Joint Locality Executive Board 22 May 2013 Agenda Item: 8 ...committeedocs.northumberland.gov.uk/MeetingDocs/15234_M1444.pdf · 14 February Berwick Family Drop-in at Jubilee Spitall

Joint Locality Executive Board 22 May 2013 Agenda Item: 8 Appendix B

Future arrangements for midwifery-led care in Berwick

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Clinicians commissioning healthcare

for the people of Northumberland

1. Meetings attended in Berwick and surrounding area to discuss the consultation

Date Meeting and venue 28 January Berwick breastfeeding support group at Berwick Children’s Centre

2 February Gadgies (group for dad, uncles and granddads) at Berwick Children’s Centre

4 February Wooler Family Drop-in at Cheviot Centre, Wooler

8 February Berwick Family Drop-in at Berwick Children’s Centre

11 February Belford Family Drop-in at Belford Youth Centre

14 February Berwick Tiny Tots at Jubilee Spitall Residents Club

14 February Berwick Family Drop-in at Jubilee Spitall Residents Club

26 February Berwick Young Mums 21 and Under at Berwick Youth Club

26 February Berwick St Mary’s Drop-in, Berwick First School

26 February Meeting after aquanatal session at Leisure Centre, Berwick

28 February Little Nippers at Fire Station, Seahouses

13 March Brilliant Baby Club at Berwick Children’s Centre

Public meetings

Date Meeting and venue 30 January Public meeting at the Maltings

6 March Public meeting at the Maltings

26 February Public meeting at Bell View, Belford

Local authority/town councils

Date Meeting and venue

17 January Northumberland County Council Care and Well-being Overview and Scrutiny Committee at County Hall, Morpeth

28 January Berwick Town Council meeting at Town Hall, Berwick

20 February Norham and Islandshire Cluster of Parish Councils at Ancroft Village Hall

25 February Wooler Parish Council at Cheviot Centre, Wooler

Meetings with midwives

Date Meeting and venue 8 January Midwives and healthcare assistants at Berwick Maternity Unit

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20 February Midwives and healthcare assistants at Berwick Maternity Unit

Save the Berwick Maternity Unit Group

Date Meeting and Venue

7 December Meeting with Save the Berwick Maternity Group at the Maltings, Berwick

20 February Meeting with Save the Berwick Maternity Group at the Maltings, Berwick

Other meetings

Date Meeting and venue 24 January Wellclose Surgery Patient Group at Surgery, Berwick

5 February Contracting meeting with North East Ambulance Service NHS Foundation Trust, Bevan House, Newcastle

6 February North Northumberland Locality Group, NHS Northumberland CCG, Blue Bell Hotel, Belford

7 February Central Northumberland Locality Group, NHS Northumberland CCG, Seaton Hirst Practice, Ashington

13 February NHS North of Tyne Maternity Partnership at Bevan House

23 February Migrant Support Group at Berwick Library

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2. Feedback received during public consultation

1 Berwick

councillor Commenting on arrangements for consultation process: Berwick people would welcome a public meeting held by the Board of North of Tyne in Berwick upon Tweed – is offering the opportunity for the general public to have an open, transparent and accountable discussion on all items on the agenda for scrutiny, in an area that the Board has played little or a token representation before its demise and the hand over of the majority of service provision to the untested CCG. Draws attention to proposed meetings scheduled for Wednesday 30 January 2013 at 1-30pm, while there is never a good time to hold public meetings, a Wednesday is regarded locally as a very quiet day when the public, particularly at this time of the year when stress levels have been exhausted and likewise the amount of money in their pockets may contribute to a lack of apathy. Suggests that the meeting be changed to an evening event for maximum participation and reconsideration of the chosen days.

2 Member of public - M McG

Registered with a GP in Coldstream. When pregnant with first daughter wasn't allowed to go to Berwick even though she only lives three miles from Berwick. The NHS would get more people to have their babies at Berwick if they were more flexible with who could go there - e.g. people in the catchment area who are registered with a Scottish doctor. Borders General is over an hour away. When she was pregnant she had independent midwife who was invaluable - very quick labour and wouldn't have been able to get to Borders in time, but would have perhaps been able to make it to Berwick. Has had two miscarriages and can only imagine how distressing it would be to have to travel over an hour whilst this was happening. If she was to have another baby, she'd be extremely anxious to have to travel anywhere other than Berwick. A friend who did go to Berwick had a very positive experience and they would both want the service to stay open.

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3 Member of public – K S

Expecting second baby in May 2013. Classed as high risk so my choice of delivery has to be at Wansbeck, which is ok as last time with first baby did have an emergency C section due to complications. The support and care received from the Berwick midwives after horrible experience with first baby was second to none and would have been lost without their advice, support and overall service throughout 5 night stay at the unit. Would like to go back to the unit this time asap as the care, support and advice is still required to make first few days as a new mother a lot less stressful and help with any issues that might occur. Please give us the unit back to us the way it was before August 2012 as we mums deserve the best service and remember the nearest hospital is 60 miles away.

4 Member of public

– G A Lives in Norham. Saddened and worried that maternity services at Berwick have been reduced. Is not true to say that women are choosing not to deliver there – many would love to have delivered there but were told to deliver at Wansbeck or Borders due to risk factor however small. Wasn’t allowed to deliver at Berwick as went overdue. Expecting again and again not allowed to deliver at BMU as would have wanted, as had slight haemorrhage after baby was born. Due date January – don’t want to give birth in car especially with risk of haemorrhaging or in ambulance without a midwife. Despite haemorrhage risk would trust BMU whole heartedly and feels safer in their care than that of larger hospitals. Option one is definitely safest – should not be about cost cutting – should always be about what is safest and option two certainly is not. Cost is an issue – if can’t drive or afford to travel backwards and forwards to visit, or if A1 is closed or road to Borders flooded.

Aftercare at unit was outstanding after had son – knew staff through antenatal appointments and weren’t embarrassed to ask them anything. Allowed you to recover and get used to being a mum – helped with any feeding problems.

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When at Borders after son was born midwives were too busy to help with breastfeeding and suggested she bottle-fed him. When transferred back to BMU, midwife helped with breastfeeding. Own recovery was faster and thinks lot of postnatal depression cases have been prevented due to BMU aftercare. The midwives at BMU are brilliant and do fantastic job. Consultation document mentions surveys and not once has she been asked to complete one – maybe more applicable to survey the expectant mothers who have all this to worry about.

5 Member of public – S R

Strongly objects to any closure of Berwick maternity unit. Is ridiculous to expect mothers to travel to either the Borders or Wansbeck. Not everyone had their own transport and it would be difficult to get by public transport.

6 Member of public - T B

Thank you for sending information regarding the proposed 2 options for midwifery-led services at Berwick. Agrees with option 2 - currently 6 months pregnant and although classed as low risk have still chosen to give birth in a midwifery-led unit that is within a hospital so can easily access a consultant-led unit if complications were to arise. Also feels that having on- call 24/7 support at Berwick and more support in the community would be beneficial.

7 Member of public – S S

Having read all the details of both options for Berwick Maternity would have to say that option 1 would be the best but maybe if option 2 could be changed slightly so that mothers could stay a bit longer than 6 hours after giving birth. 19 weeks pregnant with my 4th child, lives in Wooler so Berwick & Alnwick are the same distance away. If option 2 goes through will be opting to give birth at Hillcrest as a home birth does not appeal and a 6 hour stay really isn't long enough as would like to stay a night to recover especially as have 3 older children at home.

8 Member of public – A L

Maternity unit should remain as it was before services were suspended. Baby born 2010 - cannot fault the care received at Berwick. First child and decided to go to Borders General Hospital in case

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of any complications – had a big baby and had a 3rd degree tear, which required surgery. Had to wait three hours to go to theatre – needed two units blood. Moved to a ward where son spent next two days crying. Was left to get on with it with no explanation to why he was crying so much. Only saw another person when was being given meals. Discovered in Berwick by an experienced midwife that he had swallowed fluids when he was being born and it had given him a sore stomach. Berwick maternity unit is second to none for postnatal care and there’s no way it should even be being discussed to cut it. Could not have looked after son at home during first week as could hardly walk and needed help getting in and out of bath - even someone to look after my son when went to toilet. New mothers should be allowed to stay in hospital until they feel ready to go home. Stayed for a week at Berwick which was greatly needed. Also the breastfeeding advice was fantastic - fed son until 9 months old. He needed a bottle at night and night staff at Berwick would give him it. Showed how to bathe baby and gave advice which did not get at Borders.

9 Member of public J McL

Where will the oncall midwives come from? Will maternity unit be manned 24/7 or will midwife be called in to open unit? How flexible will the six hour stay be – know there will be some flexibility during small hours but how much during the day. If a woman needs after care and the weather means a midwife cannot attend(as often happens within an hour or so) what safeguards are in place to protect her well-being)?


Thank you for replying to queries. Many of us did not know the maternity unit would be closed after normal clinics etc . Still concerned that should a patient deliver at say midday she would not be able to stay much past her 6 hrs because it will close. Pleased this is still under consideration. Query about having an emergency plan should a midwife have a problem getting to the unit quickly - would be grateful if you would clarify this one point. Understand that midwives will not be able to give enhanced after care outside of the unit but

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hopefully if get option 1 the maternity unit will be there for 24/7 extra support if needed.


Have been looking at the Facebook page for Save Berwick Maternity unit and see that yet another baby was born earlier this week in the ambulance on the way to hospital. That's three in a very short space of time. It’s extremely worrying to think that these events could become acceptable to the NHCT.

12 Member of public – J McL

The Trust’s responses to questions relating to any problems which might arise during or after a birth where only one midwife is present without physical support of any kind was to be honest frightening. How can it be either a physically or emotionally safe environment for a woman developing complications either in delivery or after giving birth to be left unattended while a midwife has to telephone Wansbeck for advice before she can deal with a developing situation? Doubt even that the call would be answered immediately given the length of response times generally. Utterly dismayed that such a practise is considered to be a right and proper procedure for the health and well being of mothers and babies. Is it a correct that this is the present and acceptable policy for midwife and mother to be left completely alone especially throughout the night in a maternity unit without any kind of support staff at hand? I do not believe anyone would be comfortable with that situation given the alternative of an Option 1. The CCG must not consider their outcome by using data and figures alone. They must look and understand the difficulties faced already due to the travelling distances between Berwick and major hospitals. Were discouraged to speak about the ambulance service but it is very relevant - are problems both in response times and the lack of some paramedics skill/practise in delivering babies. This does not undermine their value but proves that just like our midwives they need more practical hands on experience. Any situations surrounding ambulance and transfer problems should not and must not be discounted in your evaluation as a separate issue.

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Was unclear as to whether the 5.000+ signature on the petition will be taken into consideration? Kelly read the wording out and there can be no doubt that those petitioners were calling for Option 1. Would be grateful if you would clarify concerns about this issue? Hopes that after full consideration and deliberation the CCG will determine that there is no other option but Option 1

13 Member of public – J McL

Have only just read the final Safety Review and wonder how the trust can compare Berwick with units in remote areas of Scotland some of which are serviced by helicopters in emergencies? Other comparison areas too are much closer to major hospitals than we are. Berwick does not appear on the tables alongside these other standalone midwife led units which show the approx distance and travelling time to major hospitals. The comparisons are misleading in his respect. The review also does not acknowledge the findings that low risk births are proven to be more beneficial by reducing medical intervention and should be encouraged. Low birth rate figures due to transfers should not be used to change a good maternity service. The review also emphasises more pros for Option 2 which in fact has less benefits than Option1.

14 Member of public (also member of Northumberland Local Involvement Network) – N P

Summary of 10 page document:

Description of the process by which NHS North of Tyne arrived at their options 1 and 2 as described in the consultation document cannot be described as professional level work.

Is a failure to address CO2 issues.

Appears to be some sort of payment issue if English patients attend a hospital in Scotland.

There are issues relating to the management of peripheral sites within healthcare – maybe a bigger problem in the case of Berwick due to the distance of larger sites.

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Rev Knox proposes Option 3 – out of box thinking – what Berwick needs are a few doctors with a strong obstetric background – does not come cheap in UK context. Suggest redistributing existing FTEs so that there is a mix of doctors, midwives and healthcare assistants. Obstetrician could be obtained at fairly modest uplift relative to the cost of a midwife by exploiting the wage gradient that exists between UK and central/eastern Europe. Suggestion is to look for doctors in Moldova or Belarus. Suggest setting up a partnership with Brest Regional Maternity Hospital to provide doctors to staff the Berwick Maternity Unit on a rotational basis. To keep carbon dioxide emissions low, transport between Berwick and Brest should be by rail. This relationship could result in increased trade with Belarus.

Not a fan of home births – is an advantage of having doctors involved in births. All childbirth should take place in a hospital and that hospital should have intensive care facilities. Given that the nearest hospital to Berwick with both a maternity service and intensive care is the Borders General, this is the best place for women to give birth. May be advantageous to set up a satellite clinic in Berwick for outpatient appointments.

While there are bus services between Berwick and Melrose, recommends a limited stop (express) bus service to be introduced to make travel appointments etc easier.

Real choice is between Option 3 (ie links with Belarus) and Option 4 (women giving birth at Borders). Should be an interested group of people come together to evaluate the options and develop a plan for moving forward. Personal preference is for Option 4.

15 Member of public – S W

Option one is the best move forward, having given birth to daughter there two and a half years ago and planning to give birth there again in October, will share a few points:

1 - Without employing more midwives but still requiring a 24/7 midwife cover for Option 2 how would midwives continue rotational training? So we’re as best staying with Option 1. 2 - Only having 2 midwives covering out of hours care so what happens when midwives are too ill to work or when they take holidays? Surely the two midwives would have to attend a home birth together so who then answers the on call phone whilst a lady is delivering and what happens if

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another two ladies are in labour? Unborn babies being put at unnecessary risk? 3 - In points re enhanced support in your home for Option 2, received help trying to breastfeed and learning how to bathe and look after my daughter in the unit. 4 - A very poorly made point regarding breastfeeding figures – doesn’t take into account mothers that try to feed themselves but can’t due to various reasons also breastfeeding is a very personal choice and mothers shouldn’t be pushed or stressed into it. Option one is my choice.

16 Member of public – J B

Have attended many meetings where the Trust has issued firm denials that pregnant women were being discouraged from giving birth at BMU. This week's Berwick Advertiser reports that on 6th March Sir Alan Beith read out a letter headed BMU which confirmed the suspicions previously voiced locally.

There are two points which need to be resolved: a) exactly what led to BMU closure last year - only vague assertions have been made, apparently due to privacy matters; and b) just who authorised the letter mentioned above. Local people deserve to know just what has been going on - tired of being manipulated. Firmly supports Option 1 and has already completed the survey. Please don't let us down.

17 Member of public – S R

This is totally inexcusable there are far too many of the units closing putting mothers and babies lives at risk DO NOT DO THIS please...

18 Member of public and public governor of Northumbria Healthcare – G R

Reservations about the report on maternity services at Berwick. These reservations are about the resuscitation of neonates. Statistically there may be few but the safety of the newborn is very important. Not reassured by the withdrawal of the neonatal flying squad. Do the campaigners for the maternity unit know of the risks to the newborn? One catastrophe will be enough.

19 Member of public – H T

Agrees with Option 2 being proposed for Berwick Maternity Unit. This would give opportunity to have baby at BMU in June. Have benefited so far from having regular check ups at Berwick. The staff there are excellent. Have had 2 round trips to Galashiels for scans - total miles covered 160.

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20 Member of public and local clergyman – M K

The two options are not good enough, and a third option needs to be offered - not only need the Berwick maternity unit to remain open, need it to be augmented with consultant support. According to statistics, from P7 of the consultation booklet, 95% of the women who gave birth from 1 Apr 2011 to 31 Mar 2012 opted for or needed consultant-led care (the calculations for this are below). Conclusion, however, that these 95% of women want to give birth in consultant-led units outside of Berwick is.quite wrong. If the facilities were here, the reasons to travel would drastically diminish. What these 95% want or need is a consultant-led service. This does not mean they want or need it elsewhere. At the public meeting on 30 January 2013, the constant refrain was about what was the safest option. Cannot be serious that the safest option is to travel the 1 and 1/4 hours to Wansbeck (or the new hospital, positioned so ridiculously far from Berwick and so stupidly close to the RVI). Know this road, and the journey is far, far slower in snow, at harvest or when the A1 is closed for roadworks. Cannot possibly be suggesting that it is safe for women to time giving birth just right (as they fear being sent back if they are not dilated enough). Cannot possibly be suggesting that all women from Berwick should be induced, so they do not have to time it right. Cannot possibly be suggesting that it is safer to have a paramedic deliver a baby in an ambulance than a properly trained midwife (was speaking to another Berwick mum who did this recently). If safety is paramount, need to put your money where mouth is! This is particularly the case, as so many women are not given the option, due to being classed as high-risk. Is not their fault if they are over 27! And as recent statistics show that more and more women are giving birth later in life, more and more will be forced into giving birth miles from home, unless you think more creatively. Is good that you are asking our opinions, and thank you for all the ways you have enabled them to be heard, else it feels that you are very top-down. Are various possibilities that need to be explored, including (but by no means only): consultants (perhaps on call at night) working over an area that also covers Alnwick (so the number of people they are responsible for is sensible); GPs with specialisms (with enough exposure to cases elsewhere, eg a day a week in a hospital, to keep their skills up if there are not enough births here etc).

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This whole issue about the need/desire of women in Berwick for consultant-led services needs to be seen in the bigger picture of need for consultant-led services in general in Berwick. It is great how Hilary Brown and her team have organised for consultants to come up to Berwick Infirmary. More of this is needed. Most of all, need better emergency cover in Berwick - an A&E department with appropriate consultants, so that the golden hour is not spent waiting for and then travelling in ambulances. And need operations back in Berwick, so that services which have been removed are returned. People often tell of their fear of living in Berwick when it comes to chronic or emergency health needs. In short, the NHS has moved to a higher dependency on consultants, but it has failed to provide the same services in Berwick that people paying the same taxes get in Newcastle.

21 Member of the public – P W

Thank for braving an emotionally charged Berwick yesterday evening. Have already completed survey but please regard the following twelve points as a further submission resulting from the Maltings discussion yesterday.

1. “You” face a number of problems, the first being that you personally were only the face of several different bodies, not all of whom were on the panel e.g. the ambulance service, and Sir Alan Beith (standing proxy for the political system).

2. Multiplicity/fragmentation contributes to a weakening of public trust. Sudden closure on safety grounds is seen as a function of several factors and bodies, not just the local midwives as apparently claimed by “you”.

3. Is a sense of using the local midwives as scapegoats to hide, for instance, poor

management, under-resourcing or strained emergency provision.

4. Whatever the rights and wrongs, and regardless of whether or where there might be any “blame”, 95% of Berwick births do not take place in Berwick. As Berwick is the centre of a scattered population of about 50,000 which is more than an hour’s drive from major hospitals, that can’t be right.

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5. This high percentage would seem to be a function of one or more of: -

poor management of the service here, poor provision and resourcing, poor guidance, over rigid national criteria and pressure to keep numbers up for the expensive big centres.

6. Have put forward just two Options, but there is felt to be a bias in your presentation towards

the second.

7. Described your first Option as restoring previous service but some of literature acknowledges that there would be more midwives, more rotation, more training and more resources. This is a tacit admission of more than just restoration and thus of significant weakness in what went before.

8. Over-whelming feeling of the audience was for Option 1 Plus.

9. To make that “Plus” enough, both in normal provision and in emergencies, two other factors

will have to be addressed. Both are beyond your direct control but that should not prevent joining the pressure to have them addressed.

10. First, the national criteria in this field seem to be too tight. Advice on setting the criteria is

consultant-led, favouring consultants, the “best”, therefore the most expensive, and therefore big population bases. Especially in difficult financial circumstances, the “best” provision is at the expense of the local, day-to-day, “good” provision. Logic indicates that the dominance of consultants in the mechanism for setting national guidance and criteria should be weakened by boosting the role of other lay and local stakeholders.

11. Second, the provision of emergency services in rural areas also seems to be set by time and

financial criteria from an urban context.

12. This sort of “big population” bias is wider than just the NHS e.g. schools, Post Offices. Has to be addressed or ever more of the population will be driven to the cities or to second class citizenship – need money, not rhetoric and tinkering.

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22 Members of public – A & M K

Wish to make a very strong protest about the so called temporary closure of the maternity unit in Berwick upon Tweed. Very important to have this unit in our area, midwives were wonderful and known to patients instead of the production line type of midwifery experience in the southern part of the county. How would those who made this decision like to travel the long journey in labour? Members of my family have had to do so, an experience which was just dreadful, they had been told that they could not have 1st babies in Berwick. Had both of my children in the old maternity unit Castle Hills many years ago in a very relaxed atmosphere. It really is time that the NHS listened to the patients. As the head of the NHS admitted to the parliamentary committee this week that finance was considered before the patient.

23 Member of public – G M (letter)

Following talks with past, present and future users of these services, support Option 1. Skilled and well trained staff are necessary and this service can be provided by rotating staff with other midwifery led units in the county. Because of its geographical position, Berwick will always be an expensive option but are informed cost is not a deciding factor. Have no faith in a unit that is only available for six hours – Berwick needs 24/7. Thank-you for the presentation at Ancroft Village Hall on 24 Feb to Norham and Islandshire Parish Councils Association.

24 Member of the public – L W

Currently spending the winter working abroad, but live in Fenwick Village, just outside Berwick-upon-Tweed. Therefore have been unable to join any public consultations on the closure of BMU.

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Born in Ashington Hospital, as it was then, as mother was transferred from Castle Hills hospital due to complications - brother who is 3 years younger was one of the last Castle Hills babies. Am to stay in North Northumberland as it is home - would hope also that will be able to raise a family in the part of the world which belong. Know that there is a declining population. As seasonal employee at home have been forced to travel to find work in the winter months. How do you expect to keep people in the area if there are no facilities? It sometimes seems like are driven out and forgotten about. There does seem to be a disproportionate service though. Few years ago, whilst accompanying a youth group on a camping trip, accompanied a young person to Hexham’s brand new hospital. There appeared to be no staff there, and after waiting for over 6 hours with an 11 year old with a head injury realised would have been quicker to go to Newcastle General. At that moment had the option to go to Newcastle General as it is 20 minutes drive away. Berwick is not 20 minutes drive away from anywhere really is it? Have a reduced ambulance service - yet Berwick mothers are now giving birth at the side of the

road in Norham (that’s a 15 min drive from Berwick).

Will always be times when mothers and babies need to be transferred to bigger units. But must be an option to have a birthing unit in Berwick, not because live there, not because am of child bearing age, and not because there are so few ambulances, but because we are in a rural community and Berwick serves not just the town but the borough, and borough is pretty vast. It is needed, it is not a waste of resources, or money or talent. Is view that the Berwick Maternity Unit should reopen, so that parents in Berwick are safe in the knowledge that they can make it to a hospital when they require it. That surely is something that every member of the UK population is entitled to.

25 Member of the public (Oxfordshire) – J

Wish to register objections to the alleged temporary closure Berwick Maternity Hospital. Granddaughter was born there just over 2 years ago, as the birth was rapid, there was no possibility of travelling the 52.7 miles, 1 hour 16 minutes in the best weather conditions. Was

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H shocked that so many healthy young people are being discouraged from using this amazing facility, where daughter was given first class treatment and assistance, which must surely be the envy of most UK Maternity hospitals. During May 2010 unit was full to capacity, if this was an exception, would have thought priority would be to educate local GPs in the benefits of this amazing, but under-used facility. This included 4 days of support for a first-time young mother living over 300 miles from her native home. Was a remarkable time of bonding with other new mums, the value of which is incalculable, as they have all kept in touch, forming a support network for each other, thus reducing the need for GP/hospital visits.

1) Can you imagine doing this journey when A1 is inaccessible during bad weather, or indeed peak hours in summer?

2) Have you considered the money saved by helping young mothers to form strong ties together in the initial 4 days after birth?

3) Are you planning on 24/7 helicopter support.

4) Why have you not questioned or re-educated the local GPs in importance of a local

maternity unit.

5) Berwick does not compare well with other Scottish, low delivery areas, as in those areas there is generally still more family support.

Have read your extensive consultation document and see no reason whatsoever for this decision, except desire to commit massive funding into this expensive exercise. Feel it may have been done at short notice through a sense of guilt that you know this is a retrograde step to save money, a false assumption. Please do not assume that because this is so far north, that the rest of the country will not care for

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their plight.

26 Member of the public – J A

How can even consider even a temporary closure of Berwick Maternity Unit!!!! Both sons were born

in less than one hour after contractions started. Do you have any idea of the risks involved????

How would you feel if it was you, your daughter or granddaughter at risk. Having a baby is not

always without risk. Try watching "Call the midwife" if you cannot remember that far back!!!!

27 Chief executive officer, Relate

Am a mother of 3 (youngest is 3) and have worked for Relate for 8 years. Live in Northumberland. Would like to make a comment about impact that pregnancy and having a new baby has on relationships. All couples are affected by this huge life event and often transition is difficult and at worst dangerous (domestic violence and abuse is greatly increased during this period in life). Midwives have unique opportunity, to offer information about services that are already available in Berwick. Relate offers counselling at the Sure Start Children’s Centre in Berwick. Parents to be or new parents or those whose family is growing with a new pregnancy can hugely benefit from a couple of sessions to explore their feelings, expectations, apprehension and fears. Relate counsellors are fully trained and supervised by Relate. Specialise in relationship dynamics and in prevention of domestic violence and abuse. Request is that all midwives attend some training (1/2 day) about impact on relationships with Relate and that they routinely signpost couples to the Berwick Relate service. Secondly, can provide workshops for parents, including specifically for young parents. http://www.relate.org.uk/workshop-for-parents-families/index.html for details of content. Would welcome opportunity to work more closely with midwifery services in Berwick.

28 Norham Parish Council

As Clerk of Norham Parish Council speak on behalf of the councillors: Parish Council would like to see services kept as local as possible due to geographical isolation of Berwick from other centres. The need for pregnant mothers to have maternity unit within reasonable distance is vital. Babies do not always give a great deal of advance warning of their imminent arrival! With two incidents in 13 births this is a staggeringly dangerous situation. Solution is not to close the unit but to ensure adequate training is ongoing.

29 Clerk to Berwick Councillors were asked for their views on which of the two options they would support, so that we

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Town Council – S F

could submit a 'council' view. Most had already completed the online questionnaire independently

and in their personal capacity, but majority said they would prefer Option 1, so corporate view of

Berwick-upon-Tweed Town Council is that it wishes to support Option 1.

30 Clerk to Belford Parish Council – I H

Belford Parish Council have carefully considered the options for maternity care services in Berwick. Options 1 and 2 both offer antenatal care for high and low risk mothers to be. Provides an opportunity for women to become familiar with the community midwives and comfortable about their advice and presence. However, Option 2 does not necessarily allow for women to use this familiarity when their babies are born – even if they are low risk. Midwives are still going to be available 24/7 in Option 2 but apparently the unit will not be open 24/7. Option 1 offers women who have given birth in larger maternity unit for whatever reason, to return to Berwick for a few days to be closer to families and existing children. Considering distances and difficulties involved in travel to Newcastle, Borders General or the Wansbeck, families may not be able to visit easily because of cost and transport difficulties. May make women leave hospital sooner. If Option 2 was only option, then mothers who need extra recovery time/post natal care and support locally would be denied this facility and comfort of having family close by. Is the understanding of council that birthing facilities at Berwick are to be improved, including the use of a birthing pool – if this is case then perhaps more mothers to be would choose Berwick than at present. Under Option 2, these improved facilities may not be used as extensively as they could be. Would this be a waste of resources? Option 2 will provide safe and sustainable services and enhanced postnatal care for new mums and this is desirable. Hopefully, the training and rotation regime in place now will also ensure that Option 1 will also meet these needs. Finally, a major consideration is that Berwick maternity unit is not only used by residents of Berwick but also other towns and villages on both sides of the border who choose a smaller more intimate unit in which to give birth to their children. Rurality means that residents already have to travel considerable distances for other aspects of their healthcare. If Option 2 is accepted then women

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also lose some choice in this important aspect of healthcare.

31 Care and Wellbeing OSC, Northumberland County Council – J R

Consultation Response: Berwick Hospital Maternity Service

Care and Wellbeing Overview and Scrutiny Committee were advised of the temporary closure of the Ward in November. Members were issued with a media briefing and the full report about the review. Members were aware service had been suspended whilst a safety review was undertaken. Findings of the review had since been published. There were more isolated areas which maintained a maternity service, but the low numbers of births at Berwick had been significant. For 130 days in the past year, the unit had been empty. The report detailed why some people had chosen not to use the service; the unit dealt with the lowest number of births in the country. There were stringent national guidelines to be followed, which were also detailed in the report. Northumbria Healthcare considered that there were options available. Work was taking place with the PCT to explore options, and a report was being compiled. Rachel Chapman of NHS North of Tyne also explained that a report on the issue would be considered by the Primary Care Trust on 27 November, after which further consultation would take place and independent research would be arranged. Members then discussed the issue, of which the main points were: • It was important to keep the media briefed so that residents knew what was happening and listen to local views; Northumbria Healthcare had done so • There was some fear amongst local residents about not having the service available in the meantime, which needed to be addressed • Pregnant women classified as high risk needed to know their options and feel secure • Since this issue had arisen, it had raised awareness and helped many pregnant women in south east Northumberland to plan ahead about their care • Ms Riley was thanked for all the work undertaken in response to the issue.

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In response to questions asked, members were advised that: • There had been no home births in Berwick during the past year • If there were complications when women were due to give birth, for example a blood transfusion was required, they would be transferred out to other hospitals; midwives were trained in emergency situations. Such issues would be discussed at an earlier stage when planning the birth • The Cumbria Trust had not been taken over; the final date was not confirmed yet • In response to a query about some correspondence received by a member in 2003 that pregnant women should not have to travel, it was noted that the national guidelines had changed considerably over the past five years • It was important that a safe and sustainable service was provided; Northumbria Healthcare delivered some of the best maternity services in the country. It was also requested that the committee broaden its consideration to hospital services in the Berwick area rather than just the maternity service. Following this it was: RESOLVED – that (1) The update be noted; (2) The committee be consulted on the process be followed; and (3) The committee consider the issue as a further agenda item after the consultation ends. At a subsequent meeting, an update was given by Rachel Chapman, NHS North of Tyne on the Berwick Hospital Maternity Service consultation process. Councillor Hunter, spokesperson for the Berwick Maternity Group requested that hard copies of the consultation online survey be made available as not everyone had access to the internet. A Member stated that he had received complaints regarding the access to the survey. Mrs Chapman advised that hard copies of the survey would be brought to public meetings and group meetings. Following the presentation, Members raised queries and comments as follows:-

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In response to a query regarding flyers and posters, Mrs Chapman advised that posters and 13,000 flyers had been distributed to targeted areas, hospitals and leisure centres. It was suggested that flyers and posters should be A4 so the public could advertise in their windows at home and Mrs Chapman replied that posters which had been widely distributed had mainly been in A4 format;

A Member queried if any of the Options were preferred. Mrs Chapman advised that the pros and cons had been examined in the document but wanted to hear what people thought. There would be significant investment with Option 1. Research carried out over the summer indicated women were choosing to go where there were full back up services. People seemed to choose Wansbeck or the Borders hospital

A Member commented that Option 2 presented choices to retain sustainable midwife services. Option 1 was not sustainable in the longer term

In response to a question, Members were advised that in relation to Option 2, there would be no inpatient post natal services at Berwick but enhanced post natal services would be provided

Concern was expressed that community nurses were receiving parking tickets when visiting clients and asked that the issue be investigated.

The Committee endorsed the view that the consultation process had been robust.

32 Chair of Northumberland Local Involvement Network (LINk) – C A

Thank you for email regarding the above consultation. LINk has spent time encouraging residents of Berwick to respond to this consultation and have their voice heard on this important issue as well as others. Review of Maternity Services has caused anxiety and concern for many local people, some which could have been avoided. Whilst Northumberland LINk understands safety issues relating to decision, we wish to register concern at the way decision was communicated. On reflection, am sure you agree that process would have benefitted from a continuum of dialogue with patients and public, in an open and transparent engagement process may have prevented the anxiety people felt. Lessons can certainly be learnt from this experience, demonstrating importance of effective engagement and involvement of recipients of services. Berwick people historically felt disengaged in the county, and should all be mindful of their experiences and the strong feelings held, then

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exacerbated when immediate decisions are made affecting their lives. LINk is in the process of transferring to Healthwatch Northumberland, therefore will not respond formally to the consultation, however, agree the notes from the meeting in December can be used to inform the report. Please do add the comments above as these concerns have been expressed with the support of the LINk steering group. Will ensure our partnership approach with key stakeholders including Northumbria Foundation Trust and Northumberland Clinical Commissioning Group continues to seek good outcomes for everyone.

33 Rt Hon Sir Alan Beith, MP for Berwick

As Berwick’s Member of Parliament have attended meetings which were part of the consultation, as well as a protest meeting and events organised by local mothers and families. Have had discussions with representatives of the Primary Care Trust, the Healthcare Trust and the Clinical Commissioning Group, and with many individual constituents. Have raised the issue with Ministers in House of Commons debates and questions and in discussions. Views are based on all these discussions. First of all, is a real local determination that Berwick must re-open and keep its maternity unit. Berwick is 50 miles from the Wansbeck Hospital, with no direct and very poor indirect public transport. Is over 40 miles from the Borders General, to which there is better public transport. Is concern about problems of expectant mothers travelling these distances in winter conditions, and anxiety that ambulance service does not have the capacity in Berwick, particularly at night, to provide for all transfers to distant hospitals. Secondly, is great respect for Berwick midwives, and a strong feeling that the Healthcare Trust is using the two incidents to which it has publicly referred – precise nature of which has never been disclosed – to bring about a permanent reduction in services to Berwick. Correct procedure would have been to restore service at Berwick as soon as the safety concerns had been dealt with: were being dealt with by rostering staff to Wansbeck hospital to increase and maintain experience through a larger number of deliveries. Any questions about future of free-standing midwife-led units should have been raised in the general review of policy in relation to these units across

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Northumberland, which the PCT had initiated, and which has not been completed. The presentation of options to reduce service at Berwick in isolation from the rest of the PCT area seems opportunistic, as if it arose from wider agenda to get rid of midwife-led units. Is, however, not possible to consider future of Berwick unit without taking account of the strongly held views of senior clinicians that a significant proportion of births, where any of a wide range of risks may apply, can only safely be carried out in consultant-led units with clinical skills and facilities available on site. National approach has contributed to reduction over recent years in births at Berwick, and in number of births booked for Berwick which in the end take place at either Borders General or Wansbeck. Because of Berwick’s remote situation have looked widely to see if there are current examples in England, Wales or Scotland of any kind of intermediate level of unit with additional consultant support, perhaps on an on-call basis, which would allow for some higher levels of risk to be safely accommodated in the Berwick maternity unit. Did not find an alternative model. Berwick situation is comparable to arrangements in Scottish Highland and Island areas and in mid-Wales. However, Berwick seems to have suffered from a particularly discouraging approach to mothers who consider giving birth locally. Have given Trust officials a copy of letter which was given to many mothers in Berwick. Letter appears to overstate the disadvantages of delivery in Berwick and refers to a 2-hour timescale for any unplanned ambulance transfer, reinforcing the local doubts about capacity of ambulance service, particularly at night when is only one ambulance crew in Berwick. Mothers have told me how discouraging they found advice in this letter when considering delivery at Berwick. Officials of both Trusts say that letter is unofficial and that they have not seen it before, but many mothers have received it, presumably from either GP practice or maternity unit. Mothers also lay great stress on benefits of 24-hour maternity unit even if are planning a delivery at Borders General or Wansbeck. Is a source of advice and assessment which they would otherwise have to seek by travelling 80 or 100 miles to main hospitals and back. Also provides possibility of post-natal in-patient care close to their families, following delivery elsewhere. Option 2 seems to have no local support, and preference in consultation document (page 15) for

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Option 2 is seen as a prejudging of issue. Option 2 would represent a change in services and as such would have to meet the Government’s four tests. Appears to me to fail number 2 (public and patient engagement) and number 4 (support for patient choices), and clinical evidence (no 2) does not require or suggest a change from Option 1 to Option 2. First test, support from GP commissioners, does not appear to be met, but we will not know whether it is until the Clinical Commissioning Group has reached its decision. Believe that what Berwick should have is strengthened version of Option 1, with a clearer understanding of the range of births and birth risks with which it can safely cope. This strengthened Option 1 would require:

1) The regular rota arrangements which enable midwives to maintain high level of experience. This is already under way and should be offered not only at Wansbeck but also at Borders General and perhaps at larger hospitals in Edinburgh or Newcastle.

2) Review of the capacity of ambulance service to respond quickly to any necessary transfers from the Berwick unit to Borders General or Wansbeck.

3) Review by senior clinicians of advice offered to Berwick mothers when they consider whether to book their delivery at Berwick, and promotion of Berwick as available option for those mothers for whom it is clinically appropriate.

4) Continuation of highly valued arrangement by which mothers who have delivered elsewhere but feel need for a longer stay can transfer to Berwick for post-natal care. Fact this inpatient facility is not generally available elsewhere is outweighed by Berwick’s remoteness.

If all these conditions are satisfied, should be an increase in numbers of local mothers who opt for delivery in Berwick, and commissioners should at least give this option opportunity to succeed, rather than replacing it with Option 2. Option 2 is seen by Berwick people as clear downgrading of service. It is “home births at the hospital” rather than round-the-clock staffed unit where mothers can go when they believe labour has started, and still be able to get home if advised to do so – and get back again quickly if necessary. Mother who presents at Wansbeck, is sent home, and then finds she is in labour the next day will cover 200 miles in journey to and from hospital.

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A further point to note is that when mothers are not able to deliver in Berwick, large majority of them choose Borders General not Wansbeck. My conclusion is, therefore, that Berwick Unit should be fully re-opened under a strengthened version of Option 1, and that Option 2 should be rejected. Any change from Option 1:

a) Would not satisfy the government’s four criteria for changes in NHS services, b) Would not be consistent with current policy on midwife-led units in the CCG and Trust area

as a whole, c) Would not recognise the particular problems for mothers arising from Berwick’s remote

location.

34 Patient Participation Group, Belford Medical Practice

Following public meeting at Belford in February, the Patient Participation discussed options available for midwifery led services in Berwick. Some members decided they would write personal letters but here is a summary of discussion. All members agreed that pregnant women deserved excellent ante and post natal care - wherever they lived. Also agreed that right to choose should also be available to all women wherever they lived. Frequently those of us who live in rural areas hear argument that we chose to live in country, in a small town...therefore, cannot expect to have same quality of service that exists in urban areas. Some may have chosen to live in area but many residents live here not by choice but because of historical ties - families have lived in rural North Northumberland for generations - employment is in this area...and they are entitled to equality in services provided. Rurality should be taken into account - services may well be unavailable because of space, cost, lack of consultants in rural areas leaving residents disadvantaged. Options 1 and 2 both offer antenatal care for high and low risk mothers to be. Provides an opportunity for women to become familiar with the community midwives and comfortable about their advice and presence. However, option 2 does not necessarily allow for women to use this familiarity when their babies are born – even if they are low risk. Midwives are still going to be available 24/7 in Option 2 but apparently unit will not be open 24/7.

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Option 1 offers women who have given birth in a larger maternity unit for whatever reason, to return to Berwick for few days to be closer to families and existing children. Considering distances and difficulties involved in travel to Newcastle, Borders General or the Wansbeck, families may not be able to visit easily because of cost and transport difficulties. May make women leave hospital sooner. If Option 2 was the only option, then mothers who need extra recovery time/postnatal care and support locally would be denied facility and comfort of having family close by. Understand that birthing facilities at Berwick are to be improved, including the use of a birthing pool – if this is case then perhaps more mothers to be would choose Berwick than at present. Under Option 2, these improved facilities may not be used as extensively as they could be. Are concerns in community that cost of running midwifery led services in Berwick is major consideration. Patient group obviously would prefer resources to be used efficiently. If midwives, retrained, refreshed and able to deliver, are to be available 24/7 in area and unit is to be improved, but only available during ‘office hours’, is this an efficient use of resources? Or could it be considered to be a waste of resources? Option 2 will provide safe and sustainable services and enhanced postnatal care for new mums and is desirable. Hopefully, training and rotation regime in place now will also ensure that Option 1 will also meet these needs. Finally, major consideration is that Berwick maternity unit is not only used by residents of Berwick but also other towns and villages on both sides of border who choose a smaller more intimate unit in which to give birth to their children. Rurality means that residents already have to travel considerable distances for other aspects of their healthcare. If Option 2 is accepted then women also lose some choice in this important aspect of healthcare. On the whole, group considered that maternity services should be retained as in Option 1 with advantages offered by skilled midwives and improved facilities and that this choice should be offered to pregnant women eligible under the new guidelines.

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35 Patient participation group, North Northumberland – R R

Am a member of a patient participation group in North Northumberland – recently had a meeting, at

which we discussed two options for future midwifery services in Berwick. Went to a vote – there

were 8 votes for Option 1 out of 9 people present. One person abstained. Main reasons were six

hours too short to establish breastfeeding and to support new mothers with postnatal concerns.

36 Chair of NHS North of Tyne Maternity Partnership GP Advisor on Children and Family Services, NHS North of Tyne – Dr D J

Am submitting these comments as Chair of the NHS North of Tyne Maternity Partnership. The partnership has considered consultation paper and two options presented, and would like to make following comments: Consultation process appears to have been extensive, with considerable efforts made to seek views of all interested parties. Can appreciate desirability of a local service, but recognise first and foremost that safety is paramount, and that any commissioned service must meet highest standards. Acknowledge, and are acutely aware of, pressing need to ensure NHS uses its finite financial resources in most efficient way - resources spent in one part of service pathway cannot then be used elsewhere. To that end, extra investment for development of an enhanced postnatal community midwifery service as a result of freeing resource from changes to provision of inpatient postnatal care may go some way to offset loss of previous 24/7 facility with permanently resident staff. Opportunity to develop enhanced postnatal team to provide more care at home to mothers, particular to support such important activities like breastfeeding, would be welcomed.

37 Royal College of Midwives, Mansfield Street London

The Royal College of Midwives’ response to NHS North of Tyne’s consultation about future arrangements for midwifery-led services at Berwick. The Royal College of Midwives (RCM) is professional and trade union membership organisation that represents vast majority of midwives working in Northumberland and North Tyneside. Comments set out in this submission reflect views of RCM members, representatives and officers

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with regards to two options set out in the consultation document. Consideration of options

Whilst sympathetic to Option 1 - for resuming services as they were before the temporary suspension of deliveries and inpatient postnatal services at Berwick midwifery-led unit - have reluctantly concluded that it would not be possible to maintain this level of service, or justify recruitment of additional midwives, without substantial increase in levels of activity and bed occupancy. Concern would be that without an appreciable increase in number of women choosing to give birth at Berwick, long-term sustainability of midwifery services at Berwick will be brought into question.

RCM therefore supports Option 2 to provide 24/7 on-call midwifery-led service at Berwick allied to an enhanced postnatal community midwifery service. Will ensure that women at low risk will still be able to choose to give birth locally, either at Berwick or in own home, while ensuring more efficient use of NHS resources. One potential drawback of option will be that there will no longer be any overnight inpatient postnatal care. However since only low risk women will give birth at Berwick, believe that this will be more than mitigated by enhanced community postnatal services provided under this option. With regards to enhanced community services, particularly welcome the proposed addition of trained maternity support workers, employed at band three, to support midwives delivering care in community settings.

38 North East Ambulance Service NHS Foundation Trust

Thank you for allowing opportunity to comment on public consultation about future arrangements for midwifery-led services at Berwick. Have used this time to engage and consult with colleagues within our emergency care and Patient Transport Services to formulate an opinion. In respect of the two options put forward, neither option will provide for a midwifery response in community for obstetric emergencies. In option 2, would need to know where to transport patient in an obstetric emergency - either to Wansbeck Hospital or to call out a midwife to meet the crew at Berwick Infirmary? Obviously, this would depend on nature of the emergency, but guidance would be required. Where we were needed to transport women in an emergency, would also have to consider extended journey time to Wansbeck, impact of that on ORCON performance in North

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Northumberland as well as stress on ambulance crew detailed to respond to such a case. One of senior operations managers also attended a public meeting in Berwick and we noted the concerns raised about the availability of ambulances should they be needed to transfer obstetrics and gynaecology cases. Over duration of this consultation, we were aware of two women whose cases were published in media because they needed an ambulance to transfer them to either Wansbeck Hospital or the Borders General. This concern on ambulance availability was also raised on page 11 of the consultation document where an online survey was conducted in September and October 2012. Would therefore ask that whatever option is chosen, that we are given opportunity to model impact of potential hospital transfers and subsequent demand on ambulance service. Also believe that if any additional transport resources are required that these should be included in final business case to support the future arrangements for midwifery-led services at Berwick. Finally, would also like to highlight that our PTS currently provide a home oxygen delivery service to women choosing to give birth at home in Newcastle. Service is provided Monday-Friday 8am to 5pm by team leaders from Blucher Station. Is separately commissioned by Newcastle PCT, but we mention it here because is certainly something we could provide to Northumberland area, should Option 2 be implemented.

39 Glendale Surgery - MJ

Issues in Berwick need to be looked at against background of any issues suffered by other similar maternity units, Alnwick being obvious nearest unit, and then further afield. Also concerned about ongoing training and safety needs involved with a unit with dwindling numbers of deliveries vs needs of population of women who are already at risk because of distance from nearest working maternity unit. Aware that these concerns possibly don’t further any one argument over another but they are our concerns nonetheless.

40 Berwick GP - BW Have personal experience of unit – two children born there and first born was in unit for a couple of days postnatally. Unit excels in delivering personalised maternity care for patients in Berwick and offers first class

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service for patients within locality. Saddened to see service threatened but not surprised. Has had first hand experience of Northumbria consultants over the past 10 years who have been making plain their opinion that unit should be closed for both safety and financial reasons. From own experience and from talking to patients differences in experience of labour between a DGH and the maternity unit are huge and not to be underestimated. Amount of attention given in postnatal period is also very different from a busy ward where nobody has time to team a first time mum how to breast feed and other important perinatal skills. Live in a very rural area which is in an isolated corner of country and taking a labouring woman 50 miles (on single track roads) or so to nearest hospital is not a pleasant experience for either patient or the driver. Most recent ambulance deliveries would emphasise this fact. Local women require a local option that is made readily available and am pleased that some mention of this is made in the proposed plans. Is my experience that women were actively discouraged from delivering in Berwick and this may account in part for the lower number of deliveries. Suspect that continuing to provide a local service would require a culture change in the provider organisation in order to aspire to building a first class service to the community. Have yet to see willingness from any parties to engage positively in this manner. Perhaps there is some sort of rurality payment/inducement that could be offered to a prospective provider.

41 Belford GP - DG As a local GP who has used Berwick Maternity for many years, am extremely saddened by loss of a permanent maternity unit in north of locality, however, seems to be symptomatic of the times that popularity for deliveries in small units is on decline and therefore for economic reasons, cannot see how the unit could remain viable in the current climate. Option 2 therefore seems to be the logical choice although would request that consideration be given in postnatal period for provision of postnatal care outwith six hour window for those mums not fit for immediate discharge.

42 Wooler Primary Care Team

Have negative feelings about consultation process and feel that the closure may be a foregone conclusion – thoughts about how data was collected and presented to the public would tend to support this along with the fact that midwives are already being briefed about unit closure before the end of the consultation process.

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It is necessary – for providers and commissioners and all responsible bodies, including Department of Health, to provide adequate funding which includes diseconomies of scale encountered in necessarily small remote rural healthcare units to ensure remote and rural communities are not disadvantaged. We would like to have included a third possibility – namely the merging of units in Alnwick and Berwick to produce a sustainable unit for the whole of north Northumberland.

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3. Maternity care needs assessment for Berwick

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Documents

Joint Locality Executive Board 22 May 2013 Agenda Item: 8 ...committeedocs.northumberland.gov.uk/MeetingDocs/15234_M1444.pdf · 14 February Berwick Family Drop-in at Jubilee Spitall