Special care baby unit to be downgraded?

Report by IAN MACKELLAR and ANGELA SINGER

HINCHINGBROOKE'S special care baby unit could be downgraded, meaning babies born earlier than 32 weeks would be transferred to other hospitals.

The plan has brought protests that these other hospitals - at Cambridge, Peterborough and Norwich could not cope and that they are already sending their babies to Hinchingbrooke.

A decision is expected next month from the Strategic Health Authority next month about where various grades of special care cots will be and the details determined by Cambridgeshire Primary Care Trust and other PCTs next year.

The fear is that, if cots for the tiniest babies disappear at Hinchingbrooke, eventually the unit could close altogether and take with it the maternity unit and the entire paediatric department.

In the words of one obstetric gynaecologist at Hinchingbrooke: "The whole thing will crumble."

If the proposal goes ahead, babies born earlier would go to larger units at Cambridge and Norwich. If mothers were not well enough to travel, they might be separated from their babies.

The proposal was called "horrific" yesterday by a mother whose daughter's life was saved at the Special Care Baby Unit at Hinchingbrooke after being born eight weeks early.

Claire Nicholson-Clinch was on the front page of The Hunts Post last month after raising £3,000 for the unit by tackling the Three Peaks Challenge. She said: "I have written a three-page letter to the strategic health authority. So far I have not received a reply. Sending tiny babies elsewhere and separating them from their mothers is horrific. We cannot allow that to happen."

The move has met consternation from doctors. A consultant obstetrician and gynaecologist at the hospital for 17 years, Paddy Forbes, told The Hunts Post yesterday that the downgrading threatened maternity services at the hospital and the entire paediatric department.

He said: "The whole thing would crumble. There would be a gradual erosion of services which would mean not just the end of the special care unit but also paediatrics. The maternity unit would be no more than a midwifery-led unit. The great majority of maternity services would take place elsewhere."

Mr Forbes said the situation was regarded as very serious but it was hoped that the PCT would "pull back from the brink".

He said: "Neither Cambridge nor Peterborough could cope with the extra workload, nor would they want to. Currently, Cambridge and Norwich are hugely over capacity and send their special care babies to Hinchingbrooke. They would not be able to accommodate babies from Hinchingbrooke without massive investments."

He added that Hinchingbrooke currently receives babies form Luton, Peterborough, Basildon, Colchester, Ipswich and Bedford.

He said: "The theory is that what is done by junior doctors could be done by specially trained nurses but there has to be a tier of doctors and they have to be available and in residence. Reduced throughput in the SCBU would mean that Hinchingbrooke loses recognition as a training unit, which would in turn, mean that experienced junior doctors would not be placed at the hospital. Guidelines demand a presence of doctors 24 hours a day, seven days a week. Without the junior doctors, there would be an inexorable regression to closure."

The hospital's facility is one of nearly 20 across the east of England whose provision was part of a recent consultation.

Special baby care is split into three levels in the NHS. Depending on how prematurely babies are born and how sick they are, they are cared for at level three - including Addenbrooke's, in Cambridge, Norwich and Luton - level two - including Hinchingbrooke - or level one, which meets the needs of most sick and premature babies. The expected proposal is to downgrade special care at Hinchingbrooke from level two to level one.

The East of England Strategic Health Authority's recent consultation document, Towards the best, together, said the region needed more capacity at levels three and one and less at level two.

The health authority refutes the concerns about closure, saying: "We can pledge that all acute trusts will keep an obstetric unit."

"We will also make every effort to increase the populations served by the smaller obstetric units, by ensuring they develop excellent, patient-centred services for straightforward births.

"For neonatal services all units will work towards the required British Association of Perinatal Medicine standards. This will enable patient outcomes to be improved and a better alignment of demand and capacity.

"To deliver this we will need more level three capacity to ensure that all pregnant women or babies who need a place have one. There should be sufficient high- dependency capacity in the region to allow for transfer back to the local hospitals, while allowing for the sickest and smallest babies to continue to be treated in the level three units."

The authority says various scenarios have been modelled, and the preferred option is for increased level three capacity at Luton, Norwich and Cambridge, with Essex

continuing to use facilities in Cambridge, Norwich and London. This will mean a need for fewer level two units, such as Hinchingbrooke.

The original recovery plan for Hinchingbrooke 18 months ago envisaged moving the unit to level one status, but the decision was put on hold at the request of the neo-natal network, Chris Banks, chief executive off Cambridgeshire Primary Care Trust, told The Hunts Post.

Around 10 per cent of babies need some level of special care, he added, and a change to level one would affect around 30 babies a year. "They will still have all the incubators, but not the very premature babies."

Downgrading would mean Hinchingbrooke caring for tots born after 34 weeks' gestation, compared with the current (level two) 28 weeks. Full term babies spend 39 weeks in the womb.

Decisions on the number of cots needed at each level across the region will be taken by the SHA's board on September 25, and it will then be up to PCTs to determine where that provision is made, a spokesman said.

"The pattern at the moment does not accurately reflect the need. We don't have enough cots at level one or level three, but we have more level twos than we need. At the moment, a lot of level two cots are being occupied by babies who need level one care.

"We need to ensure the right provision is available as quickly as possible for any baby who needs neonatal care."

The consultation is not just about numbers of cots, but how they should best be distributed geographically, he added.