Lesser anaesthetic staffing levels at Erne, report says

Sarah Saunderson • Published 13 May 2010 10:05 0 Comments

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A watchdog report examining services for women in labour has highlighted lesser anaesthetic staffing levels for mothers-to-be at the Erne Hospital than at the Altnagelvin.

Both hospitals are managed by the same health body, the Western Health and Social Care Trust. While the Altnagelvin has a lead obstetric anaesthetist in charge of anaesthetic services for the obstetric unit, there is no such role at the Erne at present. "There is a lead obstetric anaesthetist in Altnagelvin Hospital in charge of anaesthetic services with session that reflect the clinical and administrative workload. There is no identified lead in the Erne Hospital for obstetric anaesthetics," the RQIA (The Regulation and Quality Improvement Authority) report says.

In addition, the Altnagelvin also has a duty anaesthetist dedicated only to the labour ward and immediately available, as recommended under Safer Childbirth Standards. However, this is not the case in the Erne.

"A duty anaesthetist of appropriate competency and dedicated only to the labour ward is available 24 hours a day, seven days a week at the Altnagelvin Hospital. In the Erne Hospital, a duty anaesthetist covers other emergencies in addition to the labour ward. The review team found that the trust has an on call policy in place which stipulates that a consultant must be available from home within 20 minutes".

The RQIA report, published this week, recommends to the Western Trust that changes are made at the Erne that would bring services in line with the Altnagelvin. "The Trust should identify a lead obstetric anaesthetist for anaesthetic services at the Erne Hospital," it recommends.

The review team identified a need to review the cover available at the Erne Hospital as it said "difficulties could arise" if a caesarean section was required while another operation was already underway.

The vital role of anaesthetists is spelled out in the report: "Staffing levels need to recognise that emergencies happen frequently and often with rapidity, with a requirement to respond quickly in order to save mothers' or babies' lives. Much of the obstetric anaesthetic practice is unplanned but, as well as timely reponse to emergencies, anaesthetic services also need to respond to elective operating such that it is not normally interrupted by emergencies".

There was also praise for management of some services at the Erne too. The review team found "considerable evidence" to confirm that a professional midwife, neonatal nurse or paediatrician is immediately available for all births.

In addition, the report states: "The Trust arrangements for the management of women requiring high dependency care was felt to be an exemplar of best practice".

Other issues identified in the report:

*While women in established labour should receive one-to-one care from a midwife, it was reported that cover to maintain this care is not always available.

*Although junior medical staff cover is provided during office hours Monday to Friday, this is not being achieved out of hours.

*While all midwifery units must have one consultant midwife, the Trust does not have a consultant midwife currently employed.

*Due to a lack of a computerised information system across the Trust, figures were not available in the levels of anaesthesia used in caesarean sections at the Erne.

SDLP Fermanagh and South Tyrone MLA Tommy Gallagher has said recommendations from the RQIA for the Erne Hospital must be completed immediately to ensure the high quality of care is continued.

"I firstly want to commend the professional and dedicated staff at the maternity unit. I welcome the recommendations from RQIA to the Western Trust as they seek to maintain the high levels of health care in our area. It's essential that a lead obstetric anaesthetist is quickly identified and put in place at the Erne Hospital's labour ward without delay. It's not best practice to have an obstetric anaesthetist potentially not available for all expectant mothers, many of whom are first-time mothers and others are those who may have complications or experiencing a difficult birth. These are variables the Erne Hospital cannot control. What it can control is the continuing level of care and service for every pregnancy that comes through its door.

"Other recommendations, such as a clear policy on the wearing of identification, help create an environment where all mothers and families feel at their utmost ease during their stay at the Erne.

"The Erne Hospital and its local staff have an excellent reputation. I'm sure these recommendations, when implemented, will serve to increase the good name of healthcare in the Fermanagh area."

Western Trust Director of Women and Children's Services, John Doherty commented: "The Trust is fully committed to providing high quality maternity care. All of the RQIA recommendations have been considered and plans are being developed to ensure improvements are made.

Mr Doherty continued: "The Trust is encouraged by the fact that the report identifies the commitment of our Midwives and Obstetricians and also the positive feedback from mothers highlighting the excellent care provided to women in the western area."

From the findings of the RQIA review, six recommendations were specific to the Western Trust and the Trust has given firm assurances and a commitment to address these requirements.

This article appeared in Impartial Reporter 13 May 10

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