Consultant-led services will be concentrated in Paisley

The NHS board agreed on Tuesday to concentrate consultant-led services in Paisley.

The move, along with the creation of midwife-led units in Greenock and Alexandria, was recommended after a group conducted a review of the area's services.

Public health director Dr Lesley Wilkie, who chaired the group, said the aim was to ensure that the care on offer meets women's needs.

"Over the past two to three years, the falling birth numbers within Argyll and Clyde have combined with a number of other developments resulting in recruitment difficulties, particularly for junior paediatric medical staff," she said.

"Training requirements for junior doctors means that our smaller units are not providing enough of a range of cases for doctors to practice and maintain their skills.

Redisign services

"Implementation of the European Working Time Directive and the New Deal for junior doctors has meant the need to employ more staff to cover on call rotas."

Dr Wilkie said this had left the board unable to guarantee that it could sustain the existing pattern of services.

"We have become increasingly worried about compromising safety for women and their babies, hence the need for this review to decide how best to redesign services to ensure that we maintain a high quality, safe and, as far as possible, accessible service for women," she said.

Midwives in Argyll and Clyde are currently undergoing extensive training to enhance their skills Dr Lesley Wilkie

The vision being recommended to the board was centred on the expansion of community maternity units while still providing access to specialist services for women who need them.

"One-to-one midwifery care should be the norm for all women during pregnancy, labour and childbirth," said Dr Wilkie.

"We need to realise the full potential of our midwives."

The group produced its recommendations after a consultation exercise which included open forums, discussions with professional and voluntary groups and market research.

A community maternity unit is led and managed by midwives, occasionally with GP involvement.

It offers a range of services, including day care, early pregnancy assessment and a birthing unit for normal pregnancies.

Not suitable

However, epidurals must be carried out at a consultant-led unit, which will handle those births where there is deemed to be a risk.

Dr Wilkie said that, on average, 55% of women would be eligible to give birth in community maternity units.

They are not suitable for mothers-to-be with a medical condition, such as diabetes, or those who have experienced problems during a previous pregnancy.

It is predicted that between 10% and 20% of women will have to be transferred to a consultant-led unit during labour, with the need for an epidural being the most common reason.

One-to-one midwifery care should be the norm for all women during pregnancy, labour and childbirth Dr Lesley Wilkie

"Midwives in Argyll and Clyde are currently undergoing extensive training to enhance their skills," said Dr Wilkie.

"Where the mother requires transfer to a consultant-led unit, emergency care would be given by the midwife and transport arranged as appropriate.

"The midwife would go in the ambulance with the mother to the consultant led unit."

Concerns have been voiced about the impact of the closure of a consultant-led unit in Greenock on other services at the town's Inverclyde Royal Hospital.

Dr Wilkie accepted that the proposals would have an effect on paediatrics, gynaecology, anaesthetics, accident and emergency and the ambulance service.

Wider review

"The intensive care unit for newborn babies will be located on the same site as the consultant-led unit," she said.

"The wider impact on paediatrics will, however, be assessed as part of the overall redesign process.

"The impact on anaesthetics accident and emergency and gynaecology services is being assessed as part of a wider review of health care services within Argyll and Clyde.