Wednesday, February 23, 2011

More on Midwifery

I wrote on a blog here back in October that there was the beginnings of a threat to local midwifery services.
Since then things have moved on but I have to say that at this exact point in time I'm really not clear whether our midwifery service is going to be badly affected or just affected.
I had let Richard Davies at the Totnes Times, and Steve Peacock at the Herald know that something was afoot.
They did a dutiful bit of investigative digging but couldn't get any definitive word from Torbay on what the changes were going to be.
Their getting in touch with Torbay must have put the wind up someone though, because within days we had had calls from the Consultant in charge of the changes and one of the midwifery managers literally popped in to the surgery to attempt to reassure the doctors that the changes were going to have no impact on our service at all.
At that point I let the newspapers know of the reassurance, and Richard has since put in a piece to say all is well.
Now it begins to look again much more like that might not be the case after all.

South Hams had in 2009 a Home Birth rate of 11.3%- just below Glastonbury area I think, but the second highest in the country nonetheless. The England average is 2.7%. Some areas have only accidental home births.
This page shows a map on National Home Birth rates- demonstrating how high the south west is in general compared with other areas of England.
Our midwives in Totnes have been working for years at supporting home births, and if the statistics are anything to go by must be national experts by now. In a national survey only 22% of mums had met the midwife delivering them beforehand. In our area that is 43%. That is one of the major findings of effective team working in midwifery, and it is valued. If the proposed changes go ahead then this might suffer.
As doctors our main concern is that if midwifery services are reduced then midwifery led care will suffer. If that suffers then mums to be will end up more likely to deliver in hospital (possibly).
We know from the stats that Torbay has a Caesarean rate of around 25% of all deliveries.
It sort of flies in the face of progress doesn't it?
And why?
To attempt to save money.
As I understand it one of the major costs in providing midwifery services is the massive insurance required.
Having babies is still a dangerous business. 4.7/1000 births result in a dead baby statistically. (Not as dangerous here as in parts of Africa-184/1000 in Angola is the highest I could find)
Health trusts have to insure their professional staff against mishap. I don't have the costs but I have been told that relative to cutting staffing levels, the insurance costs outweigh the staff-cutting cost benefits vastly. The insurance costs won't change for cutting staffing numbers.

Torbay have written: "following extensive consultative work, the service is being reconfigured to safeguard the current high standard of maternity care that is nationally recognised as an exemplar, whilst acknowledging and facilitating the needs of an increasing number of pregnant women who have additional health and social risk factors, and are vulnerable".
They are doing this by "reducing the number of midwifery teams, but each team will have more midwives". So what was the previous ratio of midwives per birth, and what will it be after the changes? Expectant mums may now meet any of a large number of midwives, so the chance of continuity of care into their labour and afterwards is reduced.
Because each larger team covers a larger area, the worry is that the on call midwife in the team will be pulled all over the place geographically- which must make responsiveness to needs less. Some changes have been made to respond to the European working time directive, but this will include travelling times within the larger areas, and to and from the base for each midwife team. Getting in and out of Brixham (which is where the base is proposed to be for our midwives) can be a nightmare in the summer.
Why haven't they consulted AT ALL with the public or the GPs in this.

There are many more technical points and questions but that might make this all too long and boring.

All of my GP colleagues at Leatside have signed a letter drafted by Dr Morris to the Chief Executive of South Devon Healthcare Trust asking her to stop the process of change and review what is going on here.
This letter is copied below:

Paula Vasco-Knight
Chief Executive
South Devon Healthcare Trust

Dear Ms Knight

I am writing on behalf of Leatside Surgery with regards to our high level of concern over the upcoming changes that we have been informed second hand are going to take place within the midwifery service.  We have been told that our current provision of midwives will be dropping to 2 covering the Totnes area and that the base will be in Brixham.  We have real concerns over these changes.  Ten years ago our midwifery team was a nationally recognised team of 13 midwives just serving the Totnes area.  We also had the highest  home birth rate in the UK and national recognition in the media.    Over the years this team of 13 midwives has been reduced down to 6 and the home birth rate has dropped down from being the highest in the UK down to average. 

We have been in correspondence with the midwifery directorate and had reassurance that services to our patients will not be affected but we fail to see how dropping from 6 to 2 midwives will be of benefit to our patients.  We are also concerned that there has been no sign of any negotiation or consultation with any of the usual parties.  Certainly when this was brought up at the LMC last night there was general concern and surprise and I gather they will also be writing to you.  I also believe very little has been negotiated or discussed with the PCT.  Certainly for future commissioning the proposed set up is not one we would recommend as we foresee poor prenatal care and a substantial decrease in service to our local population. 

The whole change has caused a great deal of distress in the midwifery team who are concerned about the fragmentation of the team and increased journey times to their place of work.  There are also simple practical problems with the team being based in Brixham with the increased travelling times in the summer months due to increased traffic.  A simple journey which might normally take 30 minutes might very easily run into 2 hours or more. 

Andrew Lansley,  throughout the white paper consultations,  has stated that frontline services are to be protected and there has also been a push for an increase in home births and we fail to see how these changes would achieve either of these goals. 

We would welcome due process to be initiated on this project and it’s initiation date to be postponed until this occurs. 

Partners at Leatside 

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