In the BMJ this week “Fewer trainees, fewer ads, fewer physicians” is an honest and diplomatically understated argument by Andrew Goddard and Rob Hardwood based on “the 2018 annual census of consultant and higher specialty trainee physicians”.
…..the report on the census said that this year there was a big reduction (33%) in the number of consultant posts being advertised. “A number of factors may have contributed to this fall, including the lack of trained HSTs [higher specialty trainees] to meet the demand in shortage specialties and the deteriorating ﬁ nancial situation within the NHS, but this is a worrying pattern,”
The whole health service is short of consultants as well as GPs and Nurses. The lead in time to train replacements is so long that it was always going to get worse, and it has. This will impact on neonatal care, obstetric care, care in all distant and remote places, and where educational standards are lowest. It is these areas where recruitment is hardest.
The number of twins dying before, during or shortly after birth is increasing after several years of falling, prompting fears that their mothers are not being given specialist care.
Survival rates for twins and triplets improved after The National Institute for Health and Care Excellence (Nice) published guidance in 2011 recommending that women with multiple pregnancies be cared for by specialist obstetricians and midwives.
Between 2014 and 2016, the stillbirth rate of twins fell from 11.07 to 6.16 per 1,000 births. The neonatal mortality rate of twins — those dying before their first birthday — fell from 8.01 to 5.34 per 1,000 births between 2013 and 2016.
Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries, an Oxford University research group, has found that the rate of deaths is rising again. Between 2016 and 2017, the number of twin stillbirths increased from 6.16 to 6.99 per 1,000 births, while twin neonatal deaths also rose from 5.34 to 5.45 per 1,000 births.
In 2017, 164 twins were stillborn compared with 145 in 2016. Over the same period the rates fell for babies from a single pregnancy. A twin baby has almost double the chance of being stillborn and more than three times the chance of dying in infancy compared with a single baby.
Keith Reed, of the Twins and Multiple Births Association, said: “This is a wake-up call to all maternity units in the UK. Our research has proven that having a specialist team delivering care in accordance with Nice guidance reduces stillbirths and neonatal admissions . . . The quite significant upturn in stillbirths is likely a result of lessening adherence to the Nice guidance.”
Alexander Heazell, of the Royal College of Obstetricians and Gynaecologists, said: “We are concerned by the disparity in stillbirth and neonatal mortality rate for twins and triplets in 2017 compared to singleton pregnancies, especially as there were gradual improvements in the outcome of multiple pregnancies since 2013.
“This change is in part due to a welcome reduction in the stillbirth rate for singleton pregnancies, which are now at their lowest recorded rate, which was not mirrored in multiple births.”
One in every 65 births was a multiple birth in 2016, up from one in every 100 in 1984. This is due to more older mothers, who are more likely to release more than one egg during ovulation, and rising rates of IVF, which produces more twins.