Small maternity units should share staff, facilities, say reports

Smaller maternity units cannot operate in isolation and should share staff and facilities in order to provide sustainable services to their local populations, according to two new reports.

The development of networks of maternity units needs to be fast-tracked, the report commissioned by the HSE from a UK health consultant recommends.

Former NHS executive David Flory reviewed services at two units, Cavan General Hospital and South Tipperary General Hospital in Clonmel.

In a finding applicable to other smaller maternity units, he says they cannot sustain the breadth and depth of services without formal links and networks as part of a “bigger, stronger, more specialist units”.

Mr Flory’s report on Clonmel is strongly critical of gaps in management at the unit. “Some parts of the building are not fit for the purpose of delivering high quality and safe care. The hospital is spending more than its income and yet suffers from shortages in key areas of the workforce.”

Baby deaths

Mr Flory finds Cavan, where four baby deaths over the past three years are being investigated, has “a generally fit for purpose infrastructure overall and is quite well maintained”.

“As a consequence of these incidents there is a very bright and critical media spotlight on the hospital. This is impacting on the mood and morale of members of the maternity team and it was described how it is affecting clinical risk assessments and decisions.”

One locum consultant chose to leave the hospital because of these pressures, Mr Flory was told.

Although there is a midwife-led unit, this accounts for only 130 births in hospital out of a total of 1,800. “The doctors are very much in charge,” he comments, adding there is evidence the most senior midwife, an assistant director of nursing, is professionally isolated and unsupported.

“The hospital’s biggest challenge is coping with staff shortages in critical areas including obstetricians and midwives on the one hand and a committed level of expenditure in excess of available funding on the other hand.”