Agenda item

Dr. Neil Martin (Medical Director, East Kent Hospitals NHS University Foundation Trust), Dr. Sarah Montgomery (GP Clinical Commissioner), Lindsey Stevens, Head of Midwifery, East Kent Hospitals NHS University Foundation Trust), Ann Judges (Maternity Lead, NHS Kent and Medway), 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 thanking the Members of the Informal HOSC Liaison Group which had been established to consider this matter over the summer and those Members who had been able to attend a meeting at Kent and Canterbury Hospital on 17 August. He explained that these three, Nigel Collor, Dan Daley and Roland Tolputt would be asked to begin discussion of this item by providing a brief verbal report on their findings. The Chairman also explained that he had written to the MPs and District and Borough Council Leaders inviting their views on this matter but that it had been short notice and so the fact comments had not been received from all those who had been written to was no reflection on their interest. One comment from Roger Gale MP expressing support for the conclusions of the Hospitals Trust following a briefing with them was read out by the Chairman.

(2)       It was also explained by the Chairman that we were currently in the pre-engagement stage and that the role of the Committee was to challenge the NHS on behalf of Kent residents and ensure their concerns are debated and answered.

(3)       The Members of the informal HOSC Liaison Group each thanked colleagues in the NHS for their assistance over the summer and for arranging the informative meeting. A range of points arose from the feedback. Firstly there was a need to understand the broader context within which these changes were being proposed as the location of the existing hospitals was not necessarily ideal in that the Queen Elizabeth the Queen Mother (QEQM) Hospital in Margate had issues around difficulty of access, whereas Folkestone, the largest town in East Kent, had no hospital. The present arrangement of services came out of a reconfiguration 11 years ago and one Member commented that people would need to be assured that any proposals were sustainable in the longer term. It was also recognised that there were important difference between this situation and the reconfiguration of women’s and children’s services at Maidstone and Tunbridge Wells NHS Trust but that one lesson that needed to be learnt was the importance of ensuring the GP community supported the proposals. One Member reported having spoken to a number of people and there was a strong feeling in favour of the status quo. One Member expressed support for the concept of Alongside Midwifery Led Units as they struck the balance between choice and safety. It was felt that the current ongoing NHS reorganisation might be a good time to look at the tariff for maternity services with a view to ensuring it reflected the true cost of delivering a quality service.

(4)       A request was made of the NHS for details of location of birth broken down by postcode of residence.

(5)       On the subject of GP involvement, it was stressed by representatives of the NHS that GPs had very little influence over choice of place of birth. This was a decision usually made by mothers with midwives, based on the risk factors present in the mother’s medical history. Concerning the review, Dr Montgomery explained that is was her responsibility to keep GP colleagues informed. This was done through informal weekly meetings and formal monthly clinical commissioning meetings. Kent Local Medical Committee officers have been present at the monthly meetings. GP commissioning groups have seen the same papers as the Committee to comment on and formal support has been received from GP commissioning boards in Ashford, Canterbury and Dover, with informal support being received from elsewhere.

(6)       Members raised the issue of whether there was adequate capacity within maternity services, not only in East Kent, and more broadly across the county as a whole. The view was expressed that at first glance it appeared strange to be discussing the possible closure of birthing centres when the number of births was increasing along with a broader growth in population. It was acknowledged by representatives of the NHS that there were issues across Kent and Medway and that work was being undertaken by NHS Kent and Medway and all providers on a pan-escalation policy across the whole area. Specifically on capacity in East Kent it was explained that the alongside midwifery-led unit at the QEQM with 4 labour beds has yet to open, but that it would, increasing capacity. The alongside midwifery-led unit at the William Harvey Hospital in Ashford currently had 8 beds and delivered around 600 births each year and there were plans to increase this to 1,000 births per annum. Also within William Harvey, there were plans for two additional beds in the consultant-led unit. Concerning the capacity for home births, there was a community midwifery service in place and that would remain. No increase in home births has been seen compared to other years during the temporary closures of Dover and Canterbury. No increase in activity from the Maidstone area to William Harvey had yet been seen, but was under review. Dr Martin explained that the issue of beds was being looked at but that the crux of the capacity issue was the ratio of midwives to births in order to cope with the peaks and troughs of demand and that a £700,000 investment was being sought to raise the ratio from 1:32 to 1:28. It was also explained that there was no midwifery recruitment issue in East Kent, partly due to the location of the University, and two cohorts had been recruited this year.

(7)       A range of views was expressed around the question of choice with one Member expressing the view that while capacity might go up, choice would go down under some of the options put forward, with the potential closure of the midwifery-led units in Canterbury and Dover. An alternative perspective was offered by representatives from the NHS in that choice needed to be realistic and affordable and that hospitals with consultant-led units and alongside midwifery-led units offered that choice. The focus of the NHS was on ensuring a safe and sustainable service for the 7,000 women each year who had no choice but to give birth in an obstetric unit.

(8)       There was a wide-ranging discussion of a series of connected points around deprivation, access to services, and travelling, exacerbated by the peninsular and coastal nature of the eastern half of the county. While it was accepted that there were pockets of deprivation everywhere, it was acknowledged that in some areas, such as Dover, the lack of access to a car was a particular problem. NHS representatives were keen to stress that ante- and post-natal clinics would still take place at Canterbury and Dover and these accounted for the majority of trips taken during the maternity care pathway and that the majority of women currently already travelled to either Ashford or Margate for birth itself. A number of Members felt there was a need for firmer reassurances about the future of the whole range of women’s and children’s services as well as more certainty about the long term future of the Buckland Hospital site.

(9)       On the subject of the forthcoming public consultation, representatives from the NHS explained that a wide ranging engagement exercise had already been carried out and that the NHS would continue to actively seek the views of mums-to-be, stakeholders and the wider public during what was likely to be a 13-14 week consultation. Social media was being utilised and there was daily communication with the local media as well. Members of the Committee felt that there was a need to be assured that the consultation was going to be a genuine listening exercise and the guests from the NHS were invited back to the next meeting of the Committee, on 14 October, to discuss more fully the plans for the consultation process, which should have already just commenced.

(10)     The offer was made to the Members of the Informal HOSC Liaison Group to continue to be involved in the development of the review prior to this meeting. It was agreed that Mrs Elizabeth Green should join this group.

(11)     AGREED that the Committee consider and note the report and that the NHS be invited back to further discuss this topic at the meeting of 14 October.