Questions

Questions IT IS a pity that Professor Purt’s advisers failed to check the information they supplied him for the article in the Western Telegraph of February 5.

He should explain in what way, exactly, the service proposed by his Health Board will be better, given that all three Hywel Dda Maternity units have perinatal mortality figures, a measure of risk to babies, in the top four in Wales for the years 2009 to 2012, as published by the All Wales Perinatal Survey (2012).

He states that “we need to make sure that our paediatrics and obstetrics are staffed with the right number of staff ”, but the right grades and professions of staff are equally important.

Recruitment and retention issues are repeatedly cited as issues, but recently, appointment of candidates considered suitable by our local paediatric consultants were blocked at Health Board level.

There has been no difficulty in recruitment in the obstetrics and gynaecology department in Withybush. However, the threat of closure and split site posts, notoriously unpopular, which Hywel Dda proposes, will make recruitment difficulties a self-fulfilling prophecy. Staff uncertain of their futures are already looking at jobs elsewhere, I understand. Perhaps Professor Purt could also tell us why staff at Withybush are being offered voluntary redundancy?

The Deanery does indeed wish doctors training to be specialists to work in larger units, so that they see more patients. However, in the case of obstetrics, there is no plan to remove the total number of trainees from Hywel Dda, and the Deanery is happy for the larger unit to be on the Withybush site (personal communication).

Professor Purt, however, is confusing training needs with service needs. The service needs can be provided by career mid grade doctors who are not classed as trainees under the direction of the Deanery, supervised by consultants, as happens at present.

The Deanery does fund half the salaries of trainees – but the Health Board and Welsh Government have repeatedly stated that this is not just about money. How could it be when they are proposing multiple ambulance transfers, an expensive, bigger new helicopter which can take women in labour, unlike the present air ambulances, needing a helipad upgrade and fire engine attendances, for transfers from Pembrokeshire to Carmarthen of women booked to give birth in Glangwili and up to a quarter of women who planned to give birth in the isolated midwifery-led care unit at Withybush, that most authorities say end up needing transfer in labour?

How can we have faith in these critically important plans that the Health Board is making when it cannot even get the number of women giving birth in Withybush right? There were 1,370 in 2012, not 1,200 as quoted, that’s over three babies a week that the Health Board is ignoring.

Another document published by the Health Board stated that there are six consultant obstetricians in Withybush (there are five, though a locum covered the absence of one consultant last year), and four middle grade doctors (there are six).

They also state that “the majority of women will give birth at home or in the midwifery led unit; this is simply not true.

Women at higher risk includes all women who have had a previous Caesarean, which is around 25% of all women, women needing Caesarean or instrumental delivery (502 out of 1,370 women in 2012), all women with medical problems such as diabetes or high blood pressure, and all women who might want to be able to have the option of an epidural for pain relief in labour.

All these will need to be booked in an Obstetrician Unit. Were there an “alongside”

Midwife-led Unit, next door to the Obstetrician Unit, some of these women might be able to deliver there, but at 33 miles away, common sense will mean that fewer borderline risk patients can be booked, as instant transfer will not be an option.

Best estimates are that 300- 500 women at most would be able to book to give birth in Withybush, and up to a quarter of them would end up with an emergency rush to Glangwili during labour.

The reports from the Scrutiny Panel seem to have been completely misunderstood by Mr Purt’s advisers. Neither of the Scrutiny Panel’s reports states, “without a Level 2 Neonatal Unit no consultant obstetric care could be provided across the Health Board”. Their first report simply stated that “a final decision on the siting of a Level 2 neonatal unit can only be made when a final decision is made on which hospitals provide what type of obstetric and maternity care.”

This Scrutiny Panel seems to think being close to Swansea Neonatal Intensive Care Unit is an advantage, in case onward transfers of babies are needed, whereas the reality is that Pembrokeshire mothers and babies are going to be without ANY nearby obstetrician or Special Care Baby Unit (SCBU) services.

In 2012, there were actually very few transfers of mums and babies out of Withybush for delivery near a Neonatal Intensive Care Unit, while 43 mums and babies were transferred in, mainly to use Special Care facilities because SCBUs along the M4 corridor were closed, including Glangwili. Thus around 1,000 Pembrokeshire women could be forced to travel to Glangwili to give birth in order that a much smaller number of newborns could maybe be transferred from Glangwili to Swansea.

M RUTH HOWELLS MB, FRCOG

Retired Consultant Obstetrician and Gynaecologist

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