Why can’t we keep everything open?
One option we looked at was maintaining our existing services as well as re-establishing births in Canterbury and opening the new Margate midwife-led unit.
However, on further examination, we have concluded this is not a viable option.
To achieve this and ensure a high quality and safe service on all sites, we would need to invest more than £2million (£2,126,667) and employ an extra 64 (whole time equivalent) staff. It would take more than two years for us to achieve this level of recruitment because there are only 38 students who qualify each year in this area as midwives. There would also be continuing annual costs related to these additional posts.
Doing this would mean our midwife to birth ratios in the Canterbury and Dover midwife-led centres would remain at 1:9 and our ratio at the consultant-led units would be 1:28. Therefore across the trust this would mean we have a midwife to birth ratio of 1:25. Given that the gold standard for midwifery staffing is a ratio of 1:28, a midwife ratio of 1:25 could be viewed as excessive. Although this would allow us to maintain all services it could only be achieved by taking funding from other NHS services in east Kent.
We need to make sure we spend taxpayers’ money wisely and design services around the greatest need and this option would not satisfy these tests.
What about the Canterbury and Dover mothers who might have to travel further? Is this fair or safe?
These mothers who have to travel further are low risk mothers (less than 400) and make up just five per cent of the 7,500 mums who give birth in east Kent each year. We need to focus and design services for the majority and this means for the thousands of women choosing to give birth in Ashford and Margate.
Over the past five years women have been voting with their feet and there has been a steady decline in the number of women choosing Dover and Canterbury.
Ultimately, we realise some mothers may have to travel further but we believe this small increase in extra journey time for some will be outweighed by increasing the safe standards and levels of one to one care that we will be able to offer all mothers including the women with a higher risk of complications to their health or their babies.
Won’t it mean more back seat deliveries?
Labour is unpredictable and there will always be some mums who labour very quickly and give birth before they reach hospital.
However, we’ve looked carefully at the figures during the temporary closures of Canterbury and Dover, and there has been no significant increase in mothers giving birth before they reach the hospital.
Doesn’t your preferred option just mean less choice?
No. Women will still be able to choose a home birth, a low intervention midwife-led centre, or a consultant-led centre and they will be supported throughout their pregnancy whatever their choice. Five per cent of women (less than 400 out of 7,500) may have to travel a little further to give birth.
Doesn’t your preferred option result in a reduction in the overall number of beds?
While there will be fewer labour and postnatal beds the Canterbury and Dover services are underused. On average just 20 per cent of the beds are used. By transferring midwives to Ashford and Margate we will be able to increase capacity at these hospitals where more mothers are giving birth.
Will your decision affect the viability of building the new Dover hospital?
A decision on maternity services will be made early in the new year and East Kent Hospitals University NHS Foundation Trust intends to start work on detailed designs for the hospital in April 2012. At present, the hospital is intended to have the following services:
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minor injuries
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outpatient services
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minor procedures suite
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diagnostic including mobile MRI and CT
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renal haemodialysis
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ambulatory paediatric services
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occupational therapy
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physiotherapy
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day hospital / ambulatory care services
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antenatal and postnatal maternity services
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birthing unit (dependent on the outcome of maternity review).
Dover is an area of high deprivation with many parents on low incomes and without cars. How are they going to get to a hospital as far away as Ashford or Margate?
Some women from Dover are already making their way to these hospitals.
Remember, this is only for two journeys. For all their antenatal and postnatal care they will still be able to go to Canterbury and Dover. Of course, if it is an emergency, parents will still be able to call 999.
How long can someone stay in each of the different types of services after giving birth?
It depends how straightforward the labour and birth were. As a general rule mothers with no complications during labour are discharged after six to 12 hours from both the consultant-led wards and the co-located midwife-led units. If there are complications then they will stay for longer – up to 72 hours in a consultant-led ward if necessary. A standalone birthing centre will normally discharge women after 12 hours. Partners can stay overnight at midwife-led units only.
Will co-located midwife-led units at Margate and Ashford offer the same model of aftercare as the stand-alone centres at Dover and Canterbury?
Both midwife led centres will discharge after six to 12 hours. In the past, some mothers have transferred to a standalone midwife led units (at present Dover only) from a consultant-led centre for recuperation. This is known as ‘step-down’ care. Under the preferred option, women will go home when the midwife has agreed they are fit and healthy.
What do staff think of the review?
Overall, the people at the heart of delivering these services understand the need for a review and a change to services. We accept that some staff, understandably, may want services to remain as they are. We will need to take into account the views of staff but we must balance these with providing a service which is safe and efficient and fair to all.
