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NHS North East Essex _NHS NEE_ and Colchester Hospital University

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					   North East Essex Maternity Services Public Consultation Document
                               Summary
                            September 2009


The overarching aim for re-organising services is to improve the quality of the
service, concentrating on safety and working towards better outcomes and
satisfaction for all women and their babies. Services need to be delivered in an
appropriate setting by skilled maternity professionals with the required level of
experience and training and women should have an appropriate choice of place and
type of birth according to their individual needs and wishes.

NHS North East Essex (NHS NEE) and Colchester Hospital University Foundation
Trust (CHUFT) wish to consult on proposals to develop their maternity services for
the population of North East Essex. NHS NEE and CHUFT are committed to
ensuring that the views of service users and staff inform any major decisions made
around the re-design of maternity services , in line with guidance outlined in Maternity
Matters (2007)1 and the National Service Framework for Children, Young People and
Maternity Services (2004)2.

The Current Situation

Maternity services across North East Essex are provided from 4 sites:
1. Colchester Hospital
2. Clacton Hospital
3. Harwich Fryatt Hospital
4. Halstead

Colchester Hospital has a consultant-led unit. This is used primarily for women with
complications identified in their medical history, previous birth experiences or current
pregnancy or labour. Women with an uncomplicated pregnancy or labour can also
choose to deliver in the unit. There are obstetric theatre and neonatal intensive care
facilities on site with medical cover provision 24 hours a day. In addition there is a co-
located midwifery-led birthing unit (due to open in the Autumn of 2009). This birthing
unit is a facility for women who have experienced low risk pregnancies and wish to
be delivered in a homely environment by a midwife but who do not wish to deliver at
home. Women will deliver there and then stay for a short time after the birth. This unit
has facilities to care for women with “high risk” pregnancies and deliveries and also
provides antenatal and postnatal care with the majority of midwives who make up the
core team based there.

Clacton Hospital and Harwich Fryatt Hospital have “stand alone” birthing units that
are not co-located with a delivery suite and are staffed 24 hours a day, 7 days a
week. All complicated deliveries and emergencies are transferred directly to
Colchester Hospital. There are antenatal and postnatal care facilities at both sites.

The Halstead site is owned by NHS Mid-Essex and has a birthing centre. This
provides a facility for women with one birthing suite available for women who do not
wish to deliver at home or in the hospital setting. The birthing centre has no inpatient
stay facilities and is only opened for deliveries at the time of need. It is not staffed
24/7. All complicated deliveries and emergencies are transferred directly to
Colchester Hospital. It provides limited antenatal and postnatal facilities.




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There are also currently two community-based Midwifery Group Practices that cover
specific areas-the Valley and the Iceni. The Halstead site provides a base for the
Valley Midwifery Group Practice which is managed by CHUFT. The Valley and Iceni
midwives follow the women in their care in to deliver.

The Need for Change

Re-organisation will help to reduce inequalities in service provision, however
sustainability and affordability of services are key to reorganisation issues.

Although maternity services are available to all women within the North East Essex
district boundaries there is a current inequity of provision that needs to be addressed.

Overall, the number of women of childbearing age across North East Essex is
increasing, rising from 3858 in 2007/08 to 3880 in 2008/09. In recent years however,
there has been growing concern around the sustainability of the midwifery-led units
at Clacton and Harwich due to the relatively small number of births that take place
there-in 2008/09 there were 138 in Clacton and 113 in Harwich with 3440 taking
place at Colchester. We need to ascertain why there is a lower uptake at the coastal
units and what our communities wish to see in relation to the delivery of maternity
services.

Concurrently the midwifery staffing levels are inequitable. This ratio is calculated as
the ratio of midwives to women delivering in each locality. In 2008/09, there was an
average midwife to woman ratio of 1:39 at Colchester Hospital, 1:12 in Clacton and
1:16 in Harwich. The East of England SHA has specified that a ratio of 1:30 is to be
achieved by 2010 as well as 1:1 midwifery care whilst in established labour. This
cannot be achieved under the current service configuration.

Bed occupancy is well below half within all sites, yet it is only slightly on the increase
at Colchester, despite increased throughput. The length of stay is higher at the
coastal units than the main unit at Colchester with approximately 71% of the women
from the Clacton area and 44% of the women from the Harwich area delivering in the
main unit at Colchester due to necessity in the case of a higher risk pregnancy or
complications occurring or because of personal choice.

Some aspects of maternity services will remain the same:

    The consultant-led unit will remain at Colchester General Hospital.
    Antenatal care will continue at home, the GP surgery, clinic or hospital and at
     satellite clinics in Clacton and Harwich
    The pattern of antenatal visits and contacts will not change. This is currently a
     minimum of 9 checks for women in their first pregnancy and 7 for women who
     have been pregnant before.
    Postnatal care will continue at home, the GP surgery, clinic or hospital.
    Consultant-led satellite clinics for high risk women at Harwich and Clacton will
     continue.
    Ultrasound scans at Halstead, Colchester, Clacton and Harwich Units will
     continue to be provided.
    Parent education will continue to be offered in all areas across the district.
    Midwives based in local areas will continue to provide antenatal, postnatal
     and home birth services.
    There will continue to be a choice for women of delivering at a midwifery-led
     birthing unit or a birthing centre.



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However, we need to consider how to change the current model of provision for
maternity services to ensure that it is equitable whilst retaining the 24 hour access to
maternity services.

The Options

Option 1- Both Clacton and Harwich midwifery-led birthing units close and 7
community-based midwifery teams are created working throughout the district. The
choice for birth will be home, Colchester General Hospital or the new midwifery-led
birthing unit at Colchester General Hospital.

Option 2-Create birthing centres at both Clacton and Harwich midwifery-led birthing
units that will open at the time of need rather than be open 24 hours a day. In
addition, 7 community-based midwifery teams will be created to work throughout the
district. The choice for birth will be home, Colchester General Hospital, the birthing
centres at the coast or the new midwifery-led birthing unit at Colchester General
Hospital.

Option 3- No change.

Option 4-Both Clacton and Harwich midwifery-led birthing units close and create
traditional community midwifery throughout the district. The choice for birth will be
home, Colchester General Hospital or the new midwifery-led birthing unit at
Colchester General Hospital.

Option 5-Close Harwich midwifery-led birthing unit and maintain Clacton under the
existing arrangements. The choice for birth will be home, Colchester General
Hospital, Clacton midwifery-led birthing unit or the new midwifery-led birthing unit at
Colchester General Hospital.

With all of the options outlined above, the current service provided at Halstead will
remain unchanged.

Following initial early discussions in 2007 with service users and staff
involving a patient and public survey and an internal review of staff opinion,
Option 2 was identified as the preferred option at that time by the sample of
people questioned.

The plan is to go out to wider public consultation in early October 2009 which will run
for 3 months. The results will subsequently be collated in January 2010 with a Board
discussion on the results at this point and a final decision taken in March 2010.
Following this, Implementation Plans will be developed and approved and a roll out of
the changes will commence in June 2010.

The full consultation paper is available from Helen Kershaw-Interim Maternity
Commissioning Manager at NHS NEE.


 DH (2007) Maternity Matters: Choice, access and continuity of care in a safe service. London, The
Stationery Office
2
  DH (2004) National Service Framework for Children, Young People and Maternity Services. London,
The Stationery Office




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