System must show ‘more courage’ to relocate hospital, says CEO

Kathryn Thomson has spent the last decade articulating the safety risks attached to the standalone nature of Liverpool Women’s Hospital and trying to secure capital funding to move the services to the new Royal Liverpool Hospital in the city centre.

She told HSJ: “There is that tension with campaigners who want to see the services stay here, but Liverpool CCG has tested this city previously. And really, when it comes to the safety of mums and babies, should we be listening to political campaigners, or should we be listening to patients, midwives and consultants?

“I think it absolutely needs more courage. We had that courage previously with the [former] regulator Monitor, when we first started to articulate some of the issues and concerns. NHS Improvement were also very supportive, as well as Liverpool Clinical Commissioning Group.”

Ms Thomson, who is retiring after 15 years as CEO of the trust, said relocating the services could cost up to £200m, but that the current LWH site, which was only opened in 1995, could be repurposed for other uses.

She added: “It will now be for the new CEO, Cheshire Mersey ICB and NHS England to determine what that future is. But I’ve been around this clinical sustainability issue now for over 10 years. If you were to speak to the consultant body here today, they’d still tell you, it’s becoming increasingly important that these services are co-located with the acute hospital.”

Key risks include the lack of bowel and renal surgeons on site, as well as intensive care beds, a blood bank and imaging services. This can lead to critical delays when there is an unexpected problem like a cardiac arrest. Proposals to move the services were previously backed by the Northern England Clinical Senate and restated by consultancy firm Carnall Farrar earlier this year.

However, relocation has previously been opposed by former North West MP and ex-LWFT chair Rosie Cooper, who now chairs Mersey Care FT, while senior sources in the region have suggested to HSJ that the volume of harm due to the configuration is relatively small and there are bigger priorities on which to direct capital funding. Liverpool has already seen major investment in the new Royal site in recent years.

But Ms Thomson argued it was wrong to view the harm through numbers, as the impact of every death and harm caused is colossal for patients, families, and communities. She said the trust is currently in the process of reviewing incidents to attempt to quantify the problem.

The recent Maternal, Newborn and Infant Clinical Outcome Review Programme was also clear that hospitals must treat pregnant women “the same as a non-pregnant person” unless there is a clear reason not to, which she said was impossible to achieve without co-located general acute services.

Overhaul of regulations needed

Meanwhile, Ms Thomson said the levels of complexity and acuity now faced by maternity departments do not appear to be understood at a national level, and the payment tariff for maternity care still falls far short of the real costs of care.

Zero vacancies

LWFT has recently managed to reach zero vacancies within its midwifery workforce, probably making it the best-staffed service in the country, said Ms Thomson.

This is largely thanks to a new preceptorship scheme, increasing the amount of support given to new midwives, which has helped increase retention rates for student nurses from 40 per cent to 98 per cent.

She said: “It’s been so successful that I still pinch myself. It was a concept that some of our midwifery leaders came up with about three years ago, which really targets the newly qualified midwives with a dedicated team who are available to them while they’re on shifts, so they really support them, nurture them, encourage them, come and work alongside them.”

‘This is where Scousers are made’

Following Ms Thomson’s retirement, the leadership of LWFT is being merged with Liverpool University Hospitals.

Asked if she was concerned it could suffer from a loss of identity and having to share a CEO who has less time to champion its services, she said: “I’d be knocking on [the incoming joint CEO] James Sumner’s door and he knows that. But genuinely I think he recognises how important this place is to the city. This is where Scousers are made.

“There’s been a women’s offer here since the 1700s, so it runs really deep through its heart. If the staff felt they were being sidelined, not paid attention to, they’d be vocal about it, I’m confident of that. I don’t think James quite believes me at the minute, but it will steal a bit of his heart.”

Kathy Thomson has warned of confusion among trusts around how they are being judged by external bodies, with much of the scrutiny coming from people who lack knowledge and experience of maternity care, and too many initiatives that “somebody thinks are a nice thing to do”.

The retiring CEO of Liverpool Women’s Foundation Trust has called for a “focused rethink” around the quality measures services are assessed on, by a group who “understand” maternity services, board governance, and the challenges of balancing risks.