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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 – Tuesday 1 May 2012 Colburn Leisure Centre, Catterick Garrison 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 Jon James Dr James 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 My main concern is transport between Northallerton and The James Cook University Hospital and the cost for us mothers who do not drive or have money. What happens when a doctors says we have to go to James Cook? Jon James – It’s a good question. The transport system and services between the James Cook and the Friarage does need to be looked at. In terms of the ambulance service, they would need to up-skill and that’s the conversations we need to have with them. I wish I could say there are grants/benefits to pay for travel but unfortunately there aren’t unless families are in receipt of family support. Since the closure of the Duchess of Kent Military Hospital, it has never made sense for paediatrics and community services to be at the Friarage. Darlington is closer and quicker so surely the service should be moving to Darlington and County Durham? Vicky Pleydell – We’ve had lots of conversations with Darlington and have been assured they are very happy to see patients in this area. Patients already go to Darlington for quite a lot of specialities and have a choice to go there. As a commissioning group we do have a contract with Darlington and it is a personal choice for patients. GPs should offer you the choice of which hospital you prefer to go to. I had a baby eight months ago and there was no option to choose Darlington – it was Northallerton or James Cook. Vicky Pleydell - The midwives should be offering you the choice. I was looking at the statistics for 1,250 child births a year at the Friarage. I went from having a healthy labour to my child being on death’s door. If you had a midwifery-led unit and that happened, you couldn’t put me in an ambulance and say see you at James Cook. Vicky Pleydell – One of the issues is you would be able to go to Darlington which has all the services needed there. The problem is you can go from a having a perfectly normal birth to a critical situation… Fran Toller (divisional manager for women and children) – I think the question you’re asking is if mum’s are going to go to a midwifery-led unit, what plans are in place is something goes wrong? With any mum we have clear criteria – it’s very explicit. If you have any pregnancy deviating from what would be deemed as ‘normal’ we would not advise you to deliver in a midwifery-led unit. Obviously, we know for some people unexpected complications can arise and there is no doubt at all if that happened, the woman would have to be escorted to the nearest consultant-led unit as it would not be safe to keep them in a midwifery-led unit. There is lots of research both for and against midwifery-led units – that’s because there are no absolutes with them – so the other question we have to ask is would women use it? These units are run by trained midwives who are highly skilled and if there was a deviation, the key is quick and early transfer in an ambulance with a midwife escort. But that’s in an ideal world. The Friarage Hospital has a fantastic maternity unit now… Fran Toller – It is really difficult and I understand the point you’re making about your own delivery and the care you received at the Friarage, but all I can say to you is most deliveries occur with no consultant or staff intervention. As a midwife myself, I would say with very clear criteria and highly skilled midwives, there is a place for midwifery-led units, but as a midwife I would have to be assured we get early response from the ambulance service if we were in a position where we had to quickly transfer someone to James Cook. And the reasoning behind why I say James Cook, rather than another hospital, is the trust already has two units (James Cook and the Friarage) which work together well now. They use – and work to - the same policies and guidelines and that understanding of transfer is already there. If Darlington has a similar low birth rate why isn’t it in the same situation? Vicky Pleydell – If mum transfers – or chooses to go - to Darlington that makes the maternity unit there more sustainable. From the early results of our focus groups, most people would not choose a midwifery-led unit because of that risk if there was a complication. In Catterick, there are a large number of married families, military personnel and a lot of young families. I’ve come to the conclusion the basic problem is staffing levels. I would like to know how many professional people would be required to continue the service at the Friarage and has anybody done any costings around what it would cost to bring the service up the statutory minimum requirement? Jill Moulton (director of planning at South Tees Hospitals NHS Foundation Trust) – The honest answer is we don’t have detailed costs because we want to listen to your views and the views of other units who have made the move to a consultant-led service. Ultimately we want a service that is safe so it is interesting when you talk about staffing numbers. We do know the staffing numbers that would have to be in place but these staff would need to be able to keep their skills up to speed. Our issue is in order to meet current standards, those staff would still be seeing the same numbers of children and babies so we would have more staff but it is arguable whether the service would be safer as a result. We need to do the costing at the end of this exercise when we have established all the options and we will put this into the public domain. As a rough idea we have 5.5 paediatricians – the current standard is around 10 but to run a 24-7 rota effectively we would need more than 10 consultants. Banbury has 12 and a doctor on average costs around £120,000. You’re looking at extra doctors in paediatrics, obstetrics and neonatal care and anaesthetic cover to support maternity services. It is effectively a big bill. Vicky Pleydell – The information we have from Banbury is they spent around £2.5million. At the Friarage, the issue is there are not enough children going through the front door and people are not having enough babies so the income currently generated through the system is not enough. Cllr John Blackie then asked a number of questions Scarborough has 1,000 live births a year but has received £20million extra funding from the NHS. What is their trust and the CCG doing differently to get their money to what you’re doing here? Vicky Pleydell – The Scarborough money is specialist funding to do with quality and it is an issue which has been going on for a number of years at the trust. It’s also short term - £20million over five years – and that funding will then be withdrawn. A lot of it will be spent on redeveloping the actual site. Funding is a political issue. You are using another hospital’s experience when you talk about costs. When you do the costs can we have reassurance that you’re also including the extra cost of ambulances? The new stroke pathways costs to James Cook cost an additional £250,000 for ambulances. Can you cost having residences at James Cook for people travelling distances and the additional costs to go to remote areas in the Dales with the appropriate level of skilled cover including having paramedics on ambulances skilled in paediatric airways? What about all those costs? When I first cut my teeth in health, it was about the closure of the Duchess of Kent Hospital and people fighting for A & E. When it closed the people were reassured ‘don’t worry there will always be the Friarage’ Now we’re being assured when you close the Friarage there will always be Darlington. Even the NCAT report raises questions about Darlington. What trust can we give when promises that were made crumble in front of us? Vicky Pleydell – We can only promise what can be done in the short-term. All I can say is I was there when we had the Duchess of Kent closure and the decisions were taken in good faith by the people concerned and based on the situation at the time. None of us know what will happen in life and it would be wrong to say that people who made promises did so in a disingenuous way.
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