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Consultation launched on major maternity shake-up in South West England

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Two standalone midwifery units will close for births and postnatal beds in the community will be scrapped under major plans to revamp maternity services across Bath and North East Somerset, Swindon and Wiltshire.

Those behind the proposals, which will also see the creation of two new midwife-led units attached to hospitals, say they are designed to make the best use of funding and the maternity workforce and will mean midwives are no longer “staffing empty buildings and beds”.

“Certain services are under-used and we are often staffing empty buildings and beds”

Sarah Merritt

The plans, which were put out for public consultation this week, have been developed over the past two years by NHS organisations that make up the local maternity system in the three CCG areas.

Lucy Baker, acting director for maternity services at Wiltshire Clinical Commissioning Group (CCG) and lead director for the project, said the proposals had been informed by feedback from more than 2,000 women and families, midwives, obstetricians and others.

Despite financial pressure on the NHS locally and nationally, she stressed there were no plans to cut spending on maternity services, reduce the number of staff or close any buildings.

Under the plans two out of four existing freestanding midwifery units would no longer support births.

Women would still be able to have their babies at standalone midwifery units in Frome and Chippenham but units in Paulton and Trowbridge would no longer offer that service. However, antenatal and postnatal clinics would still take place in all four locations as well as other settings in the region.

Meanwhile, a total of nine community postnatal beds – four at Chippenham and five at Paulton – would be removed with plans to support more women at, or closer to, home.

Those who need to be admitted for medical treatment after giving birth would be treated in their local obstetric unit sat in one of the region’s three acute hospitals, with 89 antenatal and postnatal beds available.

“We believe we have the right number and mix of staff but they’re not based in the right locations”

Sarah Merritt

The proposals include the creation of two new “alongside” midwifery units – one at Salisbury District Hospital and one at the Royal United Hospital in Bath. These are on top of the existing White Horse Birth Centre at the Great Western Hospital in Swindon.

The plans are designed to address issues affecting all regions including an increase in the number of older women giving birth and a rise in the number of high risk pregnancies. These factors have ramped up demands on the obstetric units at the Royal United, Great Western and Salisbury District hospitals and the hope is the plan will reduce that pressure, said the consultation document.

In addition, many women with low risk pregnancies have been choosing to have their babies in an obstetric unit because they were worried about having to move to another site if they needed medical care, the report added.

Sarah Merritt, head of nursing and midwifery at the Royal United Hospital, said some of the changes were down to the fact some services were barely being used.

“Particularly at the RUH, certain services are under-used and we are often staffing empty buildings and beds,” she said.

She said currently 85% of women gave birth in one of the three obstetric units with less than 6% giving birth across the four freestanding midwifery units.

At the freestanding midwifery units staff were often on duty when there were no or very few births – especially at night, she said.

“On average only one baby is delivered every two or three days in each of these units but they need to be staffed to support births 24 hours a day, seven days a week,” said Ms Merritt.

Midwives have reported feeling demotivated as a result and staff are often re-deployed at the last-minute, which “can be frustrating for staff and affect morale and impact on staff retention”, said the consultation document.

“Our proposal would allow us to provide more choice for more women across our area”

Lucy Baker

Offering births at two rather than four freestanding units will free up staff to ensure better continuity of care and postnatal support – such as breastfeeding support at home - and more support for home births, it added.

Currently only 2% of babies born across the local maternity system are home births and women said they would like to see more support to allow women to choose a home birth if that is what they wanted.

Meanwhile, postnatal beds in the freestanding units are rarely used and were empty 95% of the time last year, said the document. When they were used it was mainly for breastfeeding support.

“We believe we have the right number and mix of staff but they’re not based in the right locations to ensure sufficient use of our resources and provide women with the services they need,” said Ms Merritt.

The plans should also bring benefits for midwifery staff including greater flexibility and more options to work in different care settings, which should support recruitment and retention, said the consultation document.

The consultation on the proposals will run until 24 February next year with a final decision due to made in Spring 2019.

Ms Baker hoped midwives, local families and others would participate and have their say.

“Our proposal would allow us to provide more choice for more women across our area about where and how they are supported before, during and after the birth of their baby, and allows us to make more efficient use of our resources and workforce so we can further improve our antenatal and post-natal and birthing services,” she said.

“We also want to ensure we are delivering the services that can meet the changing needs of our local women and families both now and in the future,” Ms Baker added.

Partner organisations that form the local maternity system include Great Western Hospitals Foundation Trust, Salisbury Foundation Trust, Royal United Hospitals Bath Foundation Trust and Bath and North East Somerset, Swindon and Wiltshire CCGs.

All the consultation information and documents, including ways to get involved and to provide feedback, are available on the Transforming Maternity Services website.

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