Many thanks to my nct colleagues for formulating this response.... please feel free to use the facts and points in your own response.
You might like to consider the following comment for question 16: it will fit in the number of characters permitted:
Obstetric services should be retained at Lewisham, with midwife-led units available at all local hospitals. All women need options for obstetric and midwife-led care and home birth. Since 2009 Lewisham has created a well used midwife led unit, reduced its CS rate by 2% and gained Stage 1 Baby Friendly accreditation. It is the only hospital in SE London with a normal birth rate well above the national average. The draft report emphasises best practice. Lewisham delivers it more than the other hospitals. Closing it is illogical.
Larger maternity units will lead to a reduction in the quality and safety of care. There is no evidence that they provide safer, more effective care. Increased consultant presence may be beneficial for very high risk women. However, financial pressures and workforce changes are the primary drivers. In Safer Childbirth The RCOG does not advocate concentrating birthing services in ever larger units. Safer Childbirth recognises maternity networks with home births, MLUs and obstetric units. Any changes to maternity services should be based on clear evidence that they will improve care.
Developing or retaining a standalone midwife-led unit on any site facing closure of birthing services should be considered.
The draft report wrongly states such units are not well used and not financially viable: national experience and recent research suggest the opposite when properly supported. Relevant research suggests for low risk women, giving birth in a stand-alone midwife-led unit is as safe as an obstetric unit for mothers and babies. Mothers are more likely to experience normal birth with fewer interventions. Statistics from the London Barkantine birth centre show a popular well-used facility. MLUs are also more cost effective. For low risk women the cost is lower than planning birth in obstetric units.
It is essential that neonatal cot numbers are not reduced across Bexley, Bromley, Greenwich and Lewisham. Although Despite the proposals entail the potential closure of the neonatal unit at UHL, neonatal cost numbers are not elaborated on. It is not clear if the reduction in the number of intensive, high dependency and special care cots resulting from the closure of one existing unit will be fully compensated for by creating additional local capacity. There is no commitment given that the number of funded cots (as opposed to the cots that hospitals currently operate) will be maintained or increased. This is important since local hospitals routinely operate more cots than they have funding for. The range of services provided at the Beckenham Beacon hospital once the SLHT ends its lease may be compromised. We would like essential services such as the antenatal and postnatal clinics and the Urgent Care Centre, to be retained. If antenatal and postnatal clinics at the Beacon were abolished, the local community would have to travel to the Princess Royal. I have grave concerns about current capacity at this hospital, irrespective of the additional pressure on numbers that parents travelling from Beckenham would create. The closure of the Urgent Care Centre there, which takes the pressure off the A&E departments in the area, would be catastrophic, particularly if it coincided with the simultaneous closure of Lewisham A&E. We welcome the opportunity to improve the variety of services offered at the Beacon, but it is imperative that those services which are currently provided at this site are retained.
The recommendations do not address adequate investment in maternity care. The proposals do not acknowledge larger units frequently have more difficulty retaining and recruiting midwives. Many women do not receive continuity of care, not all receive one-to-one care in labour. Overworked and under-resourced staff try to provide good care but quality of care especially postnally is variable. Many of the problems can be directly related to inadequate ratios of staff to women and problems with capacity.
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I believe that obstetric services should be retained at University Hospital Lewisham, with midwife-led units available at all local hospitals.
I believe that all women should have choice of and access to both obstetric and midwife-led care as well as the option of home birth. It is clear that women’s choices will be reduced under the proposals to close birth services at University Hospital Lewisham. The hospital has made significant improvements in its maternity services since 2009, including opening a well used midwife led unit, reducing its Caesarean section rate by 2 percentage points and gaining stage 1 UNICEF Baby Friendly accreditation. It is the only one of the five hospitals that had a normal birth rate well above the national average, of 50.5% in 2010-11. None of the other hospitals in southeast London have made similar improvements in the intervening period. Given the emphasis in the draft report to the TSA, on the use of best practice care networks and the conclusions of Healthcare for London this does not appear logical.
I am very concerned that the current drive towards larger maternity units will lead to a reduction in the quality and safety of care. There is no evidence that larger units provide safer, more effective care. The increased consultant presence on the labour wards may prove to be beneficial for very high risk women. However, we are concerned that financial pressures and workforce changes are the primary drivers for the proposals for large maternity units, and not evidence that larger units provide higher-quality, woman-focused care. In Safer Childbirth The Royal College of Obstetricians and Gynaecologists recommends levels of consultant presence for maternity units of different sizes, with increasing levels for larger units, but does not advocate the concentration of birthing services in ever larger units. Safer Childbirth explicitly recognises that a maternity network includes births at home, in midwifery units and in obstetric units. We strongly believe that any changes to the way maternity services are provided should be based on clear evidence that they will improve care for women and their families. The arguments being made for larger units were made four years ago during the ‘A Picture Of Health’ consultation. It should be noted that, three years after the reconfiguration has been fully underway, there does not appear to have been any real improvement in the services delivered by PRUH and QEH, with the exception of the provision of a midwife-led unit at the PRUH (and we understand one will be opening at QEH).
I believe that the option of developing or retaining a standalone midwife-led unit on any site facing the closure of birthing services should be seriously considered, in order to allow as many women as possible to experience continuity of carer when accessing antenatal, intrapartum and postnatal services. The draft report states that such midwife-led units are not well used and are not financially viable, yet national experience and recent research suggest the opposite when such units receive proper support and investment. Evidence from research into stand-alone birth centres suggests that they are very positive environments for normal birth and provide good outcomes for mothers and babies. The latest research on place of birth concluded that, for low risk women, giving birth in a stand-alone midwife-led unit was as safe as an obstetric unit. There were no differences in outcomes for babies, and mothers were more likely to experience a normal birth with fewer interventions. Statistics from the Barkantine birth centre in London show a popular birth centre, well-used by local women. They are also more cost effective. The Birthplace in England research project demonstrated that for low risk women, the cost to the NHS of giving birth, including treatment costs from immediate clinical complications following birth, is lower for births planned in midwifery units compared with obstetric units.
I also believe that no reconfiguration of services should result in a reduction of the number of neonatal cots available across Bexley, Bromley, Greenwich and Lewisham and ask that concrete proposals in relation to the future provision of neonatal services be clarified as soon as practicable and that options are put forward for consultation before any changes are made. It is of great concern to us that in the draft report, only passing reference is made to neonatal care, despite the fact that the proposals entail the potential closure of the neonatal unit at UHL. This is not elaborated on anywhere else in the document and is not commented on in detail in the supplementary documentation. It is therefore far from clear whether the reduction in the number of intensive, high dependency and special care cots resulting from the closure of one existing unit will be fully compensated for by creating additional capacity at neighbouring hospitals. There is also no commitment given that the number of funded cots (as opposed to the cots that hospitals currently operate) will be maintained or increased. This is important since we are aware that local hospitals routinely operate more cots than they have funding for.
I am concerned that the range of services provided at the Beckenham Beacon hospital once the SLHT ends its lease may be compromised. We would like confirmation that essential services such as the antenatal and postnatal clinics and the Urgent Care Centre, will be retained. The newly rebuilt Beckenham Beacon provides vital, local services for families living in Beckenham, Penge, Sydenham and South Norwood. If antenatal and postnatal clinics at the Beacon were to be abolished, the local community would have to travel to the Princess Royal at Farnborough and we have grave concerns about current capacity at this hospital, irrespective of the additional pressure on numbers that parents from our local area would consequently provide. The closure of the Urgent Care Centre at the Beacon, which takes the pressure off the A&E departments in the area, would also be catastrophic, particularly if it coincided with the simultaneous closure of Lewisham A&E department. While we welcome the opportunity to improve the variety of services offered at the Beacon, it is imperative that those services which are currently provided at this indispensable site are retained.
Finally, I do not believe the issue of adequate investment in maternity care has been addressed by any of the recommendations. We are also concerned that the proposals do not appear to acknowledge that larger units frequently have more difficulty retaining and recruiting midwives. Many women do not receive continuity of care in the antenatal and postnatal period, and not all have received one-to-one care in labour. It is common to hear that new parents have received good care, but from overworked and under-resourced staff. Quality of care, particularly in the postnatal period, can also be variable. We believe that many of the problems can be directly related to inadequate ratios of staff to women and problems with capacity.