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The Future of Children's and Maternity Services at the Friarage Hospital

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The Future of Children's and Maternity Services at the Friarage Hospital The future of children’s and maternity services at the Friarage Hospital, Northallerton Public engagement event – Thursday 3 May Richmond School, Richmond The panel Name Role Cllr Jim Clark Cllr Clark chaired tonight’s meeting. He also chairs the North Yorkshire Scrutiny of Health Committee. Vicky Pleydell Dr Pleydell is a local GP. She is also the Shadow Accountable Officer and tonight’s lead clinician from the Hambleton, Richmondshire and Whitby Clinical Commissioning Group Ruth Roberts Dr Roberts is a consultant paediatrician who works at the Friarage hospital and was tonight’s lead clinician from South Tees Hospitals NHS Foundation Trust Many of the questions and consultant paediatrician’s comments made below were in the context of the current thinking that option 5 is the preferred option of doctors and staff working with children at the Friarage Hospital – which was discussed in detail during the presentation. Q & A Why is there no mention of accessibility and transport for patients from more distant areas? Vicky Pleydell - Transport is and always has been an issue. If problems were simple we would have sorted it before. One of the pieces of work is looking at the three- month period when hospital paediatric services were closed and what the impact was on the ambulance service. If people have ideas about how to make transport system better I would like to hear. Transport needs investment but it is not a health issue. We would have to work with the county council. If you are going ahead with one of the suggestions you are taking it out of council’s hands as you are creating the need for extra transport. You will need to look not just at cost of putting in doctors but also how much you will have to pay to put appropriate transport into place. Vicky Pleydell - The problem is always the numbers. I am part of a practice which delivers minor injuries services at Catterick. We have had a budget for this to fund taxi transport to the Friarage if they need to go and in all the years we have done this we have only used five taxis. It is only small numbers of people, but we will happily have a conversation on how to work this out. But what we are talking about is emergencies at night. We are not talking about changing the day time service. We are talking about bringing services closer to people. There are pros and cons and not everyone will travel further. If we had five-day outpatient services at the Duchess of Kent Hospital in Catterick Garrison (one of the proposals in the hospital’s preferred option 5) many people would travel less far. We need to understand what options mean and will look at in detail. Will Darlington and Middlesbrough be able to cope with extra cases? Ruth Roberts – Some work has been done on that but it would take some future planning. Fran Toller (Divisional manager, women and children’s services and practising midwife who was in the audience) - There is no doubt we need to improve capacity at James Cook and this would be part of plans. When we closed for three months three years ago we did temporarily increase capacity, but we would need to ensure we had more accommodation, with the emphasis for women with children in the special care baby unit where lengths of stay are slightly longer. People in Middlesbrough may go home earlier and we would plan for that. Darlington –We have had discussions with Darlington and they are aware of the issues and would welcome increase in births as it would make their unit more sustainable in future. Why is it not possible for patients to travel to Northallerton from Middlesbrough to increase workload? Ruth Roberts - We have started to do this. We have kept the special care baby unit going by bringing special care babies to Northallerton from Middlesbrough. We also get some outpatients with choose and book and this is effective. It may be possible to bring day case surgery patients down from Middlesbrough. Why is it not possible for consultants to share cover with James Cook? Ruth Roberts – We do share some of the cover already and rotate to maintain skills. The difficulty is we have 10 consultant colleagues at Middlesbrough and 5 whole time equivalent consultants at Northallerton. We would have to provide a rota for both sites on-call and the college guidelines stipulate you need ten to run a safe rota so even across both sites we don’t have enough. We would be able to increase rotation by implementing option 5. We would enhance the outpatient service bringing specialists across from James Cook to Northallerton and also to Catterick Garrison. I wanted to talk about maternity services, because with option 5 you don’t know what would happen – if safety is primary factor I cannot see you would continue to allow births at the Friarage. Without paediatric back-up you would have a serious problem. At Kidderminster there were 6 unexpected neonatal deaths when they had a midwifery-led service. If you do decide to close it you would need to say this now. Ruth – All of our midwives have neonatal first responder training. At Kidderminster they had this and still had the deaths. Fran Toller– Historically having midwife-led units is a controversial area of provision. It is fair to say when the National Clinical Advisory Team came and we looked at options for paediatrics we did not have options ready. We are working through this and maternity staff have been to a number of midwifery units across the country. They have some key criteria and you must correctly select women who are eligible to have a low risk delivery - that is fundamental. If you don’t pick true low dependency women and observe for signs of complications you have got the wrong lady in the wrong place from the start. When you have successfully done this and regularly check this process, the next step is to have highly skilled, trained midwives. I have done investigations as a senior midwife as to why things have gone wrong and for the vast majority of times it is because you don’t have the right skills. You need to have the neonatal resuscitation skills which are regularly practised in a true unit. You need systems to retain those skills. Ideally you would rotate midwives at James Cook and the Friarage to ensure skills are maintained. The other key is how many babies are delivered - if you only had 100/150 deliveries the midwives aren’t getting the skill and practice and they don’t respond appropriately. Will women want to deliver there? We are getting mixed messages from the focus groups and from what we glean from our ladies. We are going to do a straw poll with women being delivered and asking whether they would wish to go to midwife-led unit. High skill helps recognise where you need to transfer early. We are not misleading anybody – we are auditing the outcome of whole engagement event, visiting units and talking to focus groups. This will determine whether we propose a midwifery-led unit or we don’t. Even professional colleagues have different views as every piece of research changes the tide of thought. The current tide of thought is that the best units are co-located with the main obstetric unit. If you truly do it correctly there is evidence you can be safer if you are a true low dependency lady. The NCT did some research from enforced closure. I don’t think mothers would not wish to go to a midwife led unit. Fran Toller – This would have to be something we need to talk to people about. We need people to use it. What would happen in situation where the patient was well chosen and the midwife was well trained but unexpected problems occurred. Fran Toller – There would be a conversation with main unit and the lady would need to be transferred via 999 with escort of midwife. Cllr John Blackie - I notice you have changed the presentation and you have softened it, but you have introduced two new issues, one about capacity issues at James Cook and the second is from Ruth Roberts that what we are doing now will only be good for another five years. What really concerns me is that if the Friarage goes in terms of maternity I believe there is as much chance of getting a midwife-led unit as I can fly to the moon so you are telling people who have connections of a lifetime with a particular hospital to go elsewhere – i.e. Darlington. The chief executive of Darlington is talking about 500 births a year. If you say this is only for 5 years, when will we have proposal for downgrading A&E like Bishop Auckland? Ruth Roberts – my five year suggestion is that for me this is about planning ahead so we don’t run into a problem. What was so difficult about the sudden and urgent closure was that it was hard to plan safely. This has come from looking ahead to the future from retirements and raised standards so we can plan. You are right to ask questions about capacity. We need time to do this properly. All these issues are important and we have to talk together so we don’t get rapid changes as we know these are difficult. Vicky Pleydell – We are learning. After each of these sessions I reflect so that the next time we do better.
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