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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?

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

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 18:21:32

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.

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.

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

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.

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 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.

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

What is a TSA please OP?

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.

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