The need to change

We want to be able to provide safe high quality care to mums and families, delivered by the right mix of staff in the right environment. We're getting lots of this right, but we face some big challenges now and in the future.

Choice

At the moment, the choices available to women when deciding where to have a baby will be different depending on where you live and which hospital you use. We want more women to have more choice.

The table below shows the current choices of where to give birth across our Local Maternity System.



Make better use of our resources

We have four Freestanding Midwifery Units across our area - in Chippenham, Frome, Paulton and Trowbridge. They are busy during the day providing antenatal and post-natal care, but just 6 per cent of our babies are born in a Freestanding Midwifery Unit in our area.

The four units support the delivery of, on average, a combined total of 52 babies a month. That means each unit helps deliver on average one baby every two or three days. We still need to staff, equip and maintain these units ready for birth, 24 hours a day, seven days a week, even if there are no babies being born.

Meanwhile, combined, the Obstetrics Units at the Royal United Hospital, Salisbury District Hospital and Great Western Hospital deliver around 800 babies a month. Demand for obstetric-led care is increasing, as low risk women are also choosing to give birth in an Obstetric Unit, creating a mismatch between demand and capacity.

Our units in Chippenham and Paulton also provide nine community post-natal beds (four at Chippenham, five at Paulton) which are empty 95% of the time as women are choosing not to use these beds. It's not a good use of our skilled staff, who want to be using their clinical expertise and caring for women, not empty beds and buildings.


Workforce

We don't always have the right staff, in the right place at the right time to offer the kind of service women and families want to receive, and we want to provide.

This is a particular issue for the Royal United Hospital, which supports births across four Freestanding Midwifery Units, an Obstetric Unit and home births, all of which have to be staffed to provide a service 24 hours a day, seven days a week.

With 2 or 3 babies born a week at each Freestanding Midwifery Unit, staff may find themselves looking after empty beds or even empty buildings at night, while colleagues in the Obstetric Unit are juggling more demands. We might need to move staff around at short notice, which is frustrating for staff.

Our consultation document shows some examples of a typical day and night at a Freestanding Midwifery Unit.

Future Sustainability

Fewer people are choosing to give birth in a Freestanding Midwifery Unit, and more people choose, or need to use an Obstetric Unit. We're seeing more older mums, and more complex births, which need higher levels of support, and this trend is continuing.

Due to the small number of births taking place in the four Freestanding Midwifery Units, the cost of supporting these births is higher than in an Obstetric Unit.

We also know that there are changes ahead in some of our areas, for example 5,500 troops are set to return to Wiltshire in 2019. We need to make sure our services can continue to meet the needs of our communities.

What will happen if we do nothing?

The challenges we face will remain - such as lack of choice, inefficient use of our staff and resources and not being in the best position to cope with future demand.

If we don't change how we provide our services across our wider area, we won't be responding to the views and needs of communities' women, families and our maternity teams who have told us they want:

  • More choice, including more support for home births.
  • Enhanced antenatal and post-natal support, including more support for breastfeeding.
  • More continuity of care - seeing the same team of midwives before, during and after birth.

If we don't change, we won't be responding to our staff who have told us they want to be:

  • Looking after women and babies, not empty beds and buildings.
  • Providing enhanced antenatal and post-natal care.
  • Able to support more home births.
  • Better able to provide continuity of care to mums and families.

What will happen if we do nothing?

The challenges we face will remain - such as lack of choice, inefficient use of our staff and resources and not being in the best position to cope with future demand.

If we don't change how we provide our services across our wider area, we won't be responding to the views and needs of communitieswomen, families and our maternity teams who have told us they want

  • More choice, including more support for homebirths
  • Enhanced antenatal and post-natal support, including more support for breastfeeding
  • More continuity of care - seeing the same team of midwives before, during and after birth

If we don't change, we won't be responding to our staff who have told us they want to be

  • Looking after women and babies, not empty beds and buildings
  • Providing enhanced antenatal and post-natal care
  • Able to support more homebirths
  • Better able to provide continuity of care to mums and families.