others in the affected areas but quickly forget about the news because their own maternity unit in their own area is in full working order so theres nothing to worry about. But when it's the unit in their own area they will be the first to complain .
Maybe I am wrong ...?

LaVolcan Tue 06-Aug-13 15:16:10

Quite Rhianna. It's madness, isn't it?

Nearly 24 hours on from when OP first posted, there have only been 12 messages, (13 with this), so it looks as though people don't care enough. Either that, or they don't know what to do, or just accept it as one of those things.

Rhianna1980 Tue 06-Aug-13 14:32:49

Just when you hear and read about maternity units closing their doors because they are over capacity, then you hear about the NHS wanting to shut some maternity hospitals to make the problem worse.

SunnyIntervals Tue 06-Aug-13 14:03:49

They should be concentrating on learning from centres of excellence, not closing them. The Friarage in Northallerton, which is an amazing award-winning unit is also under threat. sad

LaVolcan Tue 06-Aug-13 11:52:54

It's depressing, isn't it? The whole emphasis is on acute high tech care but there is a vast need out there for 'old fashioned' midwifery for childbearing women and nursing care for the sick.

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