The Nuffield Trust has published a working paper, Maternity services in smaller hospitals: a call to action. Written following a workshop with representatives of the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, and The Nuffield Trust, the report examines the challenges facing smaller maternity services in rural areas.
Despite the lack of evidence of a direct relationship between volume of births and outcomes, maternity services are perceived to be less safe in smaller hospitals. However, the closure of maternity units in rural and remote areas can mean longer transfer times and poorer support for obstetric emergencies. The working paper discusses barriers to the delivery of safe and effective maternity services and serves as a call to action for areas of improvement that are within the control of employers and national organisations.
To improve services in rural areas, the workshop members recommended that smaller maternity units should:
- promote the benefits of rural practice
- improve the working environment for all staff
- invest in training programmes and develop mechanisms that allow nurses and midwives to practice at the ‘top of their licence’
- develop high-quality local training programmes geared to the needs of rural areas
- place senior trainees in rural locations to support the viability of rural services and to prepare medical staff better for consultant roles
- review ambulance provision for maternity care
- develop skills- and team-based approaches to the delivery of maternity care in smaller units
- base professional standards for rural services on outcomes rather than staffing numbers
- develop and implement more effective, networked models of care
- change payment systems to reflect the higher costs of smaller-scale maternity services.