Maternity review warns units may close without reform

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STRUCTURE: A report into maternity services across Cumbria and North Lancashire has recommended maintaining existing consultant led units, but leaves the door open to close two of them unless fundamental reforms are achieved.

The independent review by the Royal College of Obstetricians and Gynaecologists recommended the units at Carlisle, Lancaster, Whitehaven and Barrow should be maintained, and that “alongside” them midwifery led units should be developed at the first two sites.

However, it says keeping the four units open can only be supported on “safety and sustainability grounds” if there is “increased investment” and reform.

The fear of losing maternity services in the area had reached ‘fever pitch’, the review said

Consultants at North Cumbria University Hospitals Trust would have to work in the trust’s two units in Carlisle and Whitehaven, the review says, while consultants at University Hospitals of Morecambe Bay Foundation Trust would have to work across both its Lancaster and Barrow units.

The Whitehaven unit at West Cumberland Hospital and the Barrow unit at Furness General Hospital see among the fewest number of women annually in the country, meaning clinicians working just at those sites can become deskilled.

Cumbria Clinical Commissioning Group’s medical director, David Rogers, told HSJ the workforce reforms would also involve “a much more hands on… almost first on call [consultant] presence” at the two smaller units to ensure the availability of experienced doctors to deal with complex cases.

The review says a project team should be set up to report within a year on the feasibility of implementing its recommendations.

However, it warns that if the reforms cannot be achieved, the only option may be to close the Whitehaven and Barrow units or to replace them with midwifery led units.

The review was commissioned by Cumbria and Lancashire North CCGs in November to look at how maternity services in the region could be put on a sustainable footing following longstanding concerns about their quality.

Last month an investigation led by Bill Kirkup concluded that failures of care in Furness General’s maternity unit between 2004 and 2013 may have contributed to the deaths of three mothers and 16 babies.

While the Whitehaven and Barrow units lack the “critical mass” of patients thought necessary to maintain skills, the region’s geographical isolation and long travel distances mean there are also risks to centralising services.

The royal college’s review says it was “very clear… that women, the CCGs and the majority of healthcare staff” wanted to keep four consultant led units, and that fear of losing maternity services had reached “fever pitch”.

It adds that past attempts to reform the services had been stymied by “changing health policies and regular organisational restructures”.

Repeated failed attempts to tackle the issue had left people “anaesthetised to engagement and lacking trust in the rationale and recommendations of each subsequent review”.

However, Dr Rogers said the latest review was different.

“The difference this time is that they have come out with a preferred option… which does give us a way forward,” he said.

“It gives us the benefit of having had the input from the college, and the confidence that if we can implement this … it does fulfil the guidelines and achieve the standards.”

He said he did not think the recommendations would be superseded by a national review of maternity services currently being carried out by NHS England.