Meeting at Thirsk Racecourse Panel Members: Jill Moulton – Director of Services Strategy and Infrastructure Fiona Bryce – Consultant Obstetrician and Gynaecologist Facilitator Is there anyone for the first question? Audience Good evening, someone has got to start. My name is David Tucker. I live in Thirsk and I have grandchildren and I write for the Thirsk Weekly News. My question is this: Does the CCG accept that the over-whelming majority of people in the catchment area of the Friarage Maternity and Paediatric Services, who have expressed their views, want full Maternity and Paediatric Services to be maintained at the Friarage? And does the CCG accept that this constitutes a reasonable requirement by people on their GP lists for the purposes of Section 13 of the Health and Social Care Act 2012? And if not, why not? Panel I think it’s the duty of the CCG to make sure that all Services that we commission are safe and that is the clinical duty for us. I am on the GMC Register, as are the other GPs, and it is the fundamental principle that we can’t commission an unsafe service. I think that in these days where there has been so much discussion about safety and quality, we have to be absolutely certain that the service that we are commissioning is safe. When we did the pre-engagement we listened to the public about transport, we listened to them about their concerns, particularly with the families who use the services a lot and we listened to the experts around safety – I am not an expert around Paediatrics and Maternity but I trust the people who are. We have listened to the experts locally, in the hospital, we have listened to experts nationally and internationally and I have had phone conversations with the President of the Royal College of Paediatricians and what I know is that we have looked at every option and we feel that we have no choice but to do what we think is the right thing clinically for patients. Have you any other questions? A Hang on, you haven’t answered mine. My question was do you accept, from the views that you have heard, constitute a reasonable requirement on their GP lists for the purposes of Section 13 of the Health and Social Care Act 2012? Or are you ignoring their views? P We are not ignoring their views, but there are …. What I am trying… what I think I said is that there are some ‘bottom lines’ around safety, we cannot commission an unsafe service and I think the other thing is; what we had was 600 questionnaires, we didn’t have a 121,000 responses which is our list. A That’s across the whole of the area; I’m talking about the catchment for the Friarage. P That’s 121,000 people that live in Hambleton and Richmondshire. A No, no, no, no … you are including Whitby. P No there is 144,000 people if we include Whitby. A How many have approached you that are not doctors, who are in favour of the plans you have? P Many, many people ….. A Number? P I don’t have a number, all we have is 600 people and even within that 600 we have had some people in favour of this and I think there are …. A lot of people had conversations and there are people who are unhappy with the service at the Friarage who have come to talk to be personally, they don’t come to a meeting like this, so I think it isn’t true that the majority people on our list have contacted us to say they are not in favour of this. A But you haven’t told them about the Midwife shortage, have you? You say it’s unsafe to have a clinical lead service and you want a Midwife-led service but there are 4,500 vacancies for midwives across the country, and that’s a figure from the Royal College of Midwives, so is it any safer to have a Midwife-led service when there is a dire shortage of midwives, and the Royal College says that will last until 2024? P Perhaps I can comment on that from my point…. you are talking about a national situation of course …… A Yes. P But that varies up and down the country; we have got a midwife sitting in front of me that will tell you that actually locally we don’t have a problem with recruiting. A You can very glibly say ….. with respect. P That’s not glib. A Oh it is because it only needs a change in salaries and they all drain away to other places, don’t they? P Can I tell you that that is not our experience actually and we have a very stable midwife population locally and I don’t know what change in salaries you are referring to but, you know, we do not experience recruitment problems with midwives at the James Cook or the Friarage Hospital? A Despite the national shortage? P Despite the national shortage. A Of 4,500? P We can talk at length about problems with other staff but midwives are an area where we are secure. A So you are telling, at this meeting, that you have no anxieties that you could run out of midwives? P I mean Fran, would you like to respond? I’m a midwife (TC: 00:06:00 inaudible) at James Cook and at the Friarage. There is a national shortage of midwives and that national shortage has been (TC: 00:06:06 inaudible) A 1 to 28. P (TC:00:06:14 – 00:07:03 inaudible) We have not had this problem in relation to staff, what I would say about salaries is that it is a nationally recognised set standard for salaries of midwives that is supported by the Royal College of Midwives and is supported under the gender for change and therefore there isn’t a salary issue, every midwife in this county doing a midwifery job is paid exactly the same, so we do not have the same problem in midwifery the same way that it could happen in nursing as it is a set standard. Thank you for that Fran, I think that was one question and several others, so we will just move on but you can come back. Did I see another hand towards the back of the room – the gentleman at the back there? A Hello, my name is Andrew Eaton, I’m the father of Amelia who suffered brain damage at birth from oxygen starvation. I want to ask, are all options linked with the Midwife-led Unit or is there a no birthing option? I say this because there are a number of mothers and fathers who feel that a Midwife-led unit without paediatricians is just too dangerous for low risk mothers and to add onto that I would like to see figures and the numbers of births that entered the Friarage over the last 5 years that are considered as low risk that have had paediatric or some kind of intervention that would not be there under a Midwife-led unit. That’s one question…. P Can I answer that first? A Yes, sure. P We aren’t consulting a Midwife-led Unit that’s true and I think that was a decision made by the PCT and I think that is based on the national evidence, which actually shows, there has been a big study that 1,000’s of births across the country and it showed that if you get the selection right and the right people delivering the Midwife-led Unit, it is as safe as delivering in a consultant lead unit. There are risks in both, I completely agree, there is no such thing as a completely safe delivery anywhere, not even in a consultant made unit, things go wrong but actually evidence is that it is as safe in a Midwifery-led Unit as long as you select the right patients and I think it needs to be an individual decision for each person making that choice. There will be no compulsion to go to a Midwifery-led Unit, every patient will be able to make their own choices and there are many women who would rather go to a Midwifery-led Unit because they feel that there is less medical intervention, it’s a nicer experience and actually there is some evidence that there is a lower intervention rate and they have nicer births. So there is a counter argument, but absolutely agree with you that I think there are some concerns with delivering within a Midwifery-led Unit. A I think more in a Midwifery-led Unit, the statistics you have got are when there are obstetric and paediatric support not 20 miles away. P No. A That’s where my last part of that will be, can we just show … I’m just going back as my wife entered their as a low risk and we have … I would like to see …. And she has actually asked me to ask that question – how many low risk births enter the Friarage that then needed intervention during …. That is something we would like to see and that would give you a figure of how many need to travel up the A19. P Actually the study was about standalone Midwifery-led Units, it looked at them, it looked at the ones that are alongside a consultant lead unit and it looked at those that delivered in a consultant unit, so it is all three and it did actually say it was safe.