Maternity care is getting more risky, as mothers get older, and as peripheral units have insufficent staff and experience. Shortage of Midwives, GPs and A&E consultants..

The disasters at several maternity hospitals across the country are evident to all. The situation at East Kent is in the BBC News today 23rd Jan but it is symptomatic of a general decline. There are insufficient O&G consultants, there are insufficient midwives, and there is so much litigation that the future debt burden is becoming greater than a complete year’s budget. Nothing significant has been done to increase the number of full time midwives or GPs or consultant obstetricians in training in the last three governments. Yes, choice is under threat in England, but we in Wales have already lost it. The out of date NICE advice from 2014 needs to be replaced. All pregnancies have to be regarded as risky today, even if a small minority are women under 35 with second pregnancies and no previous complications. The numbers of these are too small. The NHS guide: Your pregnancy and baby guide: where to give birth is also out of date. What they should be saying is “where to avoid”! Doctors are often “out of their depth” and “without proper cover” and no wonder they get stress. The least experienced doctors are at the coal face when this should be a place for the experienced brain to triage and sort appropriately, avoid delays and unnecessary mistakes, and avoid over treatment. Working in A&E needs “tough love”… A&E consultants are a rare breed of dedicated people, but there are not enough of them: just like GPs. The difference is that GPs are not contracted to cover emergencies, and they can down tools. The buck stops at A&E departments, and the closures across the country are as a result of too few staff across the board. The shortage was known 10 years ago, covered in the Guardian 6 years ago, and yet nothing has been done.

GPs used to share the care of pregnant women, leading to long term relationships and trust. The GPs are now working flat out and bureaucratically, for long hours, and often without examining patients.  The Nuffield Trust reports on the falling number of full time equivalent GPs across the UK, but agrees that the number of GPs has stayed the same!

A year ago in the Guardian Dennis Campbell reported: Concerns over birthing options as NHS shuts midwife-led centres – Trusts say midwives needed in hospitals, as critics argue women’s right to choose under threat

in 2014 NICE announced that Midwife-led units (are) safest for straightforward births – More women should be encouraged to give birth at midwife-led units rather than traditional labour wards, says NICE.

The NHS guide: Your pregnancy and baby guide: where to give birth 

Death of at least seven babies in East Kent: the Mail 23rd Jan

BBC M Buchanaon and J Melley cover this 23rd Jan: East Kent hospitals: Baby death parents’ heartbreak over errors

The Press Reader comment son the “extra holidays” being offered as inducements to GPs.

Pulse reported in May 2019: 11 hour days, 41 daily contacts (that’s face to face) and half of GPs working unsafe levels.

July 2013 in the Guardian: A&E crisis: shortage of consultants a ‘considerable concern’ – MPs raise alarm over ‘extraordinary’ lack of top doctors in NHS hospitals

July 2018: 4 UK health services all seeking midwives and nurses. Its getting worse, and it will progress further..

August 2017: Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

2016: The long term results of rationing midwives and doctors in training…

To date many midwives and nurses have not been able to “demonstrate they can communicate effectively”. Communication and cultural barriers in health acknowledged. Litigation results..

This entry was posted in A Personal View, Midwives, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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