19 January 2007

MSP Makes Submission To NHS Grampian On Maternity Units

Banff & Buchan MSP Stewart Stevenson has made his submission to NHS Grampian on maternity service provision in Banff and Fraserburgh.

The move follows Mr Stevenson’s visit last week to Broadford to tour the birthing unit there which has seen a trebling of local deliveries since it was established in 2003.

Health Minister Andy Kerr refused to endorse NHS Grampian’s plans to axe the units at Fraserburgh and Banff and ordered that the Health Board look at providing ‘birth units’ in the towns along the lines of the successful units in place elsewhere in Scotland.

Mr Stevenson had earlier in the year flagged up the success of the units run by NHS Highland, in particular the one at Broadford which had seen a trebling in the number of expectant mothers giving birth in their local area.

In his submission to the Chief Executive of NHS Grampian, Mr Stevenson states:

“I refer to the ongoing review relating to maternity service provision and should like to add my views to your consultation.

“During the last week, I visited the Dr MacKinnon Memorial Hospital at Broadford, Isle of Skye to tour the Birth Unit and met with Lead Midwife for Skye & Lochalsh Rona Scott for discussion.

“Firstly, I would make it clear at the outset that it is not for non-health professionals such as myself, having identified a requirement for, and a desire by the local community to have, certain health services in their own locality, to say how these should be delivered on the ground. The important point here is that it is clear to me that in both Fraserburgh and Banff that there is in fact a local demand for maternity/birth services and indeed a requirement for such services and it is now incumbent on NHS Grampian to respond positively to that demand.

“By way of background, maternity services at Broadford were re-organised in 2003 to address various factors, many of which are relevant to the situation here, such as workforce planning issues, low local delivery rates, issues of skills maintenance and competency, etc.

“It is worth noting that since re-organisation, the delivery rate at Broadford has risen from 8 in 2003 to 24 in 2005. This has fallen back slightly in 2006 but I was advised that the number of ‘bookings’ already taken for 2007 would indicate that this upward trend will continue.

“A large part of the ethos of this midwife-led service is to “demedicalise” as far as possible the experience for each expectant mother. That is to say that through the use of named midwives being assigned particular expectant mothers, a relationship is built up over the period of the pregnancy. As Lead Midwife Scott put it to me, pregnancy is a normal part of life and the service aims to keep it “normal” as far as possible with appropriate medical intervention as may be required – as in any other area of life.

“This strategy has, according to Lead Midwife Scott, led to there having to be no inductions performed, (and often, inductions can lead to a cascade of other medical interventions being required) and little requirement for expectant mothers to be administered diamorphine.

“In reaching its recommendations, NHS Grampian has placed great emphasis on the claim that at the current level of births in the units in my constituent, retention of skills is an issue. At Broadford, which we know has experienced 24 births during 2005 (a low number in relation to Fraserburgh for example), I found that no such concerns exist.

“Lead Midwife Scott advised that the 2003 re-organisation has led to an increase in both confidence and competence of the midwives along with improved leadership and support. Indeed, it seemed to me from my discussions that skills maintenance was being enthusiastically addressed on an ongoing basis by the midwives carrying out their jobs in geographical areas other than those for which they were responsible from time to time, giving them access to other situations they may not necessarily come across too regularly in Skye & Lochalsh and allowing them interaction with other members of NHS Highland staff.

“This seems to me to be a common-sense and highly practical approach to addressing this important issue and the midwives at Broadford have shown quite clearly that that can be quite easily overcome and that a valuable – and valued – local service can be maintained.

“As you will know, at my briefing meeting with NHS Grampian last week, it was confirmed to me that the criteria for expectant mothers using a birthing unit would be exactly the same as that for those who currently give birth in their own locality. Given that this is the case, I therefore see no reason why expectant mothers who are ‘low risk’ should not enjoy the benefits of a birthing unit and be able to give birth in their own community without the need for a long and sometimes stressful journey into Aberdeen.

“NHS Grampian has also expressed concern regarding expectant mothers travelling in a counter-direction to consultant-led services. The experience of Broadford clearly shows that there is no good reason why expectant mothers who wish to give birth in their own locality, and who have been assessed as ‘low-risk’ should not be able to do so. In addition, both Fraserburgh and Banff have ambulance depots, and in the case of Fraserburgh a 24-hour ambulance depot which was upgraded to full-time status several years ago following my lobbying of the Scottish Ambulance Service, and are both somewhat nearer to acute services than Broadford.

“In conclusion, I believe that the case for local delivery of health services as espoused by campaigners and the Scottish Executive has been proven. At a time when there is huge pressure on the NHS to deliver more for less cost to more patients it would be a retrograde step to centralise maternity services in the City – which are already at or over capacity - when a working and highly successful template for birth units for low risk expectant mothers exists in neighbouring health board areas which can spread the load across the region.

“I enclose for your information two documents which were given to me by Lead Midwife Scott on my visit which I am sure will be of value to you in your deliberations.

“I trust that you will take these observations on board and I look forward to hearing from you soon.”

Stewart Stevenson
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