ANSWERS TO IMPORTANT QUESTIONS ABOUT THE SILVER STAR UNIT

What is the Silver Unit?

• The specialised Silver Star and Fetal Medicine teams are a small number of consultants and midwives. The midwives do not do routine midwifery but focus on the extra problems that their patients have. There also a number of support staff who work in the unit..

• The Units is in a purpose built integrated area on Level 6 in the John Radcliffe Maternity Unit. It is the result of 40 years of clinical experience and medical evidence demonstrating that an integrated unit provides the best care for very sick mothers with high risk pregnancies. It has been seen as an exemplary role model for care and copied internationally.  Mothers who need to stay in hospital are located immediately next door to the Unit's Staff, and their monitoring facilities. Communication is the highest priority of the unit and is maximised by this configuration. The unit provides integrated and long term care from pre-pregnancy assessment to post natal follow-up.

What is the Trust proposing?

• The level 6 ward will be closed permanently and moved to Level 5. The rest of the unit will remain on level 6, with its consultant and midwifery staff. The highly efficient communication, which comes from being side by side will be severed. In effect the unit is decapitated. Daily informal and quick responses to alerts, questions, issues and emergencies will be slow and inefficient. 

• Out-patient activity will not be affected, only in-patient care, mainly the times before during and after delivery, which are the most important.

• Care on two not three levels is claimed to be more efficient and save money. The fewer beds will be in greater demand with faster turnover. Servicing such turnover requires more not less staff to make it work. But current staffing levels are extremely low.

What was the experience of last year's closure?

• 12 beds were allocated to the unit on level 5. This was grossly inadequate. By August there were as many as 22 Silver Star women crammed into the highly unsuitable environment of Level 5. 

• In a letter to Hospital managers a senior consultant has described these conditions as 'chaos'....'One of the long‑term effects was a loss of an organised way of offering care.' The problems were not just those of women attending Silver Star and Fetal Medicine but affected all women.

Why it will not work this year?

• Maternity is an acute and an emergency service, there can be no waiting list.

• The birth rate is rising

• The deficit of midwives this year is twice as bad as last year (29 vs 16 vacancies)

• The hospital is chronically short of Obstetric consultants about half the number recommended by the Royal College of Obstetricians and Gynaecologists and has delayed filling a vacancy after a retirement at the end of last year.

• The total number of beds will be reduced by 8%. Because the number of pregnant women will be the same or increased (this time of year is regularly busy) reduced bed numbers require more staff so that the bed turnover has to be accelerated.

• With such deficient staffing it is inevitable that the services will not cope.

• With Silver Star and Fetal Medicine there will be the added difficulties of delivering high level care in general ward with none of the necessary facilities immediately at hand. This is not safe and effective in the long term.

• These changes were made with NO formal consultation with the medical staff on the unit who are ultimately responsible for the women and babies in maternity.  When they found out about the closure a letter was sent expressing profound concern about the proposals to the Trust management.

Who comes to the Silver Star/Fetal Medicine unit?.

• Women with medical problems such as high blood pressure, heart, or kidney disorders, , diabetes, epilepsy, thrombosis and many more. Problems that arise during pregnancy include pre-eclampsia (high blood pressure and protein in the urine) Some of these problems threaten the baby as well as the mother. Women who attend the Fetal Medicine unit have all the problems that threaten their babies' safety for example prematurity or starvation and growth failure in the womb

                                                                  
Are medical problems in pregnancy important?

• Medical problems of pregnancy cause most of the maternal deaths that now happen in the UK (7 out of 10)

• The most recent national report on the problem emphasises the very high incidence of substandard care associated with maternal deaths with medical problems ranging from 40 -60%. It also identifies problems with communication, poor or non existent team working ; These are the issues that the Silver Star unit works night and day to address.

Conclusion

• Not a well planned or carefully considered proposal.

• Not appropriate to repeat the problems of last year's closure when they will be worse, given the weakened overall staffing.

• All pregnant women will be at risk of receiving inadequate care.

• Not sensible to reduce beds and reduce the Silver Star and Fetal Medicine services (for the most vulnerable and dangerous pregnancies) against the national evidence of how much the NHS fails to meet the needs of such women.

• A permanently split Silver Star/Fetal Medicine unit will introduce communication problems that are always highlighted in all enquiries into maternity disasters

• The split will permanently handicap its functions.

Footnote

• Silver Star supporters entirely funded the building of two prized Family Rooms on Level 6 (~£100k) providing privacy, en suite facilities, equipped for the needs of disabled mothers and allowing a partner or other family member to stay overnight. These rooms will be mothballed and eventually, presumably, dismantled. 

Issued by the Silver Star Society   7 July 2010