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Open Letter To
John Lewis (Chair) & Kim Hodgson (Chief Executive) East Sussex Hospitals Trust
Following the Hospital Trust Extraordinary Meeting held on 5th December I feel compelled to write.
The purpose of the meeting was for the Board to assess the Options and give advice to the Primary Care Trust as to how they felt was the best way forward in Obstetrics.
The presentation given by the Medical Director was not balanced, but was completely biased in favour of a single site Option as set out in his presentations in the early stages of the stakeholders meetings over 18 months ago. It completely misled the Board by referring to out of date and erroneous material and did not adhere to any advice given by the intercollegiate document “Safer Childbirth” written by the four Colleges involved.
It took no account of the fact that the Royal College of Obstetricians and Gynaecologists have stated unequivocally that single siting our two units would lead to no safer service within that unit, nor would there likely be any significant difference in the scope for improving that service. In fact single siting our two units does not fulfil Lord Darzi’s principles for change of service which is required to be evidence based as a safer and a substantially better service.
60 hour consultant cover was quoted as being required. This is blatantly not so. The Royal College say it would be preferable to have 40 hour cover however in units less than 2,500 births per year, this was not essential as long as there were continuous risk assessments and good clinical governance.
I would ask where the figure of 4,500 has come from. This was quoted as being the optimum number of births for a quality service yet this is not reflected in the intercollegiate guidance. The Royal College state 5-6,000 births per year are required as the critical mass to create new sub specialist services. This number will never be achieved by single siting our two consultant led units.
Training and the European Working Time Directive were given as reasons for change.
Under the new guidance from the Royal College they state that there should be 6 substantive posts to one trainee. This does not add up to 8 consultants and 20 junior doctors or 10 consultants and 40 junior doctors as stated in the presentation. The Royal College advise much less use of junior doctors. The training would easily be achieved by rotating the work with larger hospitals. If necessary this could also be done with the Consultants if they felt they were losing skills. I would also state that the EWTD was taken into account at the time of the 2004 Review when it was stated that two sites should remain. Therefore nothing is new now and this is just a red herring.
The presentation stated that there would be potential for providing enhanced neonatal care, however it has been stated many times by numerous professionals that there would be no upgrading of SCBU with a single site due to the less than viable number of births to warrant development. Not withstanding the PCT is on record to say that there are no plans or funding for such development.
During the question and answer debate, the Medical Director stated that the majority of emergencies occur when the mother is in the obstetric unit, and that very few mothers that get into trouble because they are a long way away. For Heaven’s sake, HOW MANY ARE VERY FEW!!!!! Not one should be tolerated.
He also stated that births that take place in the hospital car park occur when the mothers live close by and leave it too late. What arrogance! HOW DOES HE KNOW!!! Where is the evidence basis for this? Is he seriously saying he knows of babies born in the hospital car park? If true, this would question his failure to properly staff units so they are always running dangerously close to capacity and frequently have to close to admissions, surely?
The same Medical Director was asked about the domino effect. He stated that this did not happen. Once again this is against the position we have been told by the Royal College. They stated and I quote “if obstetrics is lost and of course SCBU, then paediatrics will follow. It may then be possible to keep A & E, however there would be risks to women presenting with obstetric and acute gynaecological problems to the hospital left without 24-hour obstetric medical cover”.
You will note from this that not only have the Board been misled and have colluded with your Medical Director’s deniability and lack of accountability, but a number of the rules in the Manager’s Code of Conduct have been broken, not least the fact that the local population must be listened to and have their concerns taken into account. Nowhere in the presentation was the public concern voiced by Members of Parliament from all parties or the ubiquitous professional concern of General Practitioners mentioned.
How do you think the general public perceive the self interest of a few obstetricians born out in the formula given by the Medical Director? He has already reduced the number of Gynaecologists, which is well recognised to be good for their private practice but against safe staffing of obstetric units. The Medical Director has a national reputation for removal of popular gynaecologists, hasn’t he? Needless to say this also explains why he wants lots of juniors who are not able to do private practice. Yes; and wouldn’t it be fine to have less nights on call so that everything can be left to the juniors because their skills are getting so rusty?
The biggest risk of single siting is the failure to account for the safety of mothers and babies trying to access obstetric cover. THIS IS BEING COMPLETELY IGNORED AND THEREFORE NO DECISION TO SINGLE SITE SHOULD BE TAKEN.
Margaret Williams
Chair Hands Off The Conquest Campaign
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