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Maternity Issue

21 October 04
New Maternity Model Being Proposed By NHS Highland

A new model for Maternity services is being put together by NHS highland Health Board.  NHS Highland Chairman, Garry Coutts said: ‘We know that the prospect of only a minority of mums being able to deliver in Caithness was one that the public could not support.   In response, we have begun to look at a model of care that will increase the opportunity of having your baby in Caithness.   I hope local people will work with us to develop this model fully.   A full report detailing this proposal and a way forward will be put to the NHS Highland Board meeting on December 7th.

Workshops will be held in Caithness in the coming weeks to help inform the committee report.’

Highland Councillors have been advised that a new model is emerging which could enable not only low risk, but also medium risk births to take place safely at Caithness General Hospital, Wick, while offering other specialist service enhancements.

This could result in up to two-thirds of all births taking place locally.

Councillors are asked to welcome this move and to seek Highland NHS Board's agreement to pursue the development of such a model involving the clinical community, the Council and other partners as appropriate and with community involvement. Until the new model is introduced, the Council want the current level of services to be maintained.

They will consider a report from Carron McDiarmid, Head of Policy, at their next full meeting on Thursday 28th October, which urges ongoing dialogue with NHS Highland to consider how the model could be developed.

Her report states: "As a result of the feedback to the consultation process, NHS Highland is now re-considering how best to achieve the desired outcome of having as many babies as possible, including first births where appropriate, born in Caithness in the future and at the same time enhance other specialist services locally.

"NHS Highland has explained clearly the very practical problems they face in recruiting and retaining obstetricians along with the safety concerns associated with them practicing in isolation from more specialist and intensive care facilities. Given that these difficulties exist, the move to re-consider the consultation options demonstrates the extent to which NHS Highland is willing to listen to partner and community views. It also demonstrates that the consultation and campaigning processes have been effective."

She said a new model was emerging for maternity and gynaecology services in Caithness and Sutherland.

"Accepting that the current need for high risk births to take place in Raigmore Hospital will continue, it appears that there is now real scope to design a service which would allow not only low risk births but also medium risk births to take place at Caithness General Hospital. Depending on the informed choice by women this could enable up to two thirds of births to take place locally."

The key elements of this new model could be as follows:

  • A multi disciplinary team approach using a combination of local and visiting clinicians and specialist and general staff.

  • Low risk women receiving specialist midwife led care throughout the period of their pregnancy.

  • Medium to high level risk women receiving much of their care from midwives, working closely with Obstetric and other specialist staff.   Existing midwife day care services can be further enhanced.

  • Obstetric input from a Highland wide Network of Obstetricians, based in Raigmore, visiting Caithness General regularly.

  • Networking facilitated by effective professional and technical links between midwives and Obstetricians.

  •   Emergency care supported by the Caithness General Hospital based General Surgeons and Anaesthetists, trained in a specific range of surgical gynaecology / obstetric procedures. 

  • Obstetrics and Gynaecology team providing routine, planned visiting sessions at Caithness General Hospital, including outpatients, day case surgery and inpatient surgery (within the normal standards of safety eg, excluding patients with high anaesthetic risk factors etc)

  • Caithness General Hospital medical staff supported by regular, ongoing training with the Obstetric Team, including, eg joint operating sessions for elected caesarian sections.

  • Emergency paediatric resuscitation from midwives, supported by Caithness General Anaesthetists – also explore interest in developing this role within the local GP community.

  • Midwives supported by regular, ongoing training, including emergency clinical management.

  • Increased local access to specialist care – visiting obs/gyn.  Team can bring individual sub specialities to Caithness General, eg expanded range of specialist gynaecological cancer surgery, infertility treatments, specialist pelvic floor/continence surgery.

NHS Highland reported that the key feature of the approach is that it draws on the resources and potential of the whole hospital and that if it was successful it could lead to considering a similar development programme for other hospital services at CGH.

"Such a model would of course require wider support, not least from the clinical community that would deliver it. The model is to be consulted on during the remainder of the consultation period and it is still to be considered by the Highland NHS Board at its meeting in December. An obvious vehicle for developing the detail of the model would be the North Highland Community Health Partnership (CHP)" she added.

The new model would avoid:

  • an increase in emergency or planned transfers of expectant mothers to Inverness;

  • additional ambulance costs

  • negative impact on the local econom

Ms McDiarmid added: "Developing the new model requires ongoing dialogue with clinicians, partners and communities. This thoughtful and inclusive approach is more likely to develop a sustainable and acceptable model of service delivery."

She recommends the Council should offer a full briefing for Highland NHS Board members on the final draft of the research into the socio-economic impact of the earlier models proposed. The Chairman and Chief Executive of the NHS Highland Board should be invited to attend the next council meeting in December to report on the Board's position regarding the new model and its approach to developing it.

Councillor David Flear, Convener of The Highland Council's Caithness Area Committee said: "I very much welcome this significant development.

"The new model demonstrates the willingness of NHS Highland to listen to the views of communities and partners while being realistic about service challenges."

"The new model could contribute to good practice in alternative models of maternity care in rural areas.

"We must, however, maintain the vigilance we have shown throughout this crucial community issue to ensure we secure an efficient effective and sustainable maternity and gynaecology services in Caithness and North Sutherland."