Travel Risk Fears for Mothers-to-Be

By MADELEINE BRINDLEY Western Mail

Mothers-to-be could be forced to travel miles for maternity care under plans proposed for a major NHS shake-up in West Wales. The panel’s recommendations – triggering fears of a ‘third-class health service’ – would see consultant-led services for the massive rural region of Pembrokeshire, Ceredigion and Carmarthenshire centralised to Carmarthenshire. Under the recommendations Pembrokeshire would only have a midwife-led birth centre at Withybush Hospital, with all high-risk births transferred to West Wales General Hospital, in Carmarthen. And the experts from three Royal Colleges have suggested that Bronglais Hospital, in Aberystwyth, which serves Ceredigion, should move to ‘predominantly’ midwife-led services. But consultants and patient watchdogs have criticised the recommendations from the Royal Colleges of Obstetricians and Gynaecologists, of Paediatrics and Child Health, and of Midwives. Chris Overton, a consultant in obstetrics and gynaecology at Withybush in Haverfordwest, said, ‘We have 1,250 deliveries a year and I expect two-thirds of those would end up delivering in Carmarthen. ‘This is moving towards an Australian outback system where there will be the odd death because patients can’t get to Carmarthen in time. There will be deaths – babies, not women – directly related to making Withybush and Bronglais midwife-led units.’ And Geoff Wright, chairman of Pembrokeshire Community Health Council, said, ‘We are gravely concerned about the potential impact of these recommendations, not only across maternity, children’s and women’s health provision in Pembrokeshire, but on the consequential effects on [Withybush] hospital as a whole. ‘Any loss of such core services, and the knock- on effect on other services at Withybush could be a devastating blow from which we might never fully recover.’ The Royal Colleges’ review of maternity and women’s services in West Wales was carried out in September and is ‘the first stage in a process of considering how maternity services should be developed in the future’. The subsequent report states that the present configuration of services is not sustainable in the long term, primarily because of perceived difficulties in senior medical staffing levels. It said there was no problem with midwifery recruitment in West Wales. But Mr Overton said the report was flawed as it failed to note three new consultants had been appointed at Withybush Hospital, from a pool of 17 applicants, all of who were of consultant standard. A maternity board, including medical and midwifery staff from Carmarthen, Ceredigion, Pembrokeshire, Powys and Swansea, will now be set up to review the report in detail and explore options for improving services. And the Royal Colleges’ recommendations will be considered within the overall acute services review process. A spokeswoman for Pembrokeshire and Derwen NHS Trust said, ‘As a trust, our doctors, midwives and managers will be working closely with colleagues in neighbouring trusts and local health boards to take this forward over the coming months. ‘In our discussions we will be mindful of the suggestion in the report that ‘no change’ is not an option. However, we believe there may be other options as well as those suggested in the report that will be worthy of further discussion.’ Dr Alan Axford, medical director of Ceredigion and Mid Wales NHS Trust, said, ‘ This report is in no way critical of the services we provide at Bronglais. ‘Neither is it stating there will be no obstetrician-led maternity care in Ceredigion in future. However, the report does challenge us to look more closely at the way we deliver services in partnership with neighbouring trusts to improve care we provide for women.’: What the colleges recommend:The panel of experts from the three Royal Colleges have recommended the following changes to maternity services in West Wales: West Wales General Hospital becomes the main obstetrician-led maternity unit; West Wales General Hospital becomes the main gynaecology inpatient centre for South Dyfed, supported by outreach outpatient services; Maternity services at Withybush Hospital become midwifery-led with the development of a birth centre; There is a migration to predominantly midwifery-led maternity services in Ceredigion, at Bronglais Hospital; There is an increase in local provision of antenatal clinics across Dyfed; Inpatient paediatric services are concentrated on the West Wales General Hospital site, with an extended-hours paediatric day investigation and treatment centre at Withybush Hospital, in Haverfordwest.