Dear Readers,
This is the MSLC's response to the lunatic proposals put forward by the TSA, Matthew Kershaw.
Please support us by posting your comments.
Thanks to all Lewisham MSLC's amazing service users!
Jessica
Dear
Matthew Kershaw,
Introduction
This
paper is part of the response of Lewisham Maternity Service Liaison
Committee (MSLC) to the draft report of the South London Healthcare
Trust Service Administrator (the TSA) on health services in SE
London.
MSLCs
act as a multi-disciplinary forum bringing together the different
professions involved in maternity care and a diverse range of user
representatives in order to ensure that maternity services
commissioners and maternity care provider units take account of the
views of women and families using the service.1
In Lewisham we have a
particularly active MSLC which is chaired by myself, a service-user
and a vice-chair also a service-user. Our focus has been on a number
of things but we have made it our priority to concentrate on feedback
from women and familes as to the care they receive and we have made a
point to hear this feedback from all women including those who are
disadvantaged or marginalised.
The
service-user members of our MSLC have met and we would like you to
consider this response as representative of the views of the
service-user members as due to the short consultation period, we have
not met as a whole MSLC in the time given.
Our
response to Options 1 and 2
We
have read, with interest, your recommendations which we believe, if
carried out, will have an alarmingly detrimental impact on the women
and families we represent.
There
are four key areas that we would like you to consider:
- a woman's freedom of choice as to where to give birth (at home, in a midwife-led unit or obstetric led unit)
- a woman's right to access maternity services locally
- equal access to maternity services for all women and infants, regardless of their ethnicity or income.
- how we think you can save money whilst still providing a safe and happy service to women and their families
- A woman's freedom of choice as to where to give birth
Maternity
Matters requires that all women should have, ‘choice of place of
birth. Depending on their circumstances, women and their partners
will be able to choose between three different options. These are:
• a home birth
• birth in a local facility, including a hospital, under the care of a midwife
• birth in a hospital supported by a local maternity care team including midwives,
anaesthetists and consultant obstetricians. For some women this will be the
safest option.' (Maternity Matters, 2007, p.5)
• a home birth
• birth in a local facility, including a hospital, under the care of a midwife
• birth in a hospital supported by a local maternity care team including midwives,
anaesthetists and consultant obstetricians. For some women this will be the
safest option.' (Maternity Matters, 2007, p.5)
Neither
option as outlined in your report will ensure that this standard is
met. Indeed, neither option meets the Secretary of State's own Four
Test stipulation that, ‘patients have a choice of good quality
providers’ (TSA Draft Recommendation, 2012, p.22).
- A woman's right to access maternity care locally
Option
1 would almost entirely rule out all of the above choices:
- the choice of home birth would be ruled out for most Lewisham residents because we believe women would be worried about the time it would take to move to a hospital if something went wrong in labour.
- the choice of birth i.e. a local midwifery-led facility would simply not exist.
- birth in a hospital supported by a ‘local maternity care team’ would also not exist
Your
proposals as they stand mean less choice for all Lewisham residents.
In any document produced by the Department of Health, patients and
service users may see the word 'local' repeated time and again. If
option 1 comes to fruition, Lewisham residents will no longer have
access to a useful local maternity service at all. For many women,
getting to Queen Elizabeth – particularly if they are in the early
stages of labour – is simply not a feasible option, even if they
wanted to use the services, which is highly questionable. For many
women getting to St Thomas' or King's is a challenge, although less
so than Queen Elizabeth Hospital.
- Equal access to maternity services
Our
third point is that the recommendations will have a seriously
negative impact on health equality in the borough of Lewisham. This
area of London houses some of the nation’s poorest and most
vulnerable families. Many Lewisham residents are refugees, asylum
seekers, travellers, young and highly impoverished families.
In
this response we have included the view of Lewisham Refugee and
Asylum seekers. They have told us that they are really worried that
they may not be able to afford the fares to travel longer distances
to whichever hospital they are booked at and even if they have some
antenatal care in the community, they will still need to go to
hospital for scans and some appointments. They are worried that when
they are in hospital their families will not be able to visit them.
Remember these women are unbelievably fragile with many who have fled
persecution and torture. A large number have mental health issues and
some have been able to use the caseload system at Lewisham where they
get continuity of care from one or two midwives who can get to know
them and ensure they get all the help they need. They do not have to
keep repeating their story and this care will enable them to have the
best start possible as parents under very difficult circumstances.
This
applies to many other groups including young parents and families who
simply do not have much money or support. Marginalised and
disadvantaged women live all over SE London therefore adding more
women to Kings and St Thomas’ will impact on the care their
population receives.
We
feel that your recommendations do not take any account of the major
financial impact that this will have on the most vulnerable. There
are a myriad of other challenges that will face these vulnerable
families if we lose any part of the maternity service currently
provided by Lewisham Hospital.
- How we think you can save money
We
think you can still save money by adopting the amended version of
Option 2 which the staff at Lewisham have put forward.
We
would like to state categorically that it is our understanding from
directly consulting the community that most women will not use Queen
Elizabeth Hospital. Women will flow to the already straining services
provided by St Thomas' and King's Hospitals. This will mean that
their births will hit the number which we understand will mean they
have to employ another tier of doctors and various other services.
In
addition to that, our members have all agreed that women will travel
to the unit they are giving birth in much earlier than they need to
for fear of getting caught in traffic or on the bus. If they are
having pain they will call an ambulance and you will have the cost of
that and women being on labour ward when they are not in full labour.
We know that there is then an increased chance of women having
‘interventions’ as there will not be the space for them to be
left in peace. However, women will not want to go home and wait for
labour to get going naturally for fear of being stuck on the journey
or leaving it too late. All of this will cost you more money that
what is proposed in amended Option 2.
A
huge amount of time, energy and money has been invested in the once
failing maternity service provided at Lewisham, which is now a
flourishing environment highly valued by the women and their families
who are, in steadily increasing numbers, using both the birth centre
and the obstetric-led unit. As your report notes, the population of
SE London is growing exponentially, schools are being asked to
increase their capacity year on year; it is utter lunacy to recommend
that a thriving maternity unit which serves an already dense (and
growing) population be closed or its services reduced.
It's
hard to find words to express the depth of our concern that the lives
of Lewisham women and their babies would appear to be at risk for a
cost-cutting exercise in bureaucracy to camouflage a failing Trust.
It
is clear from your report that your recommendations are financially
driven, but it is wrong that the vital organs should be snatched from
Lewisham Hospital in order to save the ailing Queen Elizabeth
Hospital.
Yours
sincerely,
Jessica Ormerod
Lay Chair Lewisham MSLC
1
DH MSLC Guidance 2006
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