Maternity unit closure: What are the 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.

The trust announced at the beginning of September that it intended to reopen the unit on 29 September but bosses have since said the service was not in a position to reopen.

The trust has not set a new provisional opening date, but said it would complete another assessment on 28 September and every two weeks after if needed.

Dr Vanessa Purday, chief medical officer at the Royal Devon trust, said bosses would continue to review reopening the service.

She said: "We know that it takes two weeks from the decision when we know we're ready and that's about moving staff, moving equipment, rewriting rotas.

"I just want to reassure people that it remains our absolute priority. We recognise the worry and the concern it causes but I want to emphasise that we need to make sure that when we reopen we reopen safely and in a way that we can stay open so that you have confidence in that."

Sean and his partner Amy, who is due mid-October, fear they will not make it to the hospital in time for the birth of their second son due to the two-hour journey.

The expectant father said they were now having to consider alternative birthing plans.

He said: "One of our options, which Amy really doesn't want to have to go through, is seriously considering just booking a C-section.

"It's got to the point where she's like: 'Am I going to make it? Is it worth the stress? Am I better off having a C-section and then dealing with the recovery afterwards?'"

Speaking about the Royal Devon University Healthcare NHS Foundation Trust, Sean said feeling "angry is a bit of an understatement".

"I just can't see them being able to bring the staff in or even contemplate reopening in a month's time," he said.

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."

Hester's 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."

Julian Brazil, leader of Devon County Council, criticised the closure: "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."

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...

"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 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.

Brazil accused the trust of "a catastrophic failure of senior management".

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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