29 June 2017

Proposals to temporarily suspend services at Midwife-Led Units (MLUs) in Bridgnorth, Ludlow and Oswestry for between three and six months were approved today (Thursday 29 June 2017).

The Shrewsbury and Telford Hospital NHS Trust (SaTH) has faced a combination of short-term and long-term sickness in recent months, as well as a significant fall in the number of midwives prepared to work overtime or temporary bank shifts to cover for colleagues at times of sickness. This has led to some significant challenges in our ability to fully staff teams at all our maternity sites, all of the time.

The number of births at the Consultant-Led Maternity Unit in Telford has also risen from 3,795 in 2014-15 to 4,194 in 2016/17.

These factors have meant we have had to deploy our existing staff in different ways to make sure we have safe staffing levels in our units and sufficient staff where they are needed most.  As a result, and due to our need to move staff between our different units to get the right cover in place, there has been an increase recently in the number of times that services have had to be temporarily suspended at our MLUs at short notice.

Today’s SaTH’s Board received a report explaining that action needs to be taken to make sure we can sustainably provide the right complement of staff to safely look after the women using the service at our Consultant-Led Unit.

 

The Board approved a report to temporarily suspend services at Bridgnorth, Ludlow and Oswestry MLUs for between three and six months from 1 July 2017.  This decision will remove uncertainty about whether an MLU will be closed at short notice.

The Board agreed to:

  • Review the decision after three months
  • Write to our clinical commissioners to ensure it doesn’t pre-empt the outcome of the Midwife-Led Unit review that the commissioners are carrying out
  • Ensure meaningful engagement with service users, stakeholders and staff to help shape the service pending the outcome of the review being led by commissioners

The proposals were put forward on safety grounds to ensure safe staffing levels.  This is not about the competence of our staff but our ability to ensure safe numbers of staff.  The decision does not pre-empt the outcome of the Midwife-Led Unit review that our clinical commissioners are carrying out. In the meantime, the Trust will also continue its efforts to recruit more Midwives.

The following services are affected:

  • Bridgnorth Midwife-Led Unit (inpatient services including the delivery suite for births and postnatal ward)
  • Ludlow Midwife-Led Unit (inpatient services including the delivery suite for births and postnatal ward)
  • Oswestry Midwife-Led Unit (inpatient services including the delivery suite for births and postnatal ward)

The following services are not affected:

  • Antenatal services at Bridgnorth, Ludlow and Oswestry MLUs which will be available from 9am-5pm.
  • Postnatal outpatient services for non-inpatients from 9am-5pm at Bridgnorth, Ludlow and Oswestry MLUs
  • Antenatal community (home) visiting, scanning and advice.
  • Post-natal community (home) visiting, and breast feeding support.
  • Home deliveries, which will continue to be available for low-risk women where appropriate 24/7; using the on-call midwife service.
  • On-call Midwives will continue to be available 24/7 to offer advice, support and/or home delivery.
  • All services at Shrewsbury MLU
  • All services at Wrekin MLU
  • All services in the Shropshire Women and Children’s Centre at the Princess Royal Hospital in Telford

What do I (as a patient) need to do?

If you are due to give birth at Bridgnorth, Ludlow or Oswestry MLU your Midwife will contact you to discuss how this will affect you.

Please follow your Midwife’s advice and the information in your birth plan.

Women due to give birth at the affected MLUs during this period will be able to access their Midwife as usual and be offered a birth at an alternative location appropriate to their birth, such as Shrewsbury or Wrekin MLU, the Consultant-Led Unit at the Princess Royal Hospital in Telford or a home birth if appropriate.

Midwives will continue to be available to provide advice 24-hours-a-day, seven-days-a-week.

If you have any concerns or questions please contact your Midwife.

Why are these changes taking place?

SaTH has faced a combination of short-term and long-term sickness, as well as a significant fall in the number of Midwives prepared to work overtime or temporary bank shifts to cover shifts at times of sickness.

The number of births at the Consultant-Led Unit in Telford has also risen from 3,795 in 2014-15 to 4,194 in 2016/17.

These factors have meant that there has been an increase in the number of times that services have had to be temporarily suspended at MLUs at short notice.

These temporary measures will ensure the safety of women using the service at the Consultant-Led Unit, and to remove uncertainly about whether an MLU will be closed at short notice.

How will long will these arrangements be in place?

The temporary suspension of services at Bridgnorth, Ludlow and Oswestry MLUs is for between three and six months from 1 July 2017. The decision will be reviewed after three months.

Deirdre Fowler, Director of Nursing, Midwifery and Quality at SaTH, said: “The safety of mothers and babies using our service is our number one priority and this proposal, albeit difficult, is something we have given careful consideration.

“An increasing number of women are choosing to give birth at our Consultant-Led Unit in Telford, rather than at our MLUs. In 2008/2009 MLU births, including home births, accounted for 26% of our activity but in 2016/17 this figure has fallen to 13.1%, with just 3.4% of this activity taking place at Ludlow (0.7%), Oswestry (1.1%) and Bridgnorth (1.6%) MLUs.

“This means we have seen a high level of demand on our Consultant-Led Unit (85% of local women are giving birth here). At the same time we have faced a combination of short-term and long-term sickness, as well as a significant fall in the number of midwives prepared to work overtime or temporary bank shifts to cover shifts at times of sickness. This has meant that at times we have had to temporarily suspend services at our MLUs due to staffing shortages.

“We appreciate that such temporary suspensions of service are disruptive for mothers-to-be, their families and our staff and create uncertainty for women about whether an MLU will be open or not when they go into labour.

“As a result, we have agreed to temporarily suspend services at our MLUs in Bridgnorth, Ludlow and Oswestry for between three and six months months in a measured and planned way, rather than having to suspend some services temporarily at short notice, to ensure we continue to provide a safe overall service.

“We recognise the significant impact that this may have on some of the women we care for about their planned place of birth and we are sorry for this. We have taken into account the many comments received regarding short-notice closures and recognise that the women we care for need assurance about their place of birth. For this reason, we have made the most difficult decision to suspend some services for a defined period of time whilst we work up alternative longer-term sustainable options. I would encourage any woman using our service who has concerns or questions about how this will affect them to discuss their birth options with their midwife.”

SaTH will be working with service users and stakeholders to ensure they are fully engaged in the process to shape the service. Head of Midwifery Sarah Jamieson is keen to hear your views. If you would like to be involved please contact her via her PA Nick Robinson by calling 01952 565996 or email nick.robinson@sath.nhs.uk

Regular meetings are planned to consider options and future models but this work will not pre-empt the outcome of the Midwife-Led Unit review that our clinical commissioners are carrying out.