• University Hospitals Plymouth Trust lacks midwifery-led unit
  • Trust’s maternity department says staff and patients are choosing other trusts
  • Director of maternity services asks for investment to “provide parity” to patients

A director of maternity services at a financially struggling trust have issued a plea to their board for investment amid reports their department is losing patients and staff due to inequitable service provision. 

Executive leaders of University Hospitals Plymouth Trust were told last month the maternity department “inevitably” loses patients to its acute neighbour in Cornwall because UHP does not have an alongside midwifery led unit. AMLUs are usually situated close to other medical facilities rather than being in a separate building. 

Despite delivering more births — nearly 5,000 annually — than any other acute trust in Devon and Cornwall, UHP only offers services at patients’ homes and on its labour ward.

This contravenes guidance from the National Institute for Health and Care Excellence, which states women should have the choice to give birth in either an obstetric facility, midwifery-led unit or at home.

The guidance followed the largest study of births in the world, which found nearly twice as many women had caesarean sections at obstetric-led units compared to AMLUs.

UHP’s neighbour to the west, Royal Cornwall Hospitals Trust, offers three midwifery-led units (including one AMLU) as well as a delivery ward and homebirth service.

According to UHP’s annual maternity report, published alongside the trust’s January board papers, this means patients living on the Cornwall/Devon border often choose to be treated at RCHT because “true choice” is offered, despite the trust being further away.

Additionally, a review of Devon’s maternity services — carried out in 2017 — concluded UHP’s patients “did not have equity of choice” compared to patients at Devon’s other acute trusts.

This has led to occasions when newly-qualified midwives have decided to leave UHP because they want to “provide midwifery-led care in a designated facility”, according to the report. 

The maternity report, by Sue Wilkins — the trust’s director of maternity services — called on the board to consider “the need for this provision to be fully discussed and considered to ensure we can ensure the best and safest care by providing parity for local families”.

Ms Wilkins added in the report that the department’s request was made with an “understanding” of the trust’s current financial situation. 

In December, the trust, which has an income of £545m, increased its forecast deficit by around £20m, from £22.5m to £42m.

A trust spokeswoman said having an AMLU was part of the trust’s strategy.

“There is commitment to progressing [it] alongside other competing priorities”, the spokeswoman said, although she added further scoping would be needed to estimate the cost of establishing an AMLU.

The trust was not able to provide numbers for how many patients and midwives have chosen to be treated and work elsewhere due to the lack of choice.

The trust’s maternity service was rated “good” overall by the Care Quality Commission after an inspection in August and September last year. 

UHP is among the 21 trusts given seed funding by the Department of Health and Social Care to draw up major capital plans which will be delivered between 2025 and 2030.