FEATURE: Maternity services will become '˜unsustainable'

Hospital bosses have said going forward Pilgrim Hospital's maternity services are '˜unsustainable' due to staff shortages and difficulty in attracting doctors to the area.

Boston's Pilgrim Hospital. Photo by David Dawson.

They added these same pressures meant they were unable to currently offer mums-to-be as many services as they would like.

Lincolnshire Health and Care’s review into health services, aims to combat a potential combined budget deficit of £100m per year by 2018.

However, there have been numerous concerns raised over some of the potential plans, including the possibility that maternity services at Boston’s Pilgrim Hospital could be downgraded.

Amidst the rumours and speculation, Daniel Jaines met with chiefs from United Lincolnshire Hospitals Trust, which runs the site, including head of midwifery and nursing for women and children’s services Sue Bennion, consultant paediatrician and Clinical director for women and children’s services for the trust Dr Sudhakar Rao, assistant director of strategy and change Julie Pipes and labour lead Hazel Harrison.

Changes suggested by a wide-ranging review of all NHS services - being conducted by LHAC and yet to be confirmed for public consultation - have raised a number of concerns across the county.

The four options previously tabled include:

n One specialist emergency centre and one consolidated inpatient Women and Children’s Service located at Pilgrim Hospital

n One specialist emergency centre and one consolidated inpatient Women and Children’s Service located at Lincoln

n One specialist emergency centre at Pilgrim Hospital and Women and Children’s at both hospitals

n One specialist emergency centre at Lincoln and Women and Children’s at both hospitals

In all of the above cases some women’s and children’s services would remain at but each site could be midwife-led.

Although financially, ULHT says it can afford to run two ‘all-singing all-dancing’ centres for women and children the real difficulty, according to Sue Bennion and Dr Sudhakar Rao, is attracting staff, with many rotas covered by what can be expensive locums. It is also not unusual for consultants to step down to a lower grade to cover shortages.

Dr Rao told the paper with that in mind, changes would need to be made. He said: “If we don’t agree anything, we are waiting for things to get worse and worse and worse.

“Should we think about that? Or Should we plan ahead to make services safer for the next 30 years?

“There will be concerns, there will be issues that people can find difficult to understand and we all are aware of that but as a team of professionals we have a duty of care to do the best for the people of Lincolnshire. We are really, really struggling to keep them [the maternity wards] safe on a day to day basis. It’s not immediately unsafe but we can see the signs.”

Dr Rao explained the struggle was due to both the location of the hospital and the number of births which it deals with. He said, busier hospitals handled more ‘complex’ cases which provide increased learning opportunities for junior doctors.

Therefore given the relatively low number of births at Pilgrim (1,999 in 2015/16) and Lincoln (3,486) combining the two units would present a more attractive proposition to those professionals.

Mrs Bennion said Pilgrim Hospital was not ‘currently offering the full menu’ of services for mothers and said maternity ‘does not centre purely around the birth’ with assessments and options being laid out from the moment the family find out about the pregnancy.

Mrs Bennion said it was important to recognise that the number of births requiring a consulatant led delivery was low compared to those which could be overseen by a widwife-led service. She said from the very start of the pregnancy ‘journey’ the mother is assessed and a suitable care plan is put in place.

She said: “Every anti-natal assessment we do is continually assessing that woman to make sure we’re meeting her health and social needs.”

She pointed to the recent ‘Better Births’ national maternity review by Baroness Julia Cumberlege, which highlighted a need to balance a high number of births, with patient travel times and said geography is no excuse for not meeting national standards.

However, many people have raised concerns that having one centre, particularly if that centre was in Lincoln, would result in longer travelling times and ambulances being tied up. Mrs Bennion was adamant ‘creative’ solutions would be looked at, suggesting that trusted taxi firms could provide transport to and from hospitals, or even purchasing the hospital’s own ambulance.

Both Mrs Bennion and Dr Rao said they were unable to comment on the LHAC options, but both said they would be putting the safety of patients first.

Dr Rao said: “I have a professional interest in safety and quality as a doctor. I have a responsibility to stand up to the right thing.”

n A number of concerned sources have told the paper that staff are being told not to call the new maternity build a maternity ‘unit’.

It is in fact being referred to as a maternity ward and not a unit – Mrs Bennion told us that the clinical facility is a maternity ‘ward’ with anti-natal and post-natal ‘services’, and it will have the classification M1.

FACT BOX: Key figures in maternity

Here are some of the key facts and figures to come out of the meeting with hopital bosses.

l In 2015/15 1,999 births took place at Pilgrim Hospital, 3,486 took place at Lincoln. A further 100 were home births.

l There are five consultantant paediatriccians/neonatologists at Pilgrim Hospital with one of those being agency staff. This compares to eight substansive staff at Lincoln Hospital.

l There are seven obstetricians and gynaecologists at Pilgrim Hospital, with one being an NHS Locum. Lincoln has 10 staff with three NHS Locums.

l ULHT admits it has a shortage of advanced neonatal nurse practicioners (ANNP), who are highly experienced nurses which can provide care and treatement to sick babies. Only two out of six posts are filled with permanent staff.

l Pilgrim Hospial deals with level one special baby care, while Lincoln Hospital deals with level two local neonatal issues. Nottingham or Leicester hospitals deals with level three neonatal intensive care. This means the sickest babies already go out of the area to Lincoln or further afield to be treated.