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Health in Moray and at Dr Gray's Hospital: 'Enormous concerns' over maternity services say group of senior staff at Raigmore Hospital in letter to Scottish Government health minister Humza Yousaf

By Alistair Whitfield

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SENIOR maternity staff at Raigmore Hospital have branded plans to let more pregnant Moray women give birth in Inverness as "unworkable" and "unsafe".

A clinical team of 18 consultant obstetricians and senior charge midwives have written a strongly-worded letter to Humza Yousaf, the Scottish Government Health Minister, to make their opposition clear.

This week they asked The Northern Scot to make their letter - written privately to the health secretary last month - public as they have not yet received a reply.

Humza Yousaf was appointed Cabinet Secretary for Health and Social Care last May.
Humza Yousaf was appointed Cabinet Secretary for Health and Social Care last May.

They say they were never consulted properly about the practicality of the plans to transfer pregnant women to Inverness.

And while sympathetic to mums in Moray, they claim Raigmore has neither the facilities or staff numbers to deal with any extra births.

The team behind the letter are consultant obstetricians Sadia Akhtar, Ibrahim Alsharaydeh, Rajesh Annappa, Adam Archibald, James Bingham, Alison Cummings, Iram Rabbani, Kate Stewart, Tracey Sturgeon, Mandy Hunter and Aik Goh, and senior charge midwives Allison Davies, Katherine Freeman, Yvonne McKenzie, Fiona MacKenzie, Aileen Summers, Lynn Forbes and Mary Taylor.

Maternity services were downgraded at Dr Gray's Hospital in Elgin in 2018 due to staff shortages.

Dr Gray's Hospital in Elgin was downgraded in 2018 due to staff shortages.
Dr Gray's Hospital in Elgin was downgraded in 2018 due to staff shortages.

Since then more than 80 per cent of Moray mums have faced the long and potentially dangerous trip to Aberdeen to give birth.

With widespread public concern at the ongoing problem, the Scottish government commissioned a review last March.

Led by Ralph Roberts, the chief executive of NHS Borders, it was asked to examine whether a consultant-led maternity service could be re-instated at Dr Gray's.

However, the review's report in December effectively ruled that possibility out for the foreseeable future.

Instead, it suggested proposals to allow more Moray women to give birth in Inverness, rather than facing the longer journey to Aberdeen.

The maternity team at Raigmore Hospital, which is run by NHS Highland, say the review team never mentioned the possibility that Moray mums might be transferred to Inverness.

They write: "Until the day of publication we had been led to understand that the purpose of the report was to investigate how NHS Grampian could reinstate obstetric services to Elgin.

"We cannot speak for the other services involved in the review, but this extraordinary lack of consultation raises enormous concern about the review recommendations in their entirety."

They add: "Raigmore is simply not configured for these extra births."

Nearly 12,500 members of the public signed a petition against downgrading maternity services at Dr Gray's.

Kirsty Watson is a mum-of three and a leading member of the Keep MUM group which was set up to try protect maternity service at the Elgin hospital.

Keep MUM campaigner Kirsty Watson.
Keep MUM campaigner Kirsty Watson.

She said: "If senior clinicians at Raigmore are saying it is not feasible, then we respect that view.

"NHS clinicians only contact the media when they feel they are not being listened to.

"The concerns expressed in the letter need to be treated with respect and responded to as a matter of urgency.

"We raised these concerns about the Inverness option at our meeting with Humza Yousaf on December 20 and in a follow-up letter.

"We believe that there is a high chance that the current overcrowding in Aberdeen Maternity Hospital would be replicated in Raigmore, along with similar significant delays to induction of labour and potential compromise of safety.

"This is not the fault of maternity staff in Raigmore Hospital.

"NHS Grampian are responsible for making sure that our current inadequate service is replaced with a better service.

"We are waiting to hear from Humza Yousaf on imminent improvements but, for now, we agree with the Inverness clinicians that the Raigmore option is impossible."

A spokesperson from Mr Humza's office responded: "We welcome the Dr Gray’s report, which is thorough and substantial.

"The Cabinet Secretary for Health met with staff, the health boards and local people in December to discuss the report in detail.

"The Scottish Government is considering all the recommendations carefully and will meet again with NHS Grampian and NHS Highland shortly to agree practical next steps.

"We would be happy to hear from clinicians at Raigmore in any further discussions."

Related article: Report into maternity services at Dr Gray's Hospital in Elgin

The letter to Humza Yousaf was written on December 10, shortly after the review made its proposals.

Here it is in full:

Dear Mr Yousaf

We represent the senior obstetric and midwifery teams delivering clinical care to mothers and babies at Raigmore Hospital in Inverness.

As the staff most closely involved in the day to day clinical workload of the maternity service here we have an unparalleled insight into its strengths and limitations.

We have carefully read the Report into Maternity Services in Moray and are grateful to the Review Team for the work they have done.

It is our collective and expert opinion that the primary recommendation for short term implementation of Model 4, ie a “Community Maternity Unit linked mainly to Raigmore” will result in an unmanageable increase in workload for the Maternity Unit at Raigmore and a consequent and unacceptable risk to patient safety for the women of Moray and for the women of the Highlands. Therefore we strongly oppose it.

In coming to this conclusion we have taken into consideration the following:

As clinical staff our primary ethical and professional responsibility is to the welfare of our patients.

Overnight the Report has added all pregnant women in Moray to the scope of that duty.

Until the day of publication we had been led to understand that the purpose of the report was to investigate how NHS Grampian could reinstate Obstetric services to Elgin.

Although we are the senior clinical staff who will be responsible for implementing any recommendations, there was no communication from the Review Group on the possibility of a Model 4 recommendation. If there had been, we are certain that this recommendation would not have been made.

We cannot speak for the other services involved in the Review, but this extraordinary lack of consultation raises enormous concern about the Review recommendations in their entirety.

The Chair of the Review and Cabinet Secretary for Health were informed of the limitations in the ability of Raigmore Hospital to safely act as a destination for women from Moray, but these specifically expressed concerns have not been followed up during the course of the Review nor prior to publication of the recommendations.

The timescale on page 45 (“Conclusions – short term”) quotes “within a reasonable timescale (up to two years)”, but in appendix 1 page 105 it is indicated that some progress is expected within 3 months. The “Route Map“ on page 114 suggests that many of the changes, in particular the choice of Raigmore as a centre for birth for women from Moray, can be expected in as little as 12 months.

This change once established would result in a very significant increase in workload at Raigmore for which, in this timescale, no provision can be anticipated.

The workload arising from the proposal has not been properly scoped. It is however likely to be very large and to increase. We note that every centre of population in Moray excepting Keith is either closer to Inverness or has a shorter road journey time.

This will have a major impact on where women will choose to give birth if Raigmore is offered as an option. We are sympathetic to the plight of women in Moray but we cannot endorse for convenience an option that stretches our capacity to such an extent that safety of care is compromised. Raigmore is simply not configured for these extra births.

The built environment and facilities at Raigmore for Maternity are in need of upgrading. This was expressly pointed out to the Scottish Government in 2016 and again with publication of “Best Start” in 2017.

Despite promises of improvement and investment, none has taken place. Therefore it cannot and must not be taken for granted that improvement promised in order to gain agreement for safe implementation of Model 4 will be achieved.

As in Elgin, there is difficulty with recruitment and retention at Raigmore Maternity. This affects midwifery staffing and also medical staffing at both middle grade and consultant level.

We are heavily reliant on locum practitioners, requiring intense attention to rostering to maintain safe provision. There is no prospect of this situation improving in the timescale suggested.

All our staff are doing their very best in difficult circumstances to provide excellent care for mothers and babies from Highland Region. We must support and protect them.

The proposed model of care with antenatal care by one provider and intrapartum care with another is inherently unsatisfactory.

In principle the suggestion that maternity care for women in Moray should be provided at Inverness is a sound one. This cannot however be provided with our current staffing and facility.

The Minister of Health for Scotland's 1988 Report “Specialist Maternity Services for Moray” examined this possibility comprehensively and at that time NHS Highland prepared a forensic assessment of the resources that would be required.

The principles outlined in paragraphs 87 and 94 pages 18- 20 of that report are just as relevant today. We have attached a copy.

Taking into account the need for any modern maternity service to offer seamless antenatal, intrapartum and postnatal care including ultrasound scanning and day case facilities, the likely timescale for upgrading the facility and staffing here is 5 to 10 years from the point of a coherent decision being made. We fully support progression of such a proposal.

Whilst acutely conscious of the distress that the decision to withdraw obstetric services is causing women in Moray, the provision of safe care must remain with the existing resources of NHS Grampian until a properly funded alternative is developed.

In dealing with that distress we need to avoid piecemeal solutions that create new and unassessed risks.

With respect to where to go from here, we request that a properly independent review of the Maternity Service at Raigmore is undertaken at the soonest possible opportunity. This could be undertaken by the Royal College of Obstetricans and Gynaecologists or another suitable expert group.

In the meantime we must request that the recommendation to implement Model 4 in the short term is not followed and that no changes are made to the model of care at Raigmore without the approval of the senior clinical midwifery and obstetric team here.

It is imperative that whilst a permanent solution is found and for the foreseeable future, women who choose to birth in Elgin are informed that there are occasions when the Raigmore Maternity Unit may not have additional capacity to safely care for them.

If a requirement for obstetric care in labour arises, the alternative of transfer to Aberdeen may need to be discussed. Our team will continue to do their utmost to assist and to keep this process safe.

We would welcome your response and the opportunity to meet with you to discuss further. Meanwhile we will work with NHS Highland to contribute to their formal response to the Review.

Yours sincerely

James Bingham, Consultant Obstetrician

Ibrahim Alsharaydeh, Consultant Obstetrician

Rajesh Annappa, Consultant Obstetrician

Sadia Akhtar, Consultant Obstetrician

Tracey Sturgeon, Consultant Obstetrician

Mandy Hunter, Consultant Obstetrician

Kate Stewart, Consultant Obstetrician

Allison Davies, Consultant Obstetrician

Adam Archibald, Consultant Obstetrician

Iram Rabbani, Consultant Obstetrician

Aik Goh, Consultant Obstetrician

Yvonne McKenzie, Senior Charge Midwife

Mary Taylor, Senior Charge Midwife

Fiona MacKenzie, Senior Charge Midwife

Katherine Freeman, Senior Charge Midwife

Aileen Summers, Senior Charge Midwife

Alison Cummings, Senior Charge Midwife

Lynn Forbes, Senior Charge Midwife

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