How many more maternity units would go?

[mulberrybush]

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?

[LaVolcan]

I read about this in the paper last week, which was passed off glibly because obstetrics needs specialist care. Where would the nearest hospital to Stafford be otherwise - North Staffs RI in Stoke? For those who genuinely need specialist input then yes, they may be better off elsewhere than Stafford, but they probably don't get referred to Stafford in the first place.

What about the 70 odd % of women who don't need obstetric care but do need decent midwifery? Are we going to carry on with the present farcical situation where hospitals are too busy, so the labouring woman gets turned away, and in practice may be unattended for much of her labour?

Now if they beefed up Community midwifery and opened an MLU so that those not needing the specialist input had a decent alternative of homebirth/MLU it would probably work out well. Will that happen? The quick answer will, I am sure, be no.

I am past the stage of having children myself, but it does make me angry and I fear for the standard of care my daughter/daughter in law will have in future. If you have a problem - fine, if you have a straighforward pregancy well, your on your own.

Yes, we do need a debate. One which in my opinion is long overdue.

[LaVolcan]

Sorry, to add - wasn't it A&E and general care which has been the problem in Mid Staffs? So why close Pediatrics and Maternity. Why not close the problem areas?

[VivaLeBeaver]

There's. consultant led unit near here which I think has about 2200 births a year and they're talking about turning it into a midwifery led unit.

When they do that they will lose a lot, more than half of the births I'd guess. A lot of women won't be suitable for midwifery led care, others will want an epidural or just want to deliver in a consultant unit.

These women will have to travel further to give birth.

If you look back 20 years at Grantham Hospital they lost their paed and consultant obs units at the time of Beverly Allit. The midwifery led unit has dwindled in numbers over 20 years and last year had 100 deliveries. It's been announced it'll close next year I believe.

[mulberrybush]

There was never a problem with Maternity or Paediatrics, Both have a very good reputation.
The problems that occurred in A&E and acute were mostly around 2006/7. and were not at the level that press has suggested. CF the 13,000 "excess deaths that the press predicted for the Keogh 14 hospitals which turned out to be nothing of the kind, Same statistics involved! - they don't do what the press think they do!
The reputational damage done to the hospital by the dodgy stats has had a knock on effect on patient choice so mums went elsewhere, resulting in a drop of births which meant unit now seen as too small for consultant led.
MLU is not being seen as an option by the TSA. Possibly could press for this, but the consensus is that once you have an MLU a lot of mums play safe by choosing a near by consultant led.

I think they want to build up the super hospital, in Stoke, which also just happens to have big PFI debts! (You will find that this coincidence occurs with many downgrades!)

The model that the TSA seems to be working towards is something that was the fashion in USA some years back. Hub and Spoke. So the spoke hospitals do all the prep stuff and the Hub hospital does all the treatments, births, acute ops, as well as the obvious stuff like stroke, trauma etc.

I understand that this is now out of fashion in USA and they are shifting towards Big Hub & little Hub clusters, that would leave more of the work being done in the small hub, with staff rotation to ensure skills & training kept up to date.

As I have said, I think that we are being used as the guinea pigs here. If there are mums nationally who think that this issue matters, and want to keep DGHs as viable places to have babies, then I think we need your help now.

I only drop into Mums net occasionally, but if you think there is anyone here who could help stimulate debate, then I would be very grateful.

[mulberrybush]

just to add to LaVolcan. Staffs is now seen as one of the 20 safest hospitals in the country. Even now getting very high Friends and family scores. The TSA are clear there is no safety problem - but they hint that there could be one in the future as the service is too expensive and hospital will struggle to recruit and retain staff.

It is about money.

[LaVolcan]

So I think you need to mount a campaign (if there isn't one) as they did with Lewisham Hospital, because it's not about standards of care or safety.

[mulberrybush]

There is a massive campaign. We had a march of 50,000 people in April, virtually unnoticed by the press!
There is an impressive community led cross party campaign that is currently out there working through the way forward.
The point that I am making here is that Stafford is the thin end of the wedge. We can only fight this by making the point that centralisation to services at a distance from the community is not the best answer.
Stafford is fighting hard. It is time for other communities who may not even realise yet that there is a threat to their hospital, to wake up, see the threat, and start making the case for good safe, local services.

The Don Berwick review, which comes out today is likely to increase the pressure on smaller hospitals. Providing safe staffing levels for smaller teams is more expensive, and this will put many more hospitals at risk. It safe staffing levels are defined, which may happen today, then this will put many hospitals into a situation where the risk of litigation is too great. They will have to axe services.

[izchaz]

I can give you a pretty good example of what happens when services are removed to a location outwith the city: Edinburgh Royal Infirmary.

-travel to access services has been affected - parking is extortionate, buses are sometimes patchy, taxis often won't take you, and ambos have to cover increased distances to get to you and then on to the hospital.
-services have not improved - the new building was too small to meet demand before it was even finished, the calculations used to work out population growth and health care needs were too conservative, so there is not enough space, no budget to meet staffing need and not enough time to get anything done. Bed constraints mean you get turfed out before you're ready or your home package of care is in place, or you get transferred miles away to another "big" hospital.
-smaller community units have suffered; either from total closure, or from staff-drain as they are moved to the bigger unit.

Net result: public confidence in the service is diminished, standards of care have fallen - even though the new building is state of the art -, the hospital routinely misses guidelines and targets for service provision (from waiting times to in-hospital transfers etc) and the hospital trust is losing money hand-over-fist paying the fines and litigations it incurs for not meeting the care needs of the people through the doors.

[LaVolcan]

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.

[Rhianna1980]

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.

[LaVolcan]

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]

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 ...?

[mulberrybush]

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.

[LaVolcan]

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.

[mulberrybush]

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!

[Rhianna1980]

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?

[Rhianna1980]

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?

[mulberrybush]

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.

[LaVolcan]

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.

[Quodlibet]

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.

[Rhianna1980]

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.