This month the NHS launched a three month public consultation on maternity services across east Kent – presenting three options for the future.
Here we explain why we need to change the way services are set up, what the three options are – and how you can have your say.
Each year, almost 7,500 women give birth in east Kent. Our top priority is to ensure every woman and her baby has the best possible care we can deliver.
This means making sure all women have a high quality, safe service and a choice of how to give birth – and that our maternity services are sustainable for the future.
A rising birth rate and a changing pattern of where women are choosing to give birth mean we need to change the way our services our delivered.
More and more women are choosing to give birth at the William Harvey Hospital in Ashford while the use of Canterbury and Dover Birth Centres is declining.
Before temporary closures at Dover and Canterbury, on average there were five births a week at Dover, seven at Canterbury, 56 at Margate and 70 at Ashford.
Current evidence suggests that a midwife to birth ratio of 1:28 allows one-to-one care by a midwife for each woman in active labour.
However, our midwife to birth ratio varies from 1:9 in the birth units at Dover and Canterbury (which are only suitable for women who are at a low risk of complications) to 1:40 in the consultant-led unit at Ashford, which deals with the most complex pregnancies and births.
In the end, just five per cent (fewer than 400 mothers) each year go on to choose to give birth in Canterbury or Dover centres.
Therefore, to maintain our high standards of safety and ensure all our mothers continue to get one-to-one care in labour, we have temporarily suspended births at Canterbury and transferred some of our midwives to the labour ward at Ashford.
This is a temporary solution and we need to find a more permanent one that reflects the choices women are making about where they give birth, meets the needs of the rising birth rate and makes the best use of our resources.
After gathering the clinical evidence and the views of parents and staff, we’ve now come up with three options, with different arrangements for services, that we are asking for your views on.
All the options include opening the new midwife-led service in Margate, which will mean mothers will have the option of two midwife led services with the back up of consultant led services close at hand in Margate and Ashford.
This was something that during the review parents told us was important to them.
Dr Sarah Montgomery
, GP and Chair of the Joint Maternity Services Review and Dr Neil Martin, Medical Director at East Kent Hospitals University NHS Foundation Trust.
We need your views
NHS Kent and Medway and East Kent Hospitals University Foundation NHS have been reviewing services.
Our Maternity Services Review Group, led by GP Dr Sarah Montgomery, has been consulting extensively with patients, parents and the public, plus community groups, midwives and GPs about their experience of maternity services.
All these comments and experiences have been taken on board and together with clinical evidence and national guidance we have come up with three options for the future that we are now asking for your views on.
Option One: (Our preferred option)
Stop births at Canterbury and Dover Midwife-led Centres but keep midwife-led antenatal care, day clinics and postnatal support and open the new midwife led centre at Margate.
The Maternity Review Group believes concentrating our resources at two hospitals – with two midwife-led units and two consultant-led units – is the safest, fairest and most sustainable option for the future.
During the review, parents told us they preferred a natural, calm and home-like midwife-led service with the back-up of a consultant-led unit close at hand. This preference is supported by local GPs.
If we arrange services in this way, we will be able to provide every woman with one-to-one care in active labour. We can also invest in around 30(full time equivalent midwifery staff, made up of midwives and support workers.
If we do this, we will be in a much stronger position to cope with the rising birth rate. Our services are less likely to be disrupted – reducing anxiety for parents – and we can open the new midwife-led service at Margate.
Parents will continue to have the full range of choices about the type of birth they want – a home birth, a low intervention birth at a midwife-led centre or a consultant-led unit for those mums at higher risk of complications.
This also means that babies will always be near one of the two special care baby units based in Ashford and Margate. Dover and Canterbury midwife-led centres would continue to offer all their current day and community services.
So, mothers-to-be will still be able to go there if they have any concerns about their baby’s movements, for their scans or for postnatal breastfeeding help and advice.
We would still run the consultant clinics at Canterbury and Dover, the various midwifery clinics and day care services on both sites as well as parent education classes.
Home births in all areas will continue to be available to low-risk women.
Most Canterbury and Dover mothers already choose Ashford or Margate, which is one of the reasons why the Canterbury and Dover centres are only running at 20 per cent bed capacity – even before the closures.
We believe retaining either or both of these centres will have little impact on reducing the staffing pressures. We don’t have a limitless pot of money and this option – while it includes an additional annual investment of more than £700,000 – is the most cost effective.
In the current climate we have to make sure we spend every NHS pound wisely. This means focusing our resources on facilities that are chosen by more than 90 per cent of mothers.
Option two:
Stop births at Dover Midwife-led Centre but keep midwife-led antenatal care, day clinics and postnatal support and open the new midwife led centre at Margate.
Option three:
Stop births at Canterbury midwife-led centre but keep antenatal care, day clinics and postnatal support and open the new midwife-led centre at Margate.
Either of these options would retain the range of choices for parents and mean the new midwife-led centre in Margate could be opened.
Once again, antenatal and postnatal care would be unaffected. The only difference would be overnight stays at either Canterbury or Dover – depending on which one is no longer open for births – would not be available.
While it would mean midwives from either Canterbury or Dover could be transferred to Ashford or Margate we believe this will have little impact on reducing staff pressures – and the birth centre remaining would still be forced to suspend services temporarily when pressures are high at Ashford or Margate.
Both of these options would need considerable investment – an extra £1.4million (£1,475,241) annually to keep Canterbury open for births, and £1.3million (£1,355,320) annually to keep Dover open for births.
This investment may mean a reduction in other NHS budgets. They will also mean that some midwives – who are staffing these units – will not be used effectively due to the small numbers of women giving birth there.
Depending on which option is chosen, people from Dover or Canterbury may have to travel a little further for a low intervention birth. Also, 25 per cent of mothers will need an ambulance transfer from Canterbury or Dover a standalone midwife-led service to a consultant-led service if they experience complications.
For a more in-depth look at the advantages and disadvantages of each of the options presented please see our full consultation document, which can be found on our website at www.easternandcoastalkent.nhs.uk/maternityservices or by calling 0800 085 6606.
