"I was pleased to hear that the Birth Centre may re-open earlier than originally planned - see details from the Trust below."
Summary of current situation
The proposed suspension of inpatient services (birthing and postnatal stays) at Andover Birth Centre is in place. It was originally suggested that the suspension would last until the end of March 2010. However, a new staffing model has been put forward and is being worked on. It could be in place early in the New Year.
Other aspects of the service offered by Andover Birth Centre (ABC) and its staff will continue as normal. These are antenatal, postnatal community care services and home births.
The Andover Birth Centre’s normal staffing is the equivalent of 12 full time midwives supported by seven maternity support workers. Maternity support workers are similar in skill level to healthcare assistants in a hospital but they specialise in maternity.
The ABC currently has three midwives off through maternity leave and sickness absence. The whole of the Trust’s maternity service, which covers community midwifery and the maternity department at Winchester’s Royal Hampshire County Hospital, has been affected by a higher than normal number of midwives on maternity leave at the same time.
Contingency measures were implemented in the summer of 2009 when the number of pregnant midwives looked likely to lead to operational difficulties. The measures included using more bank shifts, staff working longer hours and training being postponed.
For many months these measures enabled the service to operate with safe staffing levels. However, winter pressures (seasonal illness among staff and their families) and the choice of some midwives to return to work but doing fewer hours has made the contingency measures unsustainable.
Our plans also included employing two additional full time, experienced midwives. We made great efforts to appoint to these posts but there is a national shortage of midwives and we were unable to recruit.
The extra hours that many maternity staff are working to cover for colleagues cannot continue and the training that has been postponed needs to take place.
During November there were three occasions when ABC closed at short notice. This poses a risk to patients and is unsatisfactory for staff. The centre needs to operate with clarity so that its patients and partner organisations know what to expect.
Staff have been involved with developing solutions. An alternative staffing model has been suggested and is currently being worked up. It will involve additional training and new rotas and so cannot be implemented immediately. Staff and managers are enthusiastic about putting their plans into action as soon as practically and operationally possible – this is likely to be early in the new year.
Proposed new staffing model for the inpatient service
The proposed new model affects the out of hours service only. It will involve maternity support workers staffing ABC at night with the support of two on call midwives as well as assistance and advice from the maternity unit at Winchester. There is no change to the day time running of the centre – at least one midwife will always be on duty, alongside a maternity support worker.
What makes the proposed model sustainable is that midwives will not routinely be working at night unless attending a labour. The new model is more efficient and responsive and will result in more qualified midwife expertise being available across the whole service when it is needed.
It is different to the current model where we run the centre with at least one midwife and maternity support worker out of hours, even if there are no patients.
Questions and answers
Many patients, stakeholders, staff and members of the public have asked questions about the temporary suspension of inpatient services at the ABC. These have ranged from personal questions from pregnant women to queries about our planning and our rationale.
We will post these Q and As on our website (www.wehct.nhs.uk) and will update it if we get new questions.
I am due in early December – what will happen to me?
You will be offered the choice of birthing at home with your community team, at Winchester in the midwife led area of the labour ward or you could choose to go to another Trust; the nearest birth unit is Ashurst in the New Forest. Your midwife will help you make the arrangements, whichever option you choose.
Where will my maternity notes be?
You will continue to have your copy of your hand held notes. If you choose to birth in a different unit all the information regarding your pregnancy is in these notes.
I want a home birth, what will happen if I can’t and I want to go to ABC?
Home births are not affected by the temporary suspension. You will still be able to have a home birth if that is what you have planned. If anything happens before or during labour to suggest a home birth is not appropriate you would not be offered the choice of ABC anyway because it is only for low risk deliveries. Women who were considering ABC may want to consider a home birth where they will be supported by the Andover midwives.
I have heard that there are strict visiting restrictions at Winchester – what are they?
The visitor restrictions (two visitors per bed) are in place due to the increased risk of swine flu and other seasonal illnesses in the community and are there to protect you and your baby. You should plan ahead who will visit while you are an inpatient before sharing the joy of your new arrival with the wider family when you return home. In any event, we try to minimise the length of stay in hospital – feedback from past patients tells us that they like to be home with their new baby as soon as they are medically fit to be discharged.
You say health and safety is most important, how can this added stress by good for me and my baby?
We understand that changes to your birth plan cause anxiety. However, we felt it was better to make a planned change rather than try to stay open for births with the risk of closing at short notice. It is vital that you can deliver your baby with a safe number of qualified staff to look after you. Safety takes priority over stress in this situation.
Are Andover midwives better than those in Winchester?
The midwives at Winchester and Andover are part of the same team and have received the same training. There are highly qualified and experienced midwives across the team and in recent years two midwives have won national awards for their excellent level of service. The environments and type of service are different at Andover and Winchester but the quality is the same.
I won’t know anyone at Winchester
In terms of staff, the midwives and some of the maternity support workers from Andover will be working at the RHCH so we hope to provide continuity. It is our aim that all women in labour are cared for by staff they know and this is no different for those who had planned to deliver at the ABC.
In terms of other patients, around 3,000 women have their babies in Winchester every year and many of those do not know each other before they come in to deliver. Sharing a six bedded bay at Florence Portal House (the name of the maternity unit) with other women who have just experienced labour often provides good company and reassurance. If you prefer, there are private rooms available at Winchester.
Why, if the problem is at Winchester, do Andover mums have to suffer?
This Trust runs the units at both Winchester and Andover and the midwives are employed as part of a whole team. We need to put the resource where the women are and at times when the resource is limited this has a bigger effect at Andover where there is less resource anyway because there are, on average, four births there a week. We hope in future that this number will be higher.
I resent Winchester mums who don’t have to change their plans, why not send them to Andover?
The unit at Andover would not be able to cope with the high numbers of women who choose to have their babies at Winchester. They are not all from Winchester and they do not all have low risk deliveries. ABC does not cater for anything other than a straightforward uncomplicated birth.
Why wasn’t your planning better?
There is a national shortage of midwives, and although the Trust has tried to recruit it has not been successful in recruiting experienced, qualified midwives. We have done very well at recruiting and training our own midwives. We have seven who have now qualified and are consolidating their training with a six month preceptorship period which ends in March when they will be able to start work at ABC.
Women on maternity leave have flexibility in the hours they work when they return and this can make planning difficult, especially as they only need to give one month’s notice of this change.
How will you cope if there are more home births as a result of this?
Not providing staff out of hours at the birth unit will release them to work elsewhere in the service and that includes supporting home births.
Are Andover staff being relocated to Winchester?
During the suspension the midwives will spend some of their time at Winchester but they will also continue to provide community and antenatal services locally. Some of the maternity support workers will work in Winchester. The team is a whole team across both sites so it makes sense for all our staff to work at both locations and be able to support women in low and high risk deliveries.
How will Winchester cope with the added number of births?
We will have the support of the additional staff from Andover. Based on current numbers there will be approximately four extra births here per week.
Are you trying to pull the wool over our eyes, will this closure become permanent?
Firstly, it is not a closure. Only the inpatient aspects of the service are being suspended. There are no plans to permanently close ABC. We will reopen as soon as we can guarantee higher staffing levels. The Trust has recently refurbished the birth centre and ran a very successful open day. We want it to be busier in the future – the opposite of wanting it shut. When we reopen we want to welcome more mums to be, including women from a wider area.
The added journey may mean I don’t make it to hospital in time, how do I cope with giving birth on the A303?
There is added journey time which is another reason why it is better to have a planned suspension rather than sudden closures without warning. It is important to call the ABC for advice if you think you are in labour and this will help to ensure that you are in the right place with the right support for your delivery.
Our advice to all women who think they may be in advanced labour and do not think they will get to hospital before the baby arrives is to call their midwife and an ambulance.
You say you are keen to provide more services at Andover War Memorial Hospital, so why are you closing ABC, which is one of the best services we have?
The Trust has invested more than £4 million in AWMH in the past couple of years.The new Outpatients department will be a great facility. As well as an increasing number of new services and extended opening times, we want the birth centre to be busier than ever.
How will closing the centre help with the shortage of midwives?
The suspension of the birth and postnatal service will allow us to concentrate our staff where the women are. This will make the best use of midwives and maternity support workers.
Why aren’t you more like Tesco? They don’t shut when staff are off sick!
It takes a great deal longer to train a midwife than a till operator and midwives are in shorter supply!
So now it’s proposed that Winchester Hospital, serving an urban population of roughly 40,000 and another 70,000 in rural areas, should absorb extra inpatients from a nearby town with an urban and rural population of already over 50,000, and with more housing planned. In other words, Winchester’s maternity services could have to cope with almost 50% more patients as a result of this action?
We have approximately 2700 births at Winchester and 200 at Andover. If the Andover births transferred to Winchester the increase will be 7.5% not 50%.
You say this is about staffing but isn’t it really about money?
The suspension saves no money whatsoever, the deciding factor is safety. This is our number one priority.