Trust Board Febuary 2010 - Sandwell & West Birmingham Hospitals

SWBTB (2/10) 045 (a)
15. JOINT HEALTH SCRUTINY COMMITTEE
At its meeting on 7 th January 2010 the Joint Health Scrutiny Committee considered its response to the
short listed options in Improving Services for Giving Birth as part of the public consultation. The
Committee resolved that whilst ideally it would have preferred the full maternity provision to remain in
Sandwell, it would support Option 3 but with the caveat that the stand alone Birth Centre is built and
operational in Sandwell before maternity services are withdrawn from Sandwell Hospital. In addition the
Committee resolved that if this option with the caveat is not supported by Sandwell PCT Board, the
Committee is ‘minded’ to refer the matter to the Secretary of State for Health since it believes the
proposals in the consultation document as they stand are not in the interests of the local health service
because:
• They do not fit with the national choice guarantee or care closer to home agenda
• Concerns about capacity at City Hospital to deal with an increase in the number of births
• More research is required to give a full regional perspective.
The Project Steering Group has carefully considered the caveat proposed by the Committee and has
concluded that this is not achievable because:
• The caveat would require delaying the consolidation of high risk births at City Hospital. Such a
delay would be clinically unacceptable for all the reasons outlined in the clinical case for change
and subsequently endorsed by NCAT. A recent review of the service at Sandwell and the
ongoing risks of maintaining this service has shown that whilst there have been improvements
there are also significant continuing concerns. Any delay substantially increases the potential for
emergency closure of the Sandwell site on clinical grounds. The risks associated with unplanned
closure cannot be underestimated for example, City Hospital would not have the capacity to
accommodate the Sandwell births until the refurbishment work outlined in this Business Case is
complete. There is evidence of limited capacity in other local hospitals and so there is a high
possibility that some Sandwell women would need to be transferred out of the local (Birmingham
and Black Country) area to give birth in this situation.
• Establishing a stand alone Birth Centre prior to reconfiguring Consultant led / high risk services
to City Hospital will detract focus from the mitigation of risks already associated with sustaining
services over 2 sites (City and Sandwell) and will, initially at least, introduce a significant further
level of risk over and above that already identified at and persisting at Sandwell.
• Perinatal mortality rates in Sandwell are high. Spreading already limited staffing resources over
an additional area will further impact upon the quality of care provision across the whole service
and potentially exacerbate issues affecting perinatal mortality
• Establishing a stand alone birth centre requires the expertise of highly skilled and experienced
midwives familiar and comfortable with this unique model of care i.e. undertaking risk
assessments, working independently of doctors, independent decision making etc. Midwives
working within the Trust’s maternity service are not currently exposed to a midwifery led model of
care. This is reflected in the very low percentage of home births and high intervention rates
amongst low risk women. Historically, recruitment to the Trust has been poor and is one of the
key drivers for making the proposed changes. Recruitment to the co-located Birth Centre at City
Hospital in the first instance will allow midwives to develop their skills and expertise and become
familiar with this model of care – this will occur in an environment where there is immediate
access to emergency medical support and where there is an established infrastructure of
training, supervision and support. This cohort of midwives would then be suitably equipped to
provide expertise in the stand alone Birth Centre. Developing this expertise will take a minimum
33