Is Ludlow’s Midwife Led Unit being closed permanently?

Letter to Simon Wright, Chief Executive, Shrewsbury & Telford Hospital NHS Trust from Gill George, Chair of the Campaign:

Dear Simon

I note the closure of maternity services at Ludlow Hospital on Friday 14^th October, with no notice and no public consultation.

In the news release from SaTH, you describe the closure as ‘temporary’, and comment:

“The decision to temporarily suspend services is not one we have taken lightly, but one we felt to be necessary and in the best interest of mums, babies and staff.

“I have requested a number of reports, including a structural survey, to be conducted into the condition of the building. No further decisions about when services will resume will be made until the findings of those reports are returned and evaluated.

“SaTH is looking to find an alternative area locally to house our antenatal services.”

The closure of the Shrewsbury Midwife Led Unit evidently is temporary, as SaTH states that maintenance work will take two weeks.

The fear, of course, is that the Ludlow closure will be one of those ‘temporary’ events that becomes permanent. It can come as no surprise at all to SaTH that the maternity block at Ludlow Hospital is old and in a poor state of repair. It is common knowledge in Ludlow; the Community Trust has been well aware of this over some years; and the CQC’s 2015 report on Ludlow Hospital maternity services highlighted that the unit was in an old building which required some renovation.

Some obvious questions arise:

1. Has SaTH only just become aware of the poor state of Ludlow’s maternity block?
2. Was consideration given to remedial work in January 2015, when the CQC highlighted the poor state of the building?
3. Why was there no notice of the closure of the maternity unit?
4. Was consideration given to public consultation on this service change, and why were public consultation or engagement not thought necessary?
5. Did consultation take place with Philip Dunne as MP, and with the Health and Adult Social Care Scrutiny Committee of Shropshire Council?
6. I note that the SaTH news release does not mention patient safety concerns. Why then was immediate closure of the maternity unit regarded as ‘necessary and in the best interests of mums, babies and staff’?
7. Although the closure is described as temporary, no date and no criteria are given for the service to be re-opened. You have requested a structural survey and ‘a number of reports’. What other reports have you requested? What is the timescale for these? What criteria need to be fulfilled in order for the maternity unit to re-open?
8. Ludlow Community Hospital is now owned by NHS Property Services. Does SaTH lease the maternity unit from PropCo or from the Community Trust? Is SaTH responsible for necessary upgrading of the maternity block, or is PropCo obliged to keep the building in good order?
9. The news release states ‘SaTH is looking to find an alternative area locally to house our antenatal services’. What are current plans for women requiring antenatal care? Should an alternative area not have been identified before closing the service? Are you confident that an alternative area can be found?

There is of course a context for the closure of Ludlow’s maternity unit. SaTH’s 2016/17 Operational Plan states ‘In 2016/17 the Trust is taking forward the following actions’. One of the intended actions to achieve cost savings is listed as ‘Rural dis-economies of scale (maternity services)’. Elsewhere on the same page of the Operational Plan, available savings relating to ‘Rural dis­economies of scale (maternity services)’ are given as £1.5 million.

Risks to rural maternity services have been raised by members of the public at SaTH Board meetings in April and June this year. I have personally been seeking information from SaTH about its 2016/17 plans to tackle ‘rural dis-economies of scale (maternity services)’ in an FOI request submitted on 24^th June. SaTH’s reluctance to respond has been very evident indeed; I eventually received a reply a few days ago on 11^th October. This stated ‘The Carter Review highlighted that maternity services were not being adequately funded by the Commissioners, and were therefore losing the Trust £1.5m per year. The debate is not about cutting services, but rather about ensuring adequate commissioning of the service.’

With other members of Shropshire Defend Our NHS, I attended a meeting on 27^th June with David Evans, former Accountable Officer of Shropshire CCG. Our understanding at this time (from correspondence seen by members of the campaign) was that you had discussed the shortfall in funding of rural Midwife Led Units with David Evans, and that you had suggested to him that rural maternity units were at risk if the commissioners did not find additional funding for them. We raised this with David. David said the conversation with you had not taken place, but he stressed that he did not consider rural Midwife Led Units a priority, and did not believe that they were necessary going forward. It was a meeting that did not leave us convinced that SaTH or Shropshire CCG were committed to Shropshire’s rural maternity services.

Given this context, and particularly the objective of SaTH’s 2016/17 Operational Plan to achieve in-year cost savings by addressing ‘rural diseconomies of scale (maternity services)’, can you state with confidence that Friday’s closure of Ludlow’s MLU is not in any way associated with cutting costs? If it is not, when was the Operational Plan to achieve these savings changed, and why was this not reported to the SaTH Board?

You will understand that the people of Ludlow care passionately about their hospital, and are increasingly fearful for its future. The closure of the Midwife Led Unit follows the loss of 16 in-patient beds and the closure of one of the two in-patient wards last year. Ludlow people would welcome a clear commitment from you that maternity services at Ludlow Hospital will re-open in the near future.

Because of the importance of the issue, I am copying this letter to relevant parties. I also intend to circulate the letter to local media contacts.

I look forward to your response.

Gill George
Chair, Shropshire, Telford and Wrekin Defend Our NHS