Agenda item

The Committee considered a joint report of University Hospitals of Leicester NHS Trust (UHL) and Leicester, Leicestershire and Rutland Clinical Commissioning Groups (LLR CCGs) regarding the consultation on the plans to reconfigure Leicester’s Hospitals known as ‘Building Better Hospitals for the Future’, with particular emphasis on the proposals for St Mary’s Birth Centre, Melton Mowbray. A copy of the report, marked ‘Agenda Item 7’, is filed with these minutes.

 

The Committee welcomed to the meeting for this item Andy Williams, Chief Executive, LLR CCGs, Richard Morris, Director of Operations and Corporate Affairs, Leicester City Clinical Commissioning Group (CCG), Sara Prema, Executive Director of Strategy and Planning, Leicester City CCG, Rebecca Brown, Acting Chief Executive, UHL, Mark Wightman, Director of Strategy and Communications, UHL, Ian Scudamore, Director of Women’s and Children’s Services, UHL,  Justin Hammond, Head of UHL Reconfiguration PMO, UHL, and Florence Cox, Community Midwifery Matron, UHL.

 

The Chairman reported that the following petitions had been received in relation to St Mary’s Birth Centre:

 

Keep St Mary's Birth Centre Melton Mowbray Open

 

St Mary's Birth Centre Melton Mowbray should be kept open because it provides gold standard maternity care both during and after birth. The unit is the only maternity unit in the county outside the City of Leicester and provides an important choice for expectant parents both from Melton and the rest of Leicestershire. It is the only unit in the County where mothers are attended by a midwife throughout labour, which is recommended by NICE. The excellent postnatal care received at the unit helps new families become more confident and have a better transition to parenthood.

 

This petition had 1,470 supporters at the time of consideration by the Committee.

 

 

Save St Mary's Birthing Centre

 

We firmly believe that Melton needs its Birthing Unit.  As a much loved, vital service, it forms an important piece of the jigsaw for women and their families requiring maternity care.  The unit gives pregnant mothers a choice in the ethos of care and being local it saves the long drive when in labour.  Furthermore, it provides wonderful after care, including support around breastfeeding and mothers mental health.  The larger hospitals simply don't have the resources for this.

If it closed there is also the risk of more pressure on midwives as more low risk mothers might choose to have home births instead of risking the journeyy to Leicester. Each home birth requires two midwives present and the question is will there be enough to go around.

Finally, the Birthing Unit not only needs to stay open but we call on it to be properly funded going forward.

This petition has been started by The Rutland and Melton Labour Party.

 

This petition had 3,499 supporters at the time of consideration by the Committee.

 

Both Petitions were presented by Ms. Helen Cliff. In presenting the Petitions Ms. Cliff emphasised that the supporters of the Petition resided in various locations across LLR not just Melton. She also raised concerns that NHS staff were not making pregnant mothers aware that the St Mary’s Birth Centre was an option or were deterring mothers from opting to give birth there.

 

Arising from discussions the following points were noted:

 

(i)     Members welcomed the proposed £450 million investment in Leicester’s Hospitals.

 

Consultation

 

(ii)         The format of the consultation was that the CCGs and UHL set out how they were minded to proceed and the public were asked whether any issues or alternatives had not been considered and whether the proposals disproportionately impacted a particular group or area. Whilst the CCGs and UHL were not looking for a majority of the public in favour of the proposals, all responses would be taken into account and consideration would be given to whether the proposals needed to be revised. After the close of the consultation all of the responses received would be collated and analysed by an independent third party. Whilst this was not an appeal process, there were likely to be modifications to the proposals as a result of the consultation feedback.

 

(iii)       The consultation website had been visited by over 90,000 different people which was higher than expected and there had been over 4000 responses to the consultation so far, the majority of which were either positive or neutral regarding the proposals.

 

(iv)       The CCGs had committed to distribute leaflets regarding the consultation to every home in Leicester, Leicestershire and Rutland. This was unusual for a consultation such as this. The distribution had been carried out by way of solus delivery. Due to concerns raised that not all homes in LLR had received the leaflet the distribution company carried out a second delivery to all homes in LLR by way of compensation. GPS tracking data for the second delivery verified that all the required locations had been covered. An independent company then carried out phone calls to residents across LLR to verify that the leaflets had been received and it was found that the industry standard (40-60% of people phoned recalling that they received the leaflet) had been met. Reassurance was given by the CCGs that the geographical areas where concerns had been raised that leaflets had not been received actually had a greater response to the consultation therefore even if leaflets had not been received in those areas it had not inhibited the ability of the people in those areas to respond to the consultation.

 

St Mary’s Birth Centre

 

(v)        The midwifery-led unit at St Mary’s Hospital in Melton was the only standalone birth centre left in the East Midlands. The other units had been closed in the early 1990s due to mothers choosing not to use them. A review had taken place in Leicester, Leicestershire and Rutland around 2009/10 regarding standalone birthing units which found that they were not sustainable as most mothers had a preference for birthing units which were alongside other medical facilities.

 

(vi)       Annually 10,000 women gave birth in Leicester, Leicestershire and Rutland. There were approximately 1800 mothers living in Melton and surrounding post codes that could potentially choose to give birth at St Mary’s however only a sixth of those chose to give birth at St Mary’s and only a twelfth actually ended up giving birth at St Mary’s. Mothers often decided that St Mary’s Birth Centre was not the appropriate facility for them due to the transfer time to other medical facilities should there be complications with the birth. For example if the mother required a caesarean section, requested an epidural, or the baby required resuscitation then a transfer into Leicester was required. In addition, part of the NHS 10 year plan was to reduce the amount of still births and babies born with brain damage which further supported the case for moving birthing facilities alongside emergency hospital facilities. In response to queries as to the accuracy of the published statistics regarding transfer rates from St Mary’s for mothers in labour and immediately after birth, it was confirmed that the rate was currently 45% for first time mums and 10% for 2nd, 3rd and 4th babies.

 

(vii)      In response to a query as to whether the new home birthing model had impacted on the numbers of mothers opting to give birth at St Mary’s it was confirmed that there had been no impact as whilst the numbers of mothers that had opted for a home birth had increased, the numbers for St Mary’s had remained the same.

 

(viii)    UHL emphasised that St Mary’s Birth Centre was not going to be closed. It was proposed that the midwifery-led unit would be relocated to Leicester General Hospital as a pilot for 12 months to test the public appetite for this service with an indicative target of 500 births per year. Members raised concerns that this was too short a time for a trial to take place and questioned whether UHL and the CCGs were genuinely open minded about the outcome of this trial. In response reassurance was given that UHL were not expecting to close the birthing centre at Leicester General Hospital at the end of the 12 month trial period and if there was sufficient interest in the facility at that location from mothers then it would remain open. It was desirable to offer choice for mothers as to where they gave birth but each birth unit had to be financially sustainable. A member submitted that there was a lack of facts and figures in the public domain to demonstrate that St Mary’s Birth Centre was not sustainable and asked for this information to be provided. In response it was explained that the cost of a delivery at St Mary’s Birth Centre was around £4000 whereas at both the Leicester General Hospital and Leicester Royal Infirmary it was around £2000.

 

(ix)       In response to concerns raised by a member that too much emphasis was being placed on the risks of a standalone birthing unit rather than the outcomes and experience of the mother, UHL acknowledged that both the risks and benefits needed to be explained to the mother and it was important to give mothers a choice, listen to and take account of a mother’s concerns about giving birth and make a plan in case problems arose.

 

(x)        A member reported strong concerns amongst the people of Melton that  facilities were continually being lost from the area and the proposed loss of the birthing unit was the latest of many.

 

(xi)       Given the closure of many Sure Start Centres, concerns were raised regarding a lack of support for mothers with regards to breast feeding.

 

 

Neuro Rehabilitation services

 

(xii)      Neuro Rehabilitation services had previously been provided at Wakerley Lodge in the grounds of Leicester General Hospital but were now temporarily located in Ward 2 at Leicester General Hospital. Consideration was being given to whether Neuro Rehabilitation services should be permanently located at Leicester Royal Infirmary or Glenfield Hospital. Glenfield Hospital had the advantage that there was garden space which was important for patients that required Neuro Rehabilitation. The consultation feedback would be taken into account when making the assessment. A final decision on where the service would be permanently located would be made in 2024 and overall it was a 7 year project.

 

Bed numbers

 

(xiii)    In response to concerns raised that the additional beds proposed under the reconfiguration scheme would not be ready by the time there was a demand for them, reassurance was given that taking into account the model of care and the rate the population of Leicester, Leicestershire and Rutland was rising the planned bed numbers were sufficient and the new beds would be in place in time to meet demand. Care needed to be taken that the acute sector was not bigger than needed and did not unnecessarily divert funding from other areas of healthcare. Should circumstances change from that which was predicted then there was latitude to expand bed numbers in excess of those currently planned. A member suggested that the bed modelling should be extended up until 2036.

 

Car parking and transport

 

(xiv)    Under the proposals car parking at both Leicester Royal Infirmary and Glenfield Hospital was to be extended, however after the reconfiguration had taken place it was expected that footfall at LRI would reduce by 30-40% whereas at Glenfield Hospital it would increase by a similar number. A member raised concerns around pollution around Glenfield Hospital due to traffic.

 

(xv)     Other options to improve transport to Leicester’s hospitals were being considered including extending the existing Park and Ride scheme, reviewing Hospital Hopper bus routes and enabling patients to hire bikes. A member raised concerns about a lack of public transport to the hospital from rural areas such as Rutland and questioned whether there were suitable locations for Park and Ride sites on the east side of Leicester. In response reassurance was given that conversations had taken place with Rutland residents regarding solutions to their travel issues.

 

RESOLVED:

 

(a)        That the contents of the report be noted;

 

(b)        That the comments now made be fed into the consultation on Building Better Hospitals for the Future.