Published in Tribune 2 February 2007

Suresh Pushpananthan argues that under proposed changes expectant mothers will be denied the choice of where to give birth.

The reconfiguration of NHS services has recently dominated discussions about healthcare reform bringing with it intense controversy. The proposals to close smaller maternity units across the country and replace these with larger regional units has ignited strong community loyalties to local institutions and mobilised local and national political forces.

The size and location of UK hospitals has largely been the product of historical chance rather than rational planning. When the NHS was established in 1948, a patchwork of hospital services that had previously been run by local authorities and voluntary organisations were nationalised. Enoch Powell’s 1962 Hospital Plan for England and Wales was the first large scale reconfiguration programme within the NHS. This created district general hospitals designed to serve populations of between 100,000-150,000 and this basic model has remained in place since this time.

The recent trend towards increased specialisation and sub-specialisation in medicine favours a health system consisting of large hospitals offering a wide range of specialist care. This theory of healthcare has now replaced the model envisaged by Powell. Trauma and other highly specialist services should be concentrated in fewer, larger centres to maximise treatment outcomes and save lives. However, maternity services are more complex. There are many other factors beyond survival alone that need to be weighed in the balance with maternity services.

Childbirth is undoubtedly one of the most important experiences in most women’s lives and one which they hope to cherish forever. Many women hope for a natural birth in their community with minimal medical intervention. The vast majority of the half a million births a year are uncomplicated, and there is no need for women to give birth in ‘super maternity units’. We should follow other European countries and resist the excessive medicalisation of birth whilst remaining focussed on providing a safe service. Can we really tolerate pregnant women being treated like battery hens?

The Government’s plans to improve maternity services and offer greater choice – as set out in the National Service Framework for Children, Young People and Maternity Services – are being jeopardised under the current reconfiguration plans. The Government rhetoric focuses on increasing choice in the NHS, yet the current policy appears to erode choice for pregnant women. How can the government reconcile the perverse situation where parents are losing their right to choice while giving other patients meaningless choice through the flawed Choose and Book system?

It is inevitable that some maternity units, especially the smallest units in large urban areas, will have to close. The decision as to which maternity units are to be shut should not be left solely to Strategic Health Authorities and Primary Care Trusts whose current priorities are to balance budgets. The Independent Reconfiguration Panel – a body of experienced clinicians and managers that provides advice to the Secretary of State – should evaluate all proposed service closures to ensure that quality of service and safety are the only factors influencing the choice of which units are to close.

The reconfiguration of maternity services will continue to cause political waves. The potential for short-term financial and political concerns to influence local decisions makes it all the more important that there is real transparency about the factors affecting each proposed closure. The ultimate aim must be the provision of high quality maternity services to all. In addition, parents-to-be should have a choice of how and where they will give birth, something that is vulnerable under the current proposals.

Suresh Pushpananthan is a specialist registrar neurosurgeon, lecturer in neurosurgery and a member of the Central Council of the Socialist Health Association

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