Pregnant women needing emergency delivery services in Elgin should be transferred to Inverness rather than Aberdeen, a review into Moray maternity services has recommended.
Only around 20% of births in Moray will take place at Dr Gray’s for the foreseeable future, until a long-term rural-consultant maternity unit can be set-up at the Elgin hospital.
Implementing the recommendations could see as many as 70% of Moray births delivered at Dr Gray’s, if the rural consultancy plan is followed.
It could take up to two-and-a-half years for this to come into fruition, it has been warned.
The recommendations were published on Friday, following a Scottish Government independent review into Moray maternity services.
Instead of being told to go to Aberdeen Maternity Hospital, patients who are unable to give birth at Dr Gray’s will go to Raigmore, Inverness.
The distance from Elgin to Aberdeen is 65 miles, while only 37 miles separates Dr Gray’s and Raigmore.
The review ruled out leaving things as they were and removing maternity services entirely, claiming either would be “inappropriate”.
Scottish Conservative leader Douglas Ross, whose wife was transferred in an emergency from Dr Gray’s to Aberdeen, said the people of Moray had lived with the “status quo” for years and that things would not improve until patients could deliver safely at the Elgin hospital.
Recommendations
In the short term, it has been recommended to send patients who cannot give birth in Elgin to Raigmore, as the most appropriate measure to be taken, “promptly” in order to provide “a safe, high-quality maternity service to women residing in Moray”.
As such, women will be offered “a choice of intrapartum care at either Dr Gray’s,
Aberdeen or Raigmore”.
Under these measures, there would still be no facilities for emergency caesarean or instrumental deliveries at the Elgin hospital.
The medium-term plan would involve creating a rural consultant-led maternity team, which would develop the following services:
- Midwife-led and consultant-supported antenatal services in Dr Gray’s.
- Midwife-led and consultant-supported intrapartum care in Dr Gray’s, with
the service offered to women who have been carefully risk-assessed and
meet agreed criteria to give birth in Dr Gray’s. There is potential to provide
care for between 50%-70% of Moray women (based on the Scottish
Northern Isles’ approach). - Obstetric medical cover available on a 24/7 basis (on-call from home, out of
hours). This model, based on risk assessment, includes provision for
obstetric interventions, including instrumental births and emergency
caesarean sections. - Elective caesarean section service in Dr Gray’s for selected women
provided by consultant obstetrician and gynaecologists, and supported by
the anaesthetic and theatre teams. - Links for planned consultant-supported intrapartum care for higher risk
deliveries shared between Raigmore and Aberdeen as part of a “network”.
Choice of unit, dependent upon a clinical risk assessment, and the woman’s
choice and geographical location. - In the unlikely event of emergency or urgent transfers, women will be
transferred to Raigmore, unless they are clinically required to transfer to the
specialist unit Aberdeen
The report notes, however, this could only happen if the “continuing development”, including hiring and retention of staff at Dr Gray’s, can be guaranteed.
‘Inappropriate status quo’ to stay for years
Moray MP and Scottish Conservative leader Douglas Ross said the best outcome would be more women in Moray being able to give birth at Dr Gray’s.
Mr Ross met with the review team earlier this year and shared his family’s experience after his second son, James, was born in Aberdeen following an emergency transfer from Elgin.
He said: “First and foremost the review team have ruled out the status quo describing it as ‘inappropriate’ but we have been living with this level of service here in Moray for over three years. Like everyone else, I hoped the report would recommend the return of a full consultant-led unit at Dr Gray’s but they have suggested that would be undeliverable.
“While the review team conclude in the short term that transferring more women to Raigmore is the preferred option, they accept that it could take two years to get the staff and capacity in Inverness to deliver that.
“So Moray families have to continue with the inappropriate status quo for years to come. There are also major questions to be answered about how Raigmore will deal with this big increase in Moray mums giving birth there. Last year only 16 Moray women gave birth in Raigmore, compared to over 700 in Aberdeen.
“The best outcome is more women giving birth locally in Elgin with the outstanding team of midwives and staff we have here in Moray.
“There is no doubt it’s a better and shorter journey to Inverness, but I followed my wife and our unborn child as they were blue lighted from Elgin and no matter how far away the hospital is, I wouldn’t wish that journey on anyone.
“I know how stressful Krystle found the transfer, despite the best efforts of the great team with her. I agree with the report that there will always be a need for the option to transfer someone in emergency situations to a bigger hospital to get more specialised support — but they should be the exception rather than the rule.”
He continued: “The future of Dr Gray’s as a whole is brought into focus with this report as well. The various options depend on Dr Gray’s continuing as a vibrant district hospital delivery a wide range of services, yet the report highlights that development of the hospital has not continued in line with other comparable Scottish hospitals.
“We have raised concerns for a long time that the removal of services could lead to the downgrading of the whole hospital.
“These points were dismissed by NHS Grampian, but now they have to act and show this isn’t the case. That will require investment and I will be urging them to support our local services at Dr Gray’s.
“The Health Secretary has confirmed he will make a statement to Parliament and visit Moray to discuss the report and I welcome that, but it is now crucial that the Scottish Government and NHS Grampian work quickly with the local community here in Moray to improve our maternity services to save mums and families having to experience an inappropriate model of maternity services.”
Focus on women’s experiences
The report heard from mothers from the West of the Moray area spoke of having to drive past Dr Gray’s to make the journey to Aberdeen while in labour, despite Raigmore being the closest Obstetric Maternity Unit.
Mothers also expressed concern regarding the journey to Aberdeen along the A96, a single carriageway road, perceived to be prone to accidents and which can, on occasion, be closed in winter due to weather.
Some told the review they would time pregnancies to take place in the summer, to avoid any potential winter travel.
One mother said that after 35 hours she was sent to hospital in Aberdeen because her labour was not progressing.
She recalled: “My husband had to drive me and I was in so much pain that the only way I could achieve any level of comfort was to kneel in the back seat facing backwards holding the headrest. I had no seatbelt on the whole way.”
Another said: “Ever since I fell pregnant, I have noticed a background anxiety, a
nervousness, that I didn’t have in my first pregnancy. I have heard these stories of mothers travelling all the way to Aberdeen in labour and in pain, and the thought terrifies me.”
Chair of the Review Group Ralph Roberts said: “In order to reach our conclusions and recommendations we have focused on listening to the women, families and service users in Moray, as well as the staff involved in delivering the services. We have then taken on board the professional advice of our clinical experts.
“Our aim was to benefit those planning and delivering services, but most importantly to serve the mothers and babies who have a right to be appropriately supported through their pregnancy and birth experience.
“We believe these robust recommendations are most appropriate for Moray at this time and looking to the future, and we would encourage all parties to work collaboratively to deliver on them for the benefit of the whole community.
“This has been carried out at a challenging time, and I’d like to thank everyone who shared their stories in such an open and generous manner, as well as the staff and professionals across the health service who have worked closely with us.”
‘Considering carefully’
Health Secretary Humza Yousaf said: “The Scottish Government commissioned this report as part of our commitment to the reintroduction of consultant-led maternity services at Dr Gray’s in a safe and sustainable way.
“I am grateful to Ralph Roberts and his review team for their work. This is a thorough and substantial report. I would also like to express my thanks to the women, families and service users and to the staff and professionals across NHS Grampian, NHS Highland and the wider Scottish health service who shared their views and experiences to help shape this report.
“I am considering all of the recommendations carefully. At this stage, the Government does not rule out any options moving forward. We will rightly meet with local people, clinicians and elected representatives to hear first-hand from them.
“I know this is a highly anticipated report, and I repeat my commitment to move forward with making significant improvements to maternity services at Dr Gray’s with pace. Subject to discussions at Parliamentary Bureau I would be happy to make a Ministerial Statement to Parliament on this important issue, at Parliament’s earliest convenience.”