Open Letter to
Mr Michael Foster DL MP

Dear Michael

Thank you for your “survey” sent to local GPs dated 15th August.

I have no doubt that you will gain universal support from local colleagues for the maintenance of a consultant led unit in Hastings. A similar survey of Eastbourne GPs would result in the same conclusion about their own obstetric unit

However, maintaining a consultant led unit at the Conquest is not the same as option 4. Option 4 also condemns patients outside our immediate catchment area to an unsafe delay from decision to intervene, to provision of emergency care, at a time when the increased fear associated with transit will have a detrimental effect on both mother and unborn child. Agreement to option 4 means agreement to option 3 in principle in conceding the unthinkable that a mother in labour from either direction should sustain the risk of the journey across the Marsh. If the decision is then left to the SHA we could not guarantee that they would choose option 4 even if we supported it. My most recent patient who delivered a baby took 1 hour 10 minutes from recognition that she was in labour to delivery, somewhat less than (RCOG Secretary) Mr Warren’s, assessment of 1.5 to 2 hours transfer time. The ambulance would not have trained personnel or equipment for dealing with high risk complicated deliveries.

Professor Steve Goodacre’s findings announced in the media today that mortality increases by 1% for every six miles of emergency travel are relevant.

The arguments you give that favour Hastings over Eastbourne may be relevant about which site should be upgraded, but not at the cost of downgrading the other. It is unfair and in my mind unethical to suggest that a GP is asked to agree that a distant colleague’s patient’s unborn child has intrinsically less value. Core services should not be withdrawn from either hospital. Emergency surgical intrapartum intervention is a core service that clearly cannot be done by GPs. It also cannot be done by midwives alone as they are not trained in the necessary surgical or prescribing skills.

The East Sussex LMC has therefore taken a unanimous view that the options initially proposed in the “Fit for the Future” consultation paper are unsafe.

The safety of a unit is dependent on good communication between obstetricians, midwives and GPs. It is clear from my own experience of the system that considerable improvement to safety would be achieved by better communication and by risk assessments done in a timely manner at the highest available level of competence. Obstetricians would need to recognise that they do have a role and responsibility regarding decisions about patients made within community intrapartum care. Their current stance only recognises their role and responsibility within their own units. If this is not addressed it matters not how big the unit annual birthing figures are, obstetrics in East Sussex will retain unnecessary risk.

Even a “single site” will not significantly enhance available interventions as compared to units of 6000+ births per year found in cities that have a Medical School campus. A single site will not increase the experience of an individual consultant. Instead their input would decrease within larger rotas. However, smarter working where the relationships of the two units are better integrated would help diminish risk. There is less difference between 1900 and 3000 compared to 3000 and 6000+ births per year. Not much will be gained by the locality maintaining a single site, but it will be at significant cost to the other community. Improving training potential will require investment in doctors and midwives as the Royal Colleges have been saying to Trusts for some time now. The Royal Colleges will not want to be implicated within decisions that put patients at risk, just to allow funds to be released for training. It would be synonymous with throwing the baby out with the bathwater.

With regards

Dr Hugh Nicholson