Small maternity units 'not safe' - Welsh NHS official

NHS Wales' medical director admits that some smaller maternity units in Wales are not "safe or sustainable".

Dr Chris Jones said the units were dependent on temporary agency staff at a cost of millions of pounds a year.

He said the NHS had no way of ensuring the quality and competence of these staff or their immediate availability.

The assembly government said his "honest and transparent" comments reflected the views of the Royal College of Obstetricians.

They come in the wake of controversial proposals to review maternity services in north Wales, being looked at by Betsi Cadwaladr University Health Board.

Dr Jones said a number of maternity units in Wales were not delivering enough babies to attract doctors because they did not meet training guidelines for out-of-hours deliveries.

This led to an increase in vacancies at the maternity units, he said.

He said: "Now, although all our rotas are European Working Time Directive-compliant on paper, we know in practice they are only being maintained by significant expenditure.

"All of our health boards are spending hundreds of thousands of pounds in locum costs, agency costs, extra payments to doctors, to maintain these rotas.

"Betsi Cadwaladr Health Board is spending up to £1m a year to maintain their rotas.

"The difficulty is that this is not a safe or sustainable service, because you cannot always guarantee you'll get someone to fill a shift.

"If you do get someone, you can't always guarantee their experience or their competence.

"We know there are risks with peripatetic locums, and we know that this risk is increasing rapidly.

"So we realise that this is a major area of risk for these services as currently configured, and they will not be sustainable in the way they are configured in the future."

Draft strategy

Dr Eamon Jessop, a Prestatyn GP and member of the British Medical Association (BMA), said he wanted to know what Dr Jones meant by "smaller maternity units".

He said the three units in north Wales, at Ysbyty Maelor, Wrexham, Ysbyty Glan Clwyd in Bodelwyddan, and Ysbyty Gwynedd, Bangor, were all "small" in that there were between 2,500 and 3,000 births a year.

This compared to "smallish" units elsewhere where there would be around 4,000 births a year.

The health board has said it was looking at options and aimed to provide "high quality, safe and effective services".

A Welsh Assembly Government spokesperson said: "The medical director of NHS Wales was responding to questions in an honest and transparent way, which reflected the views of the Royal College of Obstetricians.

"Last week, the assembly government published a draft strategy for maternity services for consultation, which sets out our vision of providing high quality, safe and sustainable maternity services across Wales.

"It will be for the health boards to produce their plans later this year, following full local engagement."

Helen Rogers, director of the Royal College of Midwives in Wales, speaking on BBC Radio Wales, said she was "slightly disappointed" by Dr Jones's comments.

"One of the main concerns for me is that a message is going out that maternity services are unsafe and that is clearly not the case," she said.

"The vast majority of units in Wales, midwives are working extremely hard, we have got a rising birth rate but we have good staffing levels and any woman can be assured that going into any of the maternity services in Wales she will get good care.

"The midwives are not saying to me, as the director of the Royal College of Midwives, that their service is unsafe, they are not highlighting safety issues."

Welsh Liberal Democrat health spokeswoman Veronica German said: "What we are seeing is local health boards spending large sums of money on locum doctors who may not be experienced.

"This situation cannot continue, it is not good for the safety of pregnant women and it is not good for the budgets of our local health boards."