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Caithness Maternity

January 30, 2017

There is a lot of information in the public domain about the reconfiguration of the Caithness Maternity Unit from consultant led to a CMU. Here is the press release I sent to the Press and Journal at the end of November -

 

“I agree that everything must be in place for the transition to be smooth but that decision has to be made by the board. The unit is effectively operating as a CMU at the moment but without the improvements needed to support the staff and the mothers and babies. If we know what we are working towards then we can do so as a community. The interim solution cannot continue, we need clarity from NHSH about how we move forward and what is being put in place.

 

I urge everyone to read the report and come to an informed conclusion. I will continue to support NHS Highland in their efforts to make the services safer for mothers and babies in Caithness and Sutherland, in memory of the babies that died and to ensure it can never happen again.

 

I completely understand why some people in the community feel that NHS Highland have gone ahead with recommendations without proper public engagement. Many woman travelling to Inverness to give birth were unsure exactly why this was causing confusion at an already stressful time. The interim measures put in place while the review was underway applied to all first time mothers but NHSH are now looking at relaxing this rule if possible. I also have guarantees that there will be more information made available going forward. Changes to any service can be worrying and the only way to make them as easy as possible is to have the community on board.

 

I agree that we should be using Caithness General Hospital as much as we can, it’s an important resource and the building is most definitely not used to its full potential, this is why the NHS are undertaking a redesign so that the space can be used more effectively. We also have fantastic midwives and support staff and we need to trust them to get on with their jobs. The Henderson Ward is fondly looked upon by many Caithness and Sutherland families and will continue to do so by many in the future.  Unfortunately, the number of babies born to Caithness mothers has fallen in recent years and I quote from the report –

 

“In 2014/15, 169 babies were born in the maternity unit in CGH, of whom 97% lived in the Caithness district and 3% lived in the Sutherland district. The number of deliveries at CGH is predicted to fall further. In the future, we would expect to see around three births per week at CGH. This number of births would normally be dealt with by midwives. It is difficult to justify having a team of consultant obstetricians available 24 hours a day in CGH to help give birth to such a small number of births, in addition to a team of midwives. Most mothers can safely have a baby under the care of a midwife, with very few mothers requiring the care of an obstetrician.

The number of births at CGH has decreased by 30% over the last 15 years. The proportion of mothers from the Caithness district giving birth at CGH has decreased from 95% around 1990/91 to 61% in 2014/15.”

 

This means that it’s very difficult for specialists such as obstetricians or paediatricians to keep their skills up and as such, practices in Caithness General differ vastly from what is seen as normal practice. I quote from the report –

 

“UK guidance on ‘best practice’ indicates that elective caesarean sections should not be carried out before 39 weeks. The proportion of elective caesarean sections carried out at CGH was high, 23% compared to the Scottish average of 14%. This finding was statistically significant. The proportion of these carried out before 39 weeks was also high at 35% compared to 32% at Raigmore Hospital. One would expect the selection of low risk women for delivery at CGH to result in a lower, rather than higher, rate of elective caesarean sections. This finding suggests that obstetricians have been over treating patients, unintentionally increasing the risk of harm and in doing so, decreasing the overall quality of care for mothers and babies. The way in which obstetricians reach decisions about patient care can be affected by structural factors around them. These factors can encourage excessive treatment, increasing the risk of harm and unintentionally decreasing the overall quality of care for mothers and babies.”

 

This is the only model in mainland Scotland that has a consultant led unit without paediatric support and unfortunately this has led to mothers and staff to be being lulled into a false sense of security. I have spoken at length to the parents of the baby that sadly died last September. She needed antibiotics but there was no specialist present to administer them. They didn’t realise that paediatric support would not be available. They assumed because it was a consultant led unit that everything would be ok, even if their baby was unwell. They learnt, however, that it would not.

 

The report also contains distressing reports of five other cases of stillbirth and neo natal deaths that could possibly have been prevented if we had moved away from this model when it was first mooted in 2004.

I have spoken to the Cabinet Secretary for Health, the head of the Scottish Ambulance Service and the Chief Medical Officer, who herself is an obstetrician, and they are in complete agreement that the current model is far too risky to support any further.

 

The decision by the Caithness Committee yesterday to support a motion asking for an independent review was, in my view, misguided. The following medical professionals were involved, most of them from outside NHS Highland and I quote from the review –

 

The review has drawn on the expertise of an internal multi-disciplinary team, supplemented by two external reviews. I am very grateful to Dr Brian Magowan, Consultant Obstetrician and Gynaecologist, and Head of Clinical Service NHS Borders, Dr Jane Macdonell, Consultant Paediatrician, NHS Borders, Mrs Nicky Berry, Head of Midwifery, NHS Borders, and Prof. Chris Kelnar, retired Professor of Paediatric Endocrinology, University of Edinburgh, who undertook a review of team working and organisational culture. I am also very grateful to Professor Elizabeth Draper and Professor David Field, both from University of Leicester, who undertook a review of stillbirths and neonatal deaths at Caithness General between September 2010 and August 2015.

I have been ably supported in the review by a team who met weekly to take the work forward including Dr Helen Bryers, Head of Midwifery, Dr Susan Vaughan, Epidemiologist, Angela Watt, Project Midwife and Dr Stephanie Govenden, Consultant Paediatrician. Dr Cameron Stark, Public Health Consultant and Cathy Steer, Head of Health Improvement also contributed for a brief period at the beginning of the review. Dr Lucy Caird, Clinical Lead in Obstetrics & Gynaecology, Raigmore Hospital, Isabel Seaton, Advanced Neonatal Nurse Practitioner, Mairi Stewart, Advanced Neonatal Nurse Practitioner and Alan Richards, Advanced Neonatal Nurse Practitioner, provided expert advice and contributed to reviews of case notes. Jamie Forrester, Health Records Governance & Quality Manager and his staff in Raigmore and Caithness”

 

I feel that the collective experience and knowledge held by these professionals is beyond reproach. We need to take an evidence based approach to any changes to the unit and in my opinion the case has been made, the evidence is clear to see. To commission another review and to continue the interim model when it’s causing concern in the community, would be irresponsible when we could be moving to make the system safer NOW. What we need to do, if the board accept the recommendations, is ensure that patient transport is reliable and available, that mothers, babies and families are adequately cared for in Raigmore should they require to give birth there, that our own midwives are fully supported and training is kept up to date and that other gynaecological services do not suffer. I have been in talks with several medical experts on how this can be done and I will not support any changes going ahead without these improvements in place.

 

The report can be accessed at - http://www.nhshighland.scot.nhs.uk/News/PublicConsultation/CaithnessRedesign/Documents/Caithness%20Report.pdf”

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