Withybush Special Care Baby Unit will close, health minister confirms

Obstetric and maternity services at Bronglais and Withybush hospitals will become midwifery-led.

Preseli Pembrokeshire Assembly Member Paul Davies described the move as "dangerous and unsafe for the people of Pembrokeshire and will put lives at risk."

Mr Drakeford's full statement:

"I am now in a position to make my  determination in respect of the proposed Level 2 Neonatal Unit at West Wales General Hospital, Glangwili, Carmarthen. Welsh Ministers have been asked to make a determination on objections raised by the local Community Health Council to proposals for this Unit contained in the Hywel Dda Health Board’s service change plan - ‘Your Health – Your Future’.

In my statement to this Chamber on 24 September I explained that the Expert Panel set up to advise me had asked for a further piece of work from the Health Board on its plans for local obstetric and midwifery services before it could provide final advice on Neonatal services for the Hywel Dda area. That additional work was submitted just before Christmas and shared with the local Community Health Council.

On the 18th of December I wrote to the chair of the Health and Social Care Committee setting out my intention to reconvene the expert Scrutiny Panel to consider these plans.  Mr Simon Emery, Consultant Obstetrician, and Wales representative of the Royal College of Obstetricians and Gynaecologists joined the Panel to assist them with this task.

Following a further series of meeting in the  Hywel Dda area, the Scrutiny Panel has now provided me with its final, subsidiary report and recommendations. The Panel is clear that this subsidiary report should be read in the context of their original detailed report, and not as a separate entity.

Llywydd, let me therefore begin by reminding Members of some key conclusions from the Expert Panel’s Report of September 2013:
“the provision of neonatal special care facilities across all health boards hospitals is neither safe nor sustainable. Even if funds were available to establish teams of specialists at every site where babies are born it is unlikely that there would be sufficient numbers of skilled, trained staff available to recruit, and even if recruitment were possible, their skills will be inevitably, rapidly compromised through lack of sufficient patient throughput.”
The Panel was clear that the needs of pregnant  women and their babies could be safely accommodated, without a neonatal unit presence, provided that this was accompanied by emergency cover, staff trained in new born resuscitation and stabilisation and clearly defined pathways for in utero and post natal transfers are in place.

Presiding Officer, the Scrutiny Panel, following its further work, has concluded that it has not been presented with any additional  evidence that leads them to question their original support for the Health Board’s proposals to develop  a Level 2 Neonatal Unit at Glangwili.

Indeed, the Panel expressly endorses the Health Board’s intention to move to midwife led units across the Hywel Dda region. This they see as vital to the way Hywel Dda neonatal services should develop and improve in the future.

However, there are a number of important provisos to the way ahead which the panel has set out.

Firstly, mindful of the issues raised by local communities and the strength of feeling when changes are made to obstetric, midwifery and neonatal services, the panel feels it essential that until the midwife led units are fully established the Health Board should put in place a robust ‘safety net’ arrangement to provide midwives with skilled assistance in the event of an unexpected emergency.

Until the new service model is fully in place, therefore, a suitable level of consultant obstetric support will remain in place in Withybush. It is the LHBs intention that during this period, a stratified service supported by an obstetric rota will also continue at Bronglais with high risk mothers, as now, being transferred to Glangwili hospital to deliver their babies.

Secondly, to help mitigate local public anxiety over additional travelling times and for efficient transfer arrangements, the supplementary report recommends that robust emergency transfer arrangements should be put in place by the Health Board until its new Emergency Medical Retrieval Service  and improved Cymru Inter Hospital Neonatal Transfer Service (CHANTS) service become fully operation. 

I can tell the chamber this afternoon that detailed work will now go on involving my officials, and Local Health Boards, to accelerate the introduction of a new round the clock Emergency Retrieval Service for Wales, deploying specialised medical staff. The planning for that service will include the capacity to transfer sick babies and mothers in labour.

Thirdly, the panel is clear that the Midwife-led units must be  developed in strict accordance with the guidance provided by “Neonatal Support for Stand Alone Midwife Led Units; a Framework for practice”.  

The combined effect of these provisos leads the panel to recommend a phased introduction of the new service model.  . I expect the Community Health Council to assist the Health Board with the preparatory work to develop pathways and clinical protocols. The Panel recommends this work should start without delay.

An essential factor in any maternity model of care, is that the mother should be able to make a clinically informed decision on the place of birth. That is what the Panel’s recommendations produce.

For the mothers in Hywel Dda these changes will mean that the majority of maternity services – that is pregnancy day assessment, pre and post natal care will continue to be provided locally by their GP and hospital as they are now – and that the majority of women if they choose to do so can safely have their deliveries at their local Mid Wife Led Unit.

These are important changes for the people of Hywel Dda. In a further assurance measure I will commission through the Health Board an independent evaluation of the impact of the revised neonatal services on newborn outcomes and patient experiences in 12 months time.

Presiding Officer, I have provided a summary of the expert Panel’s advice and recommendations to me in this matter. I am immensely grateful to them each individually - Dr David Salter, Professor Neena Modi, Mr Jim Wardrope, and Mr Simon Emery for working tirelessly on this over the holiday period and for undertaking a challenging itinerary of visits in the Hywel Dda area. I am satisfied that the Scrutiny Panel has conducted a comprehensive examination of the proposals, has reviewed all relevant information and has supplemented that information with meetings with the CHC, the LHB and the local clinicians.

I have very carefully considered the expert clinical advice they have provided, as set out in both their original and subsidiary reports,  and so determine this matter on behalf of Welsh Ministers.

I endorse the new service model as set out in the Panel’s report.  I also make it a requirement that implementation of that model is predicated on meeting the provisos identified by the Panel and set out in this statement.

Llywydd, all change in health services is challenging and gives rise to very strong feelings. The Panel’s recommendations are expressly based on “providing the best outcomes and experience for mother and baby” and the conclusion that the new service model will “provide an improved service for Hywel Dda mothers and babies”. That is the basis on which it has secured my endorsement."