At a public meeting held today, Thursday 23 March, in Portrush, the Board of the Northern Health and Social Care Trust approved a recommendation that all hospital births should take place at Antrim Hospital.
The recommendation was made following a 14-week public consultation on a future model for acute maternity services, which commenced in late November last year.
Clinicians have advised the Trust that the current provision of maternity services at Causeway Hospital is unsustainable because of falling birth rates, workforce challenges and the absence of neonatal special care baby unit facilities at the hospital. The workforce challenges reflect the wider problem of attracting specialist clinicians to smaller hospital sites.
The consultation presented the Trust’s two ‘clinically deliverable’ options. Both options proposed the transfer of all obstetric consultant-led births from Causeway Hospital to Antrim, with retention and enhancement of early pregnancy assessment units, antenatal and postnatal clinics and scheduled ambulatory services on Causeway site.
One of the options suggested the possibility of establishing a freestanding midwifery-led unit at Causeway Hospital. This option cannot proceed at the current time ahead of the completion of a Department of Health led review that includes service provision at such units. Given the extreme fragility of maternity services in the Northern Trust, the midwifery-led unit option has therefore been discounted at the present time and will be kept under review pending the outcome of this DoH led review. It has therefore been concluded that the only viable option at this point is the transfer of all births to Antrim Hospital.
Speaking after the Trust Board Meeting, Dr Dave Watkins, Medical Director at the Northern Trust said:
“We have always been clear about the reasons why change is required. Serious concerns continue to be raised by clinicians in relation to the safety and sustainability of the Trust’s current model of maternity services and we cannot ignore those.
“Our ultimate aim is to have a new-build Women and Children’s Unit on the Antrim Hospital site. This will provide high-quality, purpose-built accommodation for maternity and paediatric services. However, it is subject to business case approval and funding availability and is unlikely to be commissioned for service before 2027/28 at the earliest.
“So we urgently need an interim solution that will address the challenges.
“The public consultation allowed us to explain the need for change and to present for consideration what we believe were the only two clinically deliverable options. Hopefully we have achieved that but we also acknowledge that change is never easy and we understand the very real concerns that many people have and which have been well reflected throughout the consultation period.
“In recommending the transfer of all hospital births to Antrim, that does not prevent us revisiting the possibility of setting up a midwifery-led unit in the Trust at some point in the future, should the outcome of the Department’s review offer that flexibility.”
The Trust recommendation will now be assessed by the Department of Health in line with its policy and guidance on change or withdrawal of service.
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The current provision of maternity services at Causeway Hospital is unsustainable because of falling birth rates, workforce challenges and the absence of neonatal special care baby unit facilities.
Therefore the two clinically deliverable options consulted on were:
• Option 3 - Consultant-led births move to Antrim site which would provide intrapartum care for an additional 600-700 births per annum. Development of a Freestanding Midwifery Led Unit (FMU) in Causeway for approximately 200-300 women suitable for low intervention midwifery-led care and birth. Retain and enhance early pregnancy assessment units, antenatal and postnatal clinics and scheduled ambulatory services on Causeway site.
NOTE: The deliverability of option 3 would be subject to the outcome of the comprehensive review by the Department of Health into staff numbers, training and policies within FMUs, as recommended by the Coroner.
• Option 4 - Move all births to Antrim site which would provide intrapartum care for an additional 900 births per annum. Retain and enhance early pregnancy assessment units, antenatal and postnatal clinics and ambulatory services on Causeway site.
Other options were discounted as they did not address the clinical safety concerns raised and would not be deliverable because of workforce constraints due to decreasing number of births.
In both options, the Trust is committed to providing antenatal and postnatal clinics closer to home in the community.
Currently woman with complex conditions or those with certain conditions must travel to have all their antenatal attendances care provided at Antrim or Ballymena. The aim is to provide this antenatal care at clinics in Causeway Hospital. By enhancing the antenatal and postnatal care at Causeway Hospital, many women will no longer be required to make multiple trips to Antrim or Ballymena for this care.
Scheduled ambulatory maternity care will also continue to be provided on the Causeway Hospital site.
Feedback was received in relation to the evidence base for the proposals for change, proposed change to maternity services, antenatal and postnatal clinics, removal of the fetal maternal assessment unit, freestanding midwifery led unit, homebirths, future of Causeway Hospital, capacity at Antrim Hospital, additional travel and workforce.
The following factors affecting safety and sustainability were also taken into account:
• The demographic estimates for the future population of the Causeway Coast & Glens Area which suggest that the birth rate will fall by 11% over the next 20 years whilst during the same period, the population will age with the numbers of people over 75 years of age increasing by a significant 65%.
• The Risk Stratified criteria commissioned by the PHA in 2013 by which women who are currently considered high risk receive all of their ante-natal, intra-partum and post-natal care at Antrim Hospital whereas in the options outlined the woman could receive her antenatal and post-natal outpatient care at Causeway Hospital.
• The workforce deficits due to challenges recruiting and retaining substantive medical and midwifery staff therefore resulting in an over reliance on medical locums and reduced availability of Midwives.
• The outcome of the comprehensive review commissioned by the Permanent Secretary at the Coroner’s request into staff numbers, experience, training and policies within Freestanding Midwifery Units reopening is not yet completed.
It has been determined that the two clinically deliverable options remain. As the Trust is not in a position to open a Freestanding Midwifery-led Unit during the Departmental review, the only viable course of action at present is to proceed to the implementation of Option 4.