Maternity Transformation – Advantages and disadvantages of the proposal and how we reached this

Advantages

Safe, sustainable staffing levels for the maternity units at Royal Stoke University Hospital and Queen’s Hospital, Burton – focusing our staff’s time where demand is greatest.

Providing choice of home births and midwife-led care – you would still be able to choose to give birth in a more relaxed, less clinical setting. This could be in midwife-led care at Royal Stoke University Hospital or Queen’s Hospital, Burton, or a home birth (if assessment shows it’s safe for you).

Reducing need for urgent transfer – if you had complications during labour at an FMBU, you would need an ambulance transfer to one of the acute hospitals. Specialist support can be given much more quickly if you are already in a midwife-led unit at one of those hospitals.

Maintaining midwives’ expertise – because of the high number of births, midwives at the bigger hospitals experience a wide range of cases, ensuring their skills and expertise stay at the right level. Being based in the bigger hospitals also means new midwives have support from a wider team as they develop their professional experience.

Equity of care – a lower number of births at the FMBUs meant on average, more midwife time per patient was given there than at Royal Stoke University Hospital and Queen’s Hospital, Burton. The proposal would make the ratios the same across all care offered.

Continuity of carer – this is having support from the same team of midwives throughout pregnancy and after your baby is born. Using our workforce more efficiently will help us provide continuity of carer for the women identified as most in need of this help. (This is already in place at Queen’s Hospital, Burton.)

Antenatal and postnatal care would continue at the FMBUs,as well as in the community.

These points are covered in more detail in our consultation document, pages 11–12, which you can download from our involvement page.

Disadvantages

There may be travel implications for women who live near County Hospital or Samuel Johnson Community Hospital and who would have chosen to give birth there.

We carried out a detailed analysis of how the proposal could impact travel time to birthing services, covering several scenarios. We did additional analysis of total travel time including urgent ambulance transfers from an FMBU to one of the main hospitals – which can be needed if complications occur during labour or birth.

Bearing in mind that FMBUs are not recommended as a birthing choice for all women, the analysis shows an impact on women who would have chosen an FMBU for birth. Women living in Stafford would be impacted the most.

You can read more about this in our consultation document, pages 17–18, and our Pre-Consultation Business Case, which you can download from our involvement page.

We have been talking to patients, the public and staff about maternity services and options for change for several years – since before the temporary closure of the birthing services in Stafford and Lichfield. The timeline further down this page shows the conversations we have had since 2019, alongside work done by staff to develop and review different options for the services.

Options appraisal in 2023

In September 2023, a technical group of clinicians and managers met to review a shortlist of five proposals, which was extended to seven during the meeting.

• Reinstating the birthing service at both FMBUs
• Reinstating a single birthing service at one or other FMBU
• Implementing a single birthing unit at an alternative site (which would need to be identified)
• Implementing an on-demand model at both FMBUs
• Implementing an on-demand model at one of the FMBUs
• Implementing an on-demand model at an alternative site (which would need to be identified)
• Permanent closure of birthing service at County Hospital and Samuel Johnson Community Hospital

The technical group checked each proposal against six essential criteria – these set out important questions we need to answer about whether a proposal is going to work.

• Clinical sustainability – can we provide good, safe services in the long term?
• Strategic fit – is the service change in line with the health system’s wider plans and aims?
• Meeting the needs of the population – would the service meet everyone’s needs? 
• Demand and capacity – are there enough people wanting to use the service and enough staff to provide the service?
• Workforce sustainability – do we have, or can we provide enough staff with the right skills to keep the service going in the long term?
• Estates – are the buildings and sites suitable?

Why is the consultation considering only one proposal?

Having considered seven proposals, the group recommended that only the proposal to permanently close the birthing services at County Hospital and Samuel Johnson Community Hospital would be viable – meaning, practical and possible to implement.

We follow guidance from NHS England, Working in partnership with people and communities, which includes NHS organisations’ legal duties and responsibilities for working with people during public consultations.

This states, “it is not appropriate to consult on options that are not genuinely under consideration or are unviable or unrealistic”.

So, while seven proposals were considered at an earlier stage, only the single proposal judged to be viable is being put forward for consultation.

This remains a proposal – no final decisions have been made.

For more detail about the proposal, read about:

• The proposal and why it is needed

Get involved

Visit our involvement page for links to the survey, event details, and to download the consultation document.