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Safety review reports on maternity services in Berwick

Thursday, 03 July, 2014
Safety review reports on maternity services in Berwick

Northumbria Healthcare NHS Foundation Trust has today reaffirmed its commitment to providing a safe maternity service for Berwick, outlining the findings of its three-month safety review following the temporary suspension of some services at Berwick Maternity Unit earlier this year.

On 1 August 2012, births and postnatal inpatient care were suspended from the midwifery-led unit in Berwick following two serious incidents which highlighted serious safety issues as a result of the low number of births at the unit, only 13 in past year (2011/12), the lowest number in England of any comparable unit.

The extremely low number of births at the Berwick midwifery-led unit resulted in a lack of opportunity for midwives to gain enough practice and variety of clinical experiences, to be able to deliver a safe service.

Since the temporary suspension began, Northumbria Healthcare took immediate steps to begin a formal rotation of its Berwick midwives, which is currently ongoing, to allow them to practise in its busier consultant-led unit at Wansbeck General Hospital.

Throughout the safety review period, the Trust has reassured its staff, members of the local community in Berwick and other stakeholders, that the temporary decision was made purely on safety grounds alone and in order to protect its midwives in Berwick and the mothers and babies in its care.

Today, the Trust has outlined two possible future options on how a full range of midwifery-led maternity services can continue to be provided safely to expectant mothers in Berwick, 24 hours a day, seven days a week.  These options will now need to be considered with the commissioners of the service NHS North of Tyne.

Safety review findings

Key findings from the safety review show:

The current configuration of maternity services in Berwick (pre suspension) is an outlier with the rest of the country, even when looking at other very rural areas.
The midwifery-led unit in Berwick dealt with the smallest number of births (13) of any comparable unit in England last year (2011/12).  The nearest comparable service in Penrith delivered 30 babies.
Stringent national safety guidance on maternity care, which all NHS Trusts must follow, has resulted in around half of Berwick women (nearly 48 per cent) not being eligible to give birth in the midwifery-led unit in Berwick in the past year, because they were classified as ‘high risk’.
Patient choice has also played a key part in the declining birth numbers at Berwick Maternity Unit.  Of the 52 per cent of Berwick women who were classified as ‘low risk’ and therefore eligible to choose Berwick Maternity Unit last year, 59 per cent (85 low risk women) chose to deliver at a consultant-led unit instead.
Only 34 per cent of low risk women (49 women) chose Berwick Maternity Unit to deliver their babies last year and of these, only 13 actually delivered in the unit.
The low birth numbers in Berwick have also dramatically impacted on the current inpatient postnatal care service at the unit (pre suspension) which has an occupancy rate of around 20 per cent.  For a third of the year in 2010/11 (129 days), this unit had no inpatients at all and was empty.
Maternity services at Berwick is further impacted by the proposed removal of the specialist neonatal retrieval team by Newcastle Hospitals, which is currently in operation.
Recommendations for the future

Northumbria Healthcare has now proposed two possible options for the future provision of a full, safe, midwifery-led maternity care service 24 hours a day, seven days a week in Berwick.

Both options will require the mandatory rotation of Berwick midwives to a busier consultant-led unit, due to the low birth numbers in Berwick, which is unlikely to change.  This is to make sure that Berwick midwives are able to regularly practise a full range of midwifery skills in different clinical situations for the long term.  In summary:

– Option one would continue with the current service in Berwick (pre suspension) and would require the recruitment of additional midwives in order for the Trust to facilitate regular rotation of midwives to maintain safety standards.  Unless there is a significant increase in the number of births at Berwick, this option would mean that the current postnatal inpatient service, which is open 24/7, would only be occupied around 20 per cent of the time.

– Option two draws on similar safe models used in other rural areas across the country and would operate a 24/7 on-call system for intrapartum care (care during labour) which would either be delivered at the home of the expectant mother or using a maternity birthing room in Berwick.  Inpatient postnatal care would be provided for up to six hours following birth, after which women would be supported in their own homes by an enhanced postnatal community midwifery service.  This would be staffed by midwives participating in an on-call rota system.

Both options would meet the required safety standards needed by Northumbria Healthcare and are now with commissioners of the service NHS North of Tyne for consideration.  Any long-term changes to the maternity service in Berwick would be subject to formal public consultation led by NHS North of Tyne.

In the interim period, births and postnatal inpatient care services in Berwick will remain suspended until the rotation of Berwick midwives is complete and clinicians at Northumbria Healthcare feel the service is safe.  Reinstating the suspended services will only be considered once all Berwick midwives have completed their current rotations which are expected to be complete by April 2013.

During this time, the unit remains open seven days a week, as it has done throughout the safety review period, for all antenatal, postnatal and consultant-led clinics including community midwifery support.  Northumbria Healthcare is committed to supporting any women who wish to have a home birth during this interim period by providing this service through community midwives based elsewhere.

Janice McNichol, Head of Midwifery at Northumbria Healthcare NHS Foundation Trust, said:  “From the outset we have been very clear that this temporary suspension has been about safety and safety alone.

“We could not ignore the safety issues that arose in Berwick and took immediate steps in the interests of patient safety and to allow our midwives to get more regular practice and exposure to a wide variety and volume of clinical scenarios which is absolutely critical for any safe maternity service in Berwick for the future.

“There are no other rural parts of England with such a low number of births as Berwick and this is also something which we cannot ignore.  These low birth numbers are not just a result of changing national guidance, which we must adhere to, but also the choices Berwick women are making about their maternity care – the majority of low risk women who could have chosen Berwick to deliver their baby, chose a consultant-led unit instead.  

“As a Trust, we are fully committed to providing a safe, round the clock, maternity service for the people of Berwick and hope this is clear from the two options for a future safe service which we have put forward to our commissioners NHS North of Tyne for consideration.  I would also like to thank our team of midwives in Berwick for their cooperation and ongoing professionalism during this difficult time.”

Click here to read a full copy of the safety review.