NHS leaders, faced with the challenge of sustaining smaller, local maternity services across large rural areas, have announced a clear, if controversial, policy. Give up; close the local units, and make those expectant mums travel.
Quite understandably, these same leaders recognise that this policy will make them extremely unpopular: so they have coupled their claim that closures are the “inevitable” conclusion with the demand that elected politicians give them their support, or, to use a military analogy, give them “air cover” for their retreat.
Matthew Hopkins, director of the NHS Alliance’s acute and ambulance network, summed up their view, declaring:
“Local and national politicians have a key role to play. They must have the courage to make the case for patient safety, offering air cover for change. We know this can be done. But it is difficult, and local NHS leaders need that support.”
Who, some will ask, are the NHS Alliance? Doesn’t it sound like the type of organisation that is looking to advance in strength, rather than retreat in disarray?
It is in fact the merger of two previous organisations, the NHS Confederation, and NHS Providers – each of which at times managed to speak up for the NHS and argue the case for sufficient funding to deliver efficient and safe services. The combined organisation, however, lacks the collective will to say boo to a goose.
Of course it claims to be very bold and dynamic:
“We represent, strengthen and support providers and commissioners of NHS care so that the NHS performs at its best and improves patient care across the UK – representing frontline reality to government, shaping policy and building capability. We work across the whole NHS as well as within its individual sectors.”
This would be more convincing if we could see signs that instead of drawing up a list of up to 20 smaller maternity units (out of the 155 consultant-led units across England) that should be closed to make life easier, the NHS Alliance was looking for ways to get the local and national politicians to support a demand for the funds and flexibility to keep smaller, often rural maternity services open.
That, indeed is what the Royal College of Midwives (RCM) are demanding. Their press release in response to the NHS Alliance was headed “Fix the staffing emergency, don’t shrink maternity services.” Hannah Leonard, the RCM’s Chief Policy Officer and Deputy Chief Midwife said:
“NHS leaders’ call to close one in eight maternity units is stark evidence of what years of underfunding have done. The problem isn’t the units, it’s a failure to invest in staff and hospitals.
“Closing units that serve some of our most rural and isolated communities means women travelling unacceptable distances in labour, and midwives redeployed miles from home to prop up stretched units. It would also widen the inequalities we already see in maternity outcomes.
“The Government and NHS leaders have a responsibility to make sure every woman can access safe care close to home and to find solutions to this problem.”
Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists (RCOG) also rejected the proposed loss of up to one in eight maternity units. She said the government should commit to “expanding the maternity workforce to ensure safe staffing levels, along with investment in training and retention of dedicated staff:
“The distinct needs and challenges of smaller units, especially in rural and coastal communities, must be recognised and supported. There are other solutions to our workforce challenges that are far safer than closing maternity units, and these should be explored.”
The problem for the NHS leaders and for ministers is that there is already a live example of the consequences of closing a smaller rural maternity unit – in Barnstaple in North Devon, where the loss of the service, allegedly because of staff shortages, has been hotly contested.
Between the closure in early August and October 12 local Tory MP Geoffrey Cox calculated that 194 women have had to have their child in Exeter, a tortuous 43 miles – and a 70-minute car journey – from Barnstaple, and up to 50 miles from other parts of North Devon.
Andy Burnham, responding to LibDem leader Ed Davey has agreed that such distance and delay in accessing services is not acceptable. In fact, far from giving air cover to this closure, politicians have been stung by the level of local anger. There are plans to reopen the unit, now new staff have been recruited.
The other problem for those arguing for centralisation of maternity care into bigger units is that recent claims that bigger maternity units are essentially safer runs up against the recent series of scandalous failures in quality of care in maternity services – almost all of which have been in larger hospitals.
By contrast a 2020 report Maternity Services in Smaller Hospitals: a Call to Action, jointly produced by the Nuffield Trust, RCM and RCOG, disputes the conventional wisdom that smaller units are by definition less safe. It points out that:
“Although the closure of maternity units in smaller hospitals may superficially appear to solve a number of problems, in reality it leaves local hospitals at greater risk of merger or closure.
“In rural and remote areas, the closure of maternity units presents particular problems. The evidence suggests that longer transfer times and poorer support for obstetric emergencies offset any gains potentially offered by delivery in a larger unit. The lack of maternity services also deters younger people from moving to or staying in rural areas.” (emphasis added)
The report also notes that things are done rather differently in other countries:
“Units in the UK that manage between 2,000 and 2,200 births a year are considered to be small. Interestingly, such units are large by international standards. In France, for example, more than 55% of deliveries are carried out in units with fewer than 2,000 births a year and around 20% in units with fewer than 1,000.”
It turns out that properly centralising services is not necessarily a cheaper, let alone a cost-free option, since it often requires very large capital investment, and when times are tight a revamped maternity service tends to look less attractive to health care leaders [and to politicians] than other calls for investment. And staffing issues are also a problem in large, stressful units. Indeed:
“In Sweden, for example, rationalisation of national maternity services negatively affected the health of mothers due to the effects of overcrowding at the remaining hospitals, while the positive impact on infant outcomes was insignificant.”
The paper concludes with a series of recommended policies to make local, smaller units viable. A worthy alternative to the NHS Alliance’s call to run up the white flag, close down small units – and beg local MPs and councillors to help share the blame.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
NHS leaders, faced with the challenge of sustaining smaller, local maternity services across large rural areas, have announced a clear, if controversial, policy. Give up; close the local units, and make those expectant mums travel.
Quite understandably, these same leaders recognise that this policy will make them extremely unpopular: so they have coupled their claim that closures are the “inevitable” conclusion with the demand that elected politicians give them their support, or, to use a military analogy, give them “air cover” for their retreat.
Matthew Hopkins, director of the NHS Alliance’s acute and ambulance network, summed up their view, declaring:
“Local and national politicians have a key role to play. They must have the courage to make the case for patient safety, offering air cover for change. We know this can be done. But it is difficult, and local NHS leaders need that support.”
Who, some will ask, are the NHS Alliance? Doesn’t it sound like the type of organisation that is looking to advance in strength, rather than retreat in disarray?
It is in fact the merger of two previous organisations, the NHS Confederation, and NHS Providers – each of which at times managed to speak up for the NHS and argue the case for sufficient funding to deliver efficient and safe services. The combined organisation, however, lacks the collective will to say boo to a goose.
Of course it claims to be very bold and dynamic:
“We represent, strengthen and support providers and commissioners of NHS care so that the NHS performs at its best and improves patient care across the UK – representing frontline reality to government, shaping policy and building capability. We work across the whole NHS as well as within its individual sectors.”
This would be more convincing if we could see signs that instead of drawing up a list of up to 20 smaller maternity units (out of the 155 consultant-led units across England) that should be closed to make life easier, the NHS Alliance was looking for ways to get the local and national politicians to support a demand for the funds and flexibility to keep smaller, often rural maternity services open.
That, indeed is what the Royal College of Midwives (RCM) are demanding. Their press release in response to the NHS Alliance was headed “Fix the staffing emergency, don’t shrink maternity services.” Hannah Leonard, the RCM’s Chief Policy Officer and Deputy Chief Midwife said:
“NHS leaders’ call to close one in eight maternity units is stark evidence of what years of underfunding have done. The problem isn’t the units, it’s a failure to invest in staff and hospitals.
“Closing units that serve some of our most rural and isolated communities means women travelling unacceptable distances in labour, and midwives redeployed miles from home to prop up stretched units. It would also widen the inequalities we already see in maternity outcomes.
“The Government and NHS leaders have a responsibility to make sure every woman can access safe care close to home and to find solutions to this problem.”
Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists (RCOG) also rejected the proposed loss of up to one in eight maternity units. She said the government should commit to “expanding the maternity workforce to ensure safe staffing levels, along with investment in training and retention of dedicated staff:
“The distinct needs and challenges of smaller units, especially in rural and coastal communities, must be recognised and supported. There are other solutions to our workforce challenges that are far safer than closing maternity units, and these should be explored.”
The problem for the NHS leaders and for ministers is that there is already a live example of the consequences of closing a smaller rural maternity unit – in Barnstaple in North Devon, where the loss of the service, allegedly because of staff shortages, has been hotly contested.
Between the closure in early August and October 12 local Tory MP Geoffrey Cox calculated that 194 women have had to have their child in Exeter, a tortuous 43 miles – and a 70-minute car journey – from Barnstaple, and up to 50 miles from other parts of North Devon.
Andy Burnham, responding to LibDem leader Ed Davey has agreed that such distance and delay in accessing services is not acceptable. In fact, far from giving air cover to this closure, politicians have been stung by the level of local anger. There are plans to reopen the unit, now new staff have been recruited.
The other problem for those arguing for centralisation of maternity care into bigger units is that recent claims that bigger maternity units are essentially safer runs up against the recent series of scandalous failures in quality of care in maternity services – almost all of which have been in larger hospitals.
By contrast a 2020 report Maternity Services in Smaller Hospitals: a Call to Action, jointly produced by the Nuffield Trust, RCM and RCOG, disputes the conventional wisdom that smaller units are by definition less safe. It points out that:
“Although the closure of maternity units in smaller hospitals may superficially appear to solve a number of problems, in reality it leaves local hospitals at greater risk of merger or closure.
“In rural and remote areas, the closure of maternity units presents particular problems. The evidence suggests that longer transfer times and poorer support for obstetric emergencies offset any gains potentially offered by delivery in a larger unit. The lack of maternity services also deters younger people from moving to or staying in rural areas.” (emphasis added)
The report also notes that things are done rather differently in other countries:
“Units in the UK that manage between 2,000 and 2,200 births a year are considered to be small. Interestingly, such units are large by international standards. In France, for example, more than 55% of deliveries are carried out in units with fewer than 2,000 births a year and around 20% in units with fewer than 1,000.”
It turns out that properly centralising services is not necessarily a cheaper, let alone a cost-free option, since it often requires very large capital investment, and when times are tight a revamped maternity service tends to look less attractive to health care leaders [and to politicians] than other calls for investment. And staffing issues are also a problem in large, stressful units. Indeed:
“In Sweden, for example, rationalisation of national maternity services negatively affected the health of mothers due to the effects of overcrowding at the remaining hospitals, while the positive impact on infant outcomes was insignificant.”
The paper concludes with a series of recommended policies to make local, smaller units viable. A worthy alternative to the NHS Alliance’s call to run up the white flag, close down small units – and beg local MPs and councillors to help share the blame.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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