Answers Provided by the Trust to Questions raised under the Freedom of Information Act

Communications Department
Sky Level
Worcestershire Royal Hospital
Charles Hastings Way
Worcester
WR5 1DD
9 August 2006
BY EMAIL

Dear Mr Stote,

I write in response to your request under the Freedom of Information Act received by me on 12 July 2006, in which you request various pieces of information relating to maternity services provided by our Trust and information regarding the Clinical Service Review.

Your questions are set out below, with my answers where I have been able to provide the information you request.

1) The clinical evidence that relates to the proposed closure of Maternity at Alexandra Hospital as referred to at the last trust board meeting on July 6th.

The reasons for the proposed centralisation of deliveries are summarised in the pre-consultation document which is published on the Acute Trust section of the www.worcestershirehealth.nhs.uk website. The document can be downloaded from http://www.worcestershirehealth.nhs.uk/Acute_Trust/Service_Review/

In addition, you will know that we sought independent external validation from
Nick Naftalin, a Fellow of the Royal College of Obstetrics and Gynaecology. A copy of his report is attached along with this reply.

2) The numbers of times Worcester Royal Maternity services has been on alert and the numbers of mothers in labour sent to the Alexandra or elsewhere as a result of these alerts for the period 2004 to present.

Neither of our maternity units ever close. However, like all such units they can have extremely busy periods and we have a detailed escalation policy to protect the safety of pregnant women and their babies.

When a certain level of occupancy is reached (all beds full in the ward and labour ward at full capacity minus two) then there is provision for women to be diverted to another site. However, they would first be brought in for assessment (in one of the two free labour ward beds) to make sure that any divert was safe. In the period you specify, only two women have been transferred to another hospital in these circumstances.

In September 2005, one woman (not in labour) was transferred from Worcestershire Royal Hospital to the Alexandra for an elective induction.

Over New Year 2005/6, a woman in labour was diverted from Worcestershire Royal Hospital to the Alexandra.

3) Number of pregnant women referred to Worcester before they enter labour for the period 2004 to present

Please see answer to question 4, below.

4) Number of pregnant women referred to Worcester during labour for the period 2004 to present

Questions 3 and 4 above both refer to in utero transfers. We can provide you with totals for these (ie women transferred before and during labour) as follows:

Inutero transfers 1/1/04-31/12/04 = 106
Inutero transfers 1/1/05-31/12/05 = 106

Because of the way they are recorded, to distinguish between the two would be a task of considerable magnitude taking up many hours of staff time to read through the records, collect and analyse the data. We do not have an electronic maternity data system so all data of this type has to be manually collated.

There is no doubt that the cost to our Trust in terms of staff hours of providing the information you require would be significant, particularly since it would have to be done by a member of staff with the necessary knowledge and experience.

Section 12 (1) of the Freedom of Information Act 2000 states the Act:

“does not oblige a public authority to comply with a request for information if the authority estimates that the cost of complying with the request would exceed the appropriate limit.”

In the Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004, laid before Parliament on 9 December 2004, this appropriate limit was set at £450. Given that the work entailed in providing you with the information you request would take several weeks, the cost would clearly be far more than this.

5) Average use of the Neo Natal Ward - i.e. how many beds are used at any one time for the period 2004 to present

6) Number of women requiring emergency intervention during their pregnancy and labour for the period 2004 to present

Interpretation of the term 'emergency intervention' is difficult as this may incorporate a number of events during the woman's care pathway. However we have interpreted your request to mean the number of women requiring urgent or immediate delivery.

Our classification of 'emergency' is threefold:
- Immediate threat to life of the woman or foetus
- Maternal or foetal compromise which is not immediately life threatening
- No Maternal or foetal compromise but needs early delivery

We have based our figures on the number of women requiring emergency caesarean section (during the antenatal or labour period) and the number of women who required instrumental delivery during labour.

The above figures should not be taken as an indicator of all emergency referrals to a consultant in or before labour as a large number of women would require referral to a consultant for an urgent opinion (i.e for an urgent scan, bleeding in pregnancy etc).

Intrapartum transfer figures may also be interpreted as emergency intervention (see question 3 & 4) as a number of these women would have required delivery at less than 36 weeks.

7) Number of pregnant women that would have needed care that would not be provided by the proposed Midwife-led Centre in the North of the County for period 2004 to present.

I should point out here that although the possible development of a midwife-led centre in the north of the county is mentioned in our pre-consultation document, it is made clear that further detailed discussions with the PCT would be required before any definite proposals could be put forward.

In terms of the information you request, I regret to say that for 2004, that data was not collected. I am however able to give you the numbers of women at the Alexandra requiring consultant-led care in 2005 and a figure for the first part of 2006.

In 2005 - 1,495 women from a total of 1,780 required consultant led care.

In January to May 2006 - 523 from a total of 693 women required consultant led care.

8) Number of women that give birth at the Alexandra Hospital from inside the county for the period 2000 to present.

2000 1,541
2001 1,402
2002 1,486
2003 1,511
2004 1,698
2005 1,596
2006 741 (January - June)

9) Number of women that give birth at the Alexandra Hospital from outside the county for the period 2000 to present.

2000 169
2001 155
2002 224
2003 207
2004 220
2005 215
2006 102 (January - June)

With regards to answers 8 and 9 above, I acknowledge that there is a variation between the totals for 2004 and 2005 and the total deliveries as per the answer to Questions 6 and 7.

It is worth pointing out that collecting the information for your request has taken considerable time and effort by a number of senior members of staff in our maternity, information and communications departments.

We have tried to answer your questions as fully as we are able and this has meant we have had to take data from a number of different sources as we do not have a central maternity computer system from which we could extract all these figures.

In the case of Questions 6 and 7, the figures are based on a manual analysis of delivery suite records and for 8 and 9 they are drawn from our computerised patient administration system (PAS). These figures represent the best information that is currently available to us. An exercise to cross-refer these two sets of figures (which are very close to each other) would be a time consuming and very costly undertaking.

If you have any further questions then you can contact me directly in writing at the address at the top of this letter, or using the email address below.

If you have a complaint about the way this inquiry has been dealt with, you should contact our Complaints Department, c/o the Alexandra Hospital, Woodrow Drive, Redditch. B98 7UB.

Yours Sincerely

Head of Communications/FOI Lead