Closure of maternity services at Whittington Hospital, North London

news.bbc.co.uk/1/hi/health/8617460.stm

Just saw this now - does this include the Whittington? Has someone spoken to the local Conservative candidate? I guess with the election so close all these things up in the aair.

For evidence, start with this:
www.healthcareforlondon.nhs.uk/assets/Publications/A-Framework-for-Action/maternityand NewbornReport.pdf

Note the recommendation that obstetrics units have 98hr+ per week consultant presence. That requires a reasonably large unit to be viable.

The evidence is clear across lots of healthcare: the higher the throughput for complex procedures (ie what obstetricians are supposed to catch), the better the care. Read what Phil Hammond (MD in Private Eye and the hero who broke the Bristol hearts scandal) has had to say about the appalling intransigence of many clinicians to stop doing procedures where they know that throughput isn't high enough for safety.

I'm a huge fan of personalised care we had our first baby in a birth unit and our second at home. I recognise the risks of depersonalised care in a big obstetrics unit. But I also recognise the risk of unnecessarily poor outcomes where things are going wrong and consultants aren't available. Of course, travel time is an issue as you say but there's no point travelling to the closest hospital if it doesn't have a consultant to hand when you get there. (And incidentally, travel time is important but not overwhelmingly important, else we'd have to build about a gazillion hospitals all over the countryside)

Perhaps I'm out of line, and the Whittington is providing 168 hours of consultant cover for the 3000 births. Do you know? If that is the case, then there is ultimately an issue of whether it's right to spend that much on those births vs say shifting a tranche of births to other locations that already provide the consultant cover and also opening up more standalone birth centres or increasing the size of home birth midwifery teams. The budget is not unlimited, after all.

It's a really good question as to how the Royal Free, UCLH and other hospitals eg N Mids will cope with the extra births. I guess the answer depends on a few things, eg how close to capacity they are at present, what room there is to expand the capacity, how many births can be (and should be) managed in more appropriate settings eg home births etc.

Finally, on staff retention, there are lots of factors that play into staff retention including the size of the organisation (with some preferring the backup available in larger, others preferring the intimacy of smaller) -- but I think there will be other factors higher up the list. For example, Hospital A is renowned for autocratic consultants who treat the midwives like silly girls; Hospital B is known for having instituted true multidisciplinary teams. Unsurprisingly, it's B that has the better retention.

Whittingtonmum- I think they are hoping that lots of us will go to the North Mid instead, but it is really not the hospital of choice around here even though it doesn't take long to get there when the N Circ is moving. People in my community go to the Whit in general, or UCLH for planned sections - not the N Mid. Reckon a lot of babies will be born stuck in traffic on the way to UCLH if this goes ahead.

Erm I work in the NHS and was briefed by a manager at least 8 months back, staff across the NHS would be cut by 10%.
Thats before the evil Tories has a sniff.

Erm Go NuZanuLabour Go!!

Well, the inverse care law persists, that's for sure. But that said, both hospitals serve significant deprived populations as well. And the best PCT in London serves the most deprived community in London (Tower Hamlets).

But those two you mention are the local hospitals of the affluent!

No no no! They're not all falling apart. There are some really excellent maternity units out there: the Royal Free's birth centre and the UCLH neonatal care unit are just two examples.

The NHS is creaking in some places, but it's not all that bad. Nor should it be for £100bn quid! However, costs are rising fast and there's no extra money for the next few years, so it's going to be a painful transition.

LOL, tis okay. They're all falling apart anyway! The NHS is creaking at the seams!

I think I shouldn't name the hospital or do any more confirmations or denials, as it may have improved in the year since I last heard about it.

Not QE11?

Yes, they've spent lots of money on it. That's what happens if you have to keep on running unsustainable services, it costs more than a more sensible arrangement would.

There are lots of weak maternity services -- look at the Healthcare Commission investigation of Northwick Park, for example. But neither Northwick Park nor Chase Farm are the one I'm thinking of, which was further north, and never got on to the regulator's radar.

'there's one in the home counties north of London'

Well that is almost certainly Chase Farm then where I gave birth to my first!

What? But they've just spent £££££££££ on improving it!

I'm sorry to disagree with you, but I do. I'm sure lots of people have had really excellent care, but the clinical evidence is pretty unequivocal -- maternity units that are low volume tend to provide worse care. If you catch a doctor at the right moment, they might tell you the stories of which hospitals they know to avoid for maternity (there's one in the home counties north of London) because the care is unsafe, because the unit is too small.

There are too many maternity units across North Central London for the number of births happening. The Whittington maternity unit is not sustainable for high quality care at any reasonable cost.

I saw a protest march about this the other week. I too feel v as both my girls were born there. the fabric of the hospital is a bit grim but the clinical care was excellent.

how sad ds(16) was born there

I was born there a very long tie ago. What sad news. if there is a petition I'll sign up. To be a Londoner and be born at The Whittington is lovely.

Whitingtonmum, great blog. I shall watch the chat tomorrow closely.

I think this is the sort of thing we all need to do. Blog it, FB it, Twitter, MN, whatever forums you happen to be on. The more publicity generated the better.

Politicians scare surprisingly easily. Unfortunately, Trust CEs don't; so ultimately it has to be the politicians who are persuaded. That does include Local Councillors though.