Maternity unit closure: What are next steps?

Pregnant women living in a rural area of Devon say the suspension of a maternity services has left them feeling anxious about their birthing plans.

The Royal Devon University Healthcare NHS Foundation Trust (RDUH) suspended standard birthing services at North Devon District Hospital (NDDH) in Barnstaple on 11 August, which it said it was the "only safe course of action" due to staffing issues.

The trust said it began planning for a potential temporary suspension to services in July due to serious staffing issues.

At the beginning of August, the trust said it had explored and exhausted every option, including securing locum cover and mutual aid support from partner organisations, and concluded a temporary suspension was the best solution.

It said had carefully reviewed its staffing levels against clinical safety requirements.

In a recent update, the trust said it was "cautiously optimistic" births could resume at the hospital by the end of September subject to recruitment and safety.

Carolyn Mills, the Royal Devon trust's chief nursing officer, said: "We have worked tirelessly alongside our partners, including NHS Devon, Cornwall and the Isles of Scilly Integrated Care Board and NHS England regional colleagues, to explore every possible option to avoid this outcome."

The National Childbirth Trust (NCT) has called for "greater transparency" about how the trust came to its decision, while Devon County Council leader Julian Brazil said the closure was "a catastrophic failure of senior management".

The trust said it had contacted more than 300 women who were 34 weeks pregnant or more, as well as those identified as vulnerable or clinically high-risk.

Rebekah Hester, from Ilfracombe, is classed as high-risk due to having pre-eclampsia, a complex condition which causes high blood pressure that can put both baby and mother at risk, and said she was looking at tutorials on giving birth and home deliveries.

Hester said coming to the realisation having a birth which may be not as planned was "terrifying".

She said: "You turn to midwives and you turn to Google, and Google is saying an hour-and-a-half drive is too far, you need to find a closer maternity unit, or you need to watch these tutorials on giving birth and home deliveries."

Her due date is in December, so she said she has had time to work out a plan, adding she felt for women due a lot sooner.

Hannah Winne-Dennis said her pregnancy had to be a lot more controlled due to it involving a high-risk in vitro fertilisation (IVF) process.

She said the plan was always to have an induction at 39 weeks on Monday 17 August, originally at the north Devon hospital, but she was now facing having to travel to Royal Devon and Exeter Hospital.

Members of the Unison union for the South Western Ambulance Service and Allied Health said losing local provision meant people in labour and other patients needing urgent maternity care faced "significantly longer journeys to Exeter".

A union spokesperson said: "Given the rural geography of north Devon, and the road network in the area, this isn't just an inconvenience, it adds real travel time at moments when minutes matter."

Brazil, from Devon County Council, criticised the closure, saying: "Some remote parts of North Devon are a two-hour drive from Exeter - and that's when there is no traffic or road closures.

"This closure is extremely concerning. It is not a decision which would be countenanced in other parts of the country and we should not accept second-rate NHS provision here."

A trust board meeting was held on 26 August to discuss a reopening plan for the maternity unit after saying it was "cautiously optimistic" it may be in a position to do it by the end of September.

A spokesperson said after the meeting on 26 August: "The briefing clearly demonstrated the solid progress being made towards securing the required number of senior medical staff required and the board confirmed agreement of these requirements to enable us to reopen safely.

"Before confirming a reopening date, the board has asked for final assurance that those requirements have been met in full."

They said the reopening would be subject to final board assurances on operational "readiness, resilience and sustainability".

"We understand that women, families and the wider community want certainty, and we remain focused on reopening the service as soon as it is safe and sustainable to do so," they added.

Another meeting of the board is due to be held in the week beginning of Monday 31 August.

In response, the NCT welcomed the possibility of birthing services resuming, but only if it was sustainable and provided confidence to women locally that services could be maintained in the future.

NCT chief executive Angela McConville said: "We recognise the critical importance of ensuring maternity services are safe and adequately staffed.

"At the same time, women and families in rural and coastal communities deserve access to safe, accessible, local maternity care and meaningful choice about where they give birth.

"We look forward to hearing more about the plans and how women, parents and local communities will be kept informed and involved."

Chief medical officer Dr Vanessa Purday previously said fears the unit would not reopen were unfounded.

"Our priority is we reopen in north Devon in the soonest time frame that we can and that reopening is safe and sustainable for the women in north Devon," she said.

"I'm a mum myself. I've had three children born in Devon, so, for me and my colleagues here at Royal Devon Hospital, our commitment is to get this service reopened.

"Recognising the need of women in north Devon is a decision we've taken a huge amount of consideration and the balance.

"The absolute priority is that women have the right level of safe staffing from our specialist obstetricians when they arrive... That is why we've had to take this decision."

On 15 August hundreds of protested in Barnstaple over the suspension of birthing services.

At the demonstration expectant mothers said the decision meant they faced longer travel times to get to hospital, with the nearest maternity services located in Exeter and Taunton.

The decision to suspend birthing services at the hospital also led to the resignation of the trust's medical director Dr Karen Davies who said she could not "support the way the trust has handled, and is handling, the maternity situation".

In response, Purday said the trust "has a responsibility to make decisions based on clinical risk, patient safety and the available evidence".

"The decision to temporarily suspend birthing services was reached through established clinical, executive and system governance processes when safe staffing could no longer be assured," she said.

Devon County Council leader Julian Brazil accused the trust of "a catastrophic failure of senior management" and on 15 August hundreds of people protested in Barnstaple over the decision.

The National Childcare Trust said it was "deeply concerned" by the closure.

In response, the NHS trust said: "We understand why people are protesting and the strength of feeling being expressed about the temporary suspension of birthing services and how vital these services are to all of us in northern Devon.

"These services matter enormously to local families, communities and our colleagues, and like everyone, we want to see births return to North Devon District Hospital as quickly and safely as possible.

"We share the determination of those demonstrating to see these services restored.

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