Some English hospitals should be stripped of doctor-led maternity care and specialist children's services, a government advisor says.
Some English hospitals should be stripped of doctor-led maternity care and specialist children's services, a government advisor says.
Dr Sheila Shribman, the children and maternity tsar, calls for regional super-centres instead.
Dr Sheila Shribman, the children and maternity tsar, calls for regional super-centres instead.
Hospitals that lose consultant-led maternity services may get midwife-led birthing centres, she said.
Hospitals that lose maternity units may get midwife-led services and more support for home births will be provided to give women greater choice.
Dr Shribman said the plans would improve care, not damage it as critics have argued.
Dr Shribman said the move would improve care, not damage it as critics say.
Women will not be losing access to a consultant should they need one, it might not just be down the road Dr Sheila ShribmanChildren and maternity tsar
Women will not be losing access to a consultant should they need one, it might not just be down the road Dr Sheila ShribmanChildren and maternity tsar
Some have argued that hospital cuts are being driven by NHS deficits - the health service finished last year over £500 million in the red.
Some have argued that hospital cuts are being driven by NHS deficits - the health service finished last year over £500 million in the red.
But Dr Shribman said EU restrictions on working hours meant specialist services could not be safely provided in every local hospital.
But Dr Shribman said EU restrictions on working hours meant specialist services could not be safely provided in every local hospital.
Round-the-clock care
Round-the-clock care
She said it would be better to have the best doctors on hand round-the-clock in regional centres.
She said it would be better to have the best doctors on hand round-the-clock in regional centres.
She said: "I do not believe the changes I am proposing are about the budget.
She said: "I do not believe the changes I am proposing are about the budget.
We need more than fine words to ensure that this vision is translated into maternity services that provide not only choice but one-to-one care Dame Karleen DaviesRoyal College of Midwives
We need more than fine words to ensure that this vision is translated into maternity services that provide not only choice but one-to-one care Dame Karleen DaviesRoyal College of Midwives
"I understand people feel anxious when they think they might lose something."
"I understand people feel anxious when they think they might lose something."
She added: "Women will not be losing access to a consultant should they need one, it might not just be down the road."
She added: "Women will not be losing access to a consultant should they need one, it might not just be down the road."
The prospect of hospitals losing services has sparked anger among the public with demonstrations seen up and down the country.
The prospect of hospitals losing services has sparked anger among the public with demonstrations seen up and down the country.
The government has already floated the idea of taking A&E and specialist heart services away from some hospitals.
The government has already floated the idea of taking A&E and specialist heart services away from some hospitals.
Many NHS trusts are already drawing up plans to re-design services.
Many NHS trusts are already drawing up plans to re-design services.
Dr Shribman's report suggested networks of care could be created for maternity services, intensive neo-natal care and paediatric and child cancer services.
Dr Shribman's report suggested networks of care could be created for maternity services, intensive neo-natal care and paediatric and child cancer services.
She said regional centres providing this specialist care would be supported by enhanced community services.
She said regional centres providing this specialist care would be supported by enhanced community services.
These could include midwife-led birth centres, either in local hospitals or community clinics.
These could include midwife-led birth centres, either in local hospitals or community clinics.
There would also be better support for home births.
There would also be better support for home births.
Choice
Choice
The government has promised to give women a choice of where they give birth by 2009.
The government has promised to give women a choice of where they give birth by 2009.
But the Royal College of Midwives (RCM) has said another 10,000 midwives would be needed on top of the 24,000 already working in England.
But the Royal College of Midwives (RCM) has said another 10,000 midwives would be needed on top of the 24,000 already working in England.
Dame Karlene Davies, RCM general secretary, said real choice was good news for women.
Dame Karlene Davies, RCM general secretary, said real choice was good news for women.
But she said: "We need more than fine words to ensure that this vision is translated into maternity services that provide not only choice but one-to-one care from the same midwife throughout pregnancy, as the government promised in its 2005 general election manifesto."
But she said: "We need more than fine words to ensure that this vision is translated into maternity services that provide not only choice but one-to-one care from the same midwife throughout pregnancy, as the government promised in its 2005 general election manifesto."
Mary Newburn, of the National Childbirth Trust, welcomed the move to provide more midwife-led maternity care via midwife-led birth centres, local children's centres and at home.
Mary Newburn, of the National Childbirth Trust, welcomed the move to provide more midwife-led maternity care via midwife-led birth centres, local children's centres and at home.
She said: "Just because services have been organised around hospitals in the past doesn't mean this is the best or only way of providing care."
She said: "Just because services have been organised around hospitals in the past doesn't mean this is the best or only way of providing care."
However, she stressed good communication was essential to ensure women who needed specialist care could be transferred swiftly.
However, she stressed good communication was essential to ensure women who needed specialist care could be transferred swiftly.
Dr Shribman refused to be drawn on how many regional centres would be needed, but the Conservatives have identified 43 maternity units at risk - a fifth of the total.
Dr Shribman refused to be drawn on how many regional centres would be needed, but the Conservatives have identified 43 maternity units at risk - a fifth of the total.
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