Agenda item

Hazel Carpenter (Director of Commissioning Development and Workforce, NHS Kent and Medway), Dr. Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), and Dr. Sarah Montgomery (GP Clinical Commissioner) will be in attendance for this item.

Hazel Carpenter (Director of Commissioning Development and Workforce, NHS Kent and Medway), Dr. Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), Dr. Sarah Montgomery (GP Clinical Commissioner) and Sara Warner (Assistant Director Citizen Engagement, NHS Eastern and Coastal Kent) were in attendance for this item.

Michael Lyons declared a personal interest in this item as a Governor of East Kent Hospitals University NHS Foundation Trust.

(1)       The Chairman introduced the item by welcoming his guests and explaining to the Committee that the next meeting of the East Kent Maternity Review Board was going to be that afternoon and Members had the opportunity to make comments which would be fed back to the meeting through the NHS representatives attending for this item. NHS colleagues would return and present an update at the 9 September meeting, and in the interim the Chairman had approached a small number of Members who may be willing to form an informal HOSC Liaison Group to be involved in discussions over the summer and feed back to the Committee as well at the 9 September meeting. Several Members expressed an interest during the meeting.

(2)       Hazel Carpenter began by explaining that the Review Board included representatives from the emerging Clinical Commissioning Groups (CCGs) in East Kent. Of the 6 CCGs, 5 had patient flows into East Kent Hospitals NHS University Foundation Trust (EKHUFT). The detail required in the evidence was recognised. Representatives of the NHS welcomed the opportunity to return on 9 September with options and a consultation plan and looked forward to engaging with a smaller group of Members over the summer.

(3)       As a representative of one of the CCGs, Dr Montgomery explained that GPs are deeply concerned with this issue and were very close to the families affected. She explained that feedback from the 4 GPs on the Board was fed back to all Chairs of the CCGs and any options regarding future services would need to be based on robust evidence and the services needed to be safe and sustainable. The distance between hospitals was being considered by the panel but it needed to be made clear that standalone midwifery led units were not appropriate for all women and the admissions criteria was the same as for home birth and it was often the case that it was women from the more deprived areas which needed to travel to consultant led services more than others. These consultant led services were still available at Ashford and Margate.

(4)       In response to a range of questions Dr Neil began by explaining that all birth units in East Kent were safe and provided excellent care. The standalone midwifery units in Dover and Canterbury provided quality 1 to 1 care and this level of care in labour was the ideal. However, there was a cost related to the time for midwives to care. At Dover and Canterbury, there was a ratio of around 11 births for each midwife, but across Kent this was on average 35 births per midwife, sometimes reaching 48 in the high risk units. Also, while the care in Dover and Canterbury was exceptional, the condition of the estate was not.

(5)       In terms of problems recruiting midwives, Dr Neil said he was not aware of a real midwife recruitment problem. While staffing levels at neonatal intensive care units were not quite at British Association of Perinatal Medicine levels, they were comparable with similar units. The review came from the observation of nursing, midwifery and consultant staff at William Harvey Hospital about a possible safety issue there. The Trust decided to increase midwifery levels at this high risk site but this meant moving staff from other areas of East Kent. Regarding costs, it was a general truism across England that Trusts were underfunded for maternity services. A recent benchmarking exercise undertaken by EKHUFT along with other Foundation Trusts showed that while the cost of a normal birth in an obstetric unit was roughly equivalent to the tariff, the costs of a birth in midwifery led units was twice that.

(6)       The point was also raised that in an obstetric unit it was still midwives who carried out the majority of deliveries, though consultant obstetricians and paediatricians were on hand for advice. The question in East Kent was how best to use the skilled midwifery resource and the midwifery recruitment issue could be overcome if that was deemed the best solution. For home births, 2 midwives were required for the actual delivery and so this had cost implications. The maternity service was learning that there was a role for maternity support workers.

(7)       There was a broader discussion about the communications aspect of the process and comments on the different messages which are sometimes found in the media. Comparisons with the situation relating to women’s and children’s services at Maidstone and Tunbridge Wells NHS Trust were also made; though it was stressed there were also important differences. Representatives from the NHS explained that communicating and developing proposals were a complex equation and that the driving force behind them was to ensure the safety and sustainability of the service. There was also a recent report from the Royal College of Obstetricians and Gynaecologists which needed to be taken into account.

(8)       AGREED that the Committee note the report and examine this issue in more depth at a later meeting and that a small working group of Committee Members be established to further investigate and prepare a report for HOSC.