HOTC Press Release 21/10/07

Further to Michael Foster’s Press Statement last week, your readers might appreciate more information. In Public Meetings the PCT have consistently stated:

1) That Royal Colleges have stated that Maternity Units of less than 2,500 births per year would not be able to perform emergency caesarean sections

2) Giving birth was completely natural and only very few births became complications

3) New working conditions from the EU would make our Units unviable

4) Better for complications to be treated in an state of the art unit despite further travel

5) Training would suffer in small units, with difficult recruitment of good consultants.

6) No domino effect on the hospital losing the consultant led unit.

In contrast, Mr. Richard Warren, Honorary Secretary, and Dr. Tahir Mahmood, Vice President of the Royal College, stated:

1) The College would never say that small units, i.e. fewer than 2,500 births a year would not be able to carry out emergency caesareans, and that for anyone to say that a baby would not be able to be delivered that way in a small unit was “absolute madness”, adding that draft documents should not be used as guidance.

2) 1 in 5 pregnancies could require medical intervention unexpectedly due to complications, involving 25 – 30 first time mums and 10 – 15 per hundred mums with two or more children.

3) Nothing in the recently published “Safer Childbirth” stated that there had to be “40 hour consultant cover” in smaller units; though recommended, it was not a requirement unless they provided “all risks cover” (not planned in PCT proposals).

4) Mr. Warren has lived and worked in both Eastbourne and Hastings agreed that the Marsh Road was a thorny issue, and that should there be single site adequate transport infrastructure would have to be in place. 30 minutes had always been the benchmark from decision to medical intervention, the actual time from decision to incision could be anything up to 2 hours. He said you must take into account the time from telephoning the ambulance, travel time, getting the patient settled to the time of medical intervention.

5) A combined unit of just over 3,000 births per-year would not offer any different service or improved standards than units can, of our current size. Only units of 5- 8 thousand births per year could offer more. Putting our two units together would not give consultants more experience as the combined numbers would be diluted by increased number of consultants on the rota. However our smaller units could still ensure best practice and give better training for junior doctors by integrated working within, and between sites.

6) If Paediatrics is lost then the domino effect takes place; if obstetrics is lost and of course the Special Care Baby Unit, then paediatrics will follow. Whilst it may be possible to keep an A & E, there would be risks to women presenting with obstetric and acute gynaecological problems (such as ectopic pregnancy) to the hospital left without 24 hour obstetric cover.

Our visit confirmed our perspective, that the PCTs’ original proposals risks compromising patient safety and reducing one site to a Cottage Hospital.

Margaret Williams

Dr Hugh Nicholson