It's time for change in the NHS - for good reason

I'm glad that he was pleased with the response of our services during the birth of his grandchild.

However, I thought that it was worth picking up several of his points about the maternity proposals.

The first is that he is incorrect to say that there are plans on the table to create midwifery-led units. I'd like to make a clear statement for the record: at this time, there aren't.

I've seen many letters to the Bury Times, which make the same assumption. But the children and maternity network has made its position clear on this. It has also been reported in the Bury Times on several occasions, including in the recent 'Question and Answer' feature.

The Making It Better consultation is dealing with inpatient services only - stand alone midwifery-led units will not be considered as part of the consultation.

Local decisions on those midwifery-led units would have to follow afterwards, but it is clear that the network only envisages them even being considered if there is demand from local women. They will not be imposed from above.

Bury Primary Care Trust, which would have to commission this service, has stated its position as follows: 'Should Bury not have a 24 hour inpatient maternity service, there would only be a stand alone Midwifery Led Unit in Bury if this is a viable option and should local people and stakeholders want it.'

Midwifery-led units wouldn't ever be replacements' for full obstetrics units. That isn't how they work. They are a different type of service, offering a different type of choice.

Within that context, Mr Isaacson raises the issue of risks to babies and their mothers. But risk is present throughout everything the NHS does, and that is true in maternity as it is in all of our other services. The issue is how we manage that risk and design systems to make them as safe as possible.

For that we rely on national guidance, including that of the Royal Colleges. Yes, there are risks in midwifery-led units. But there are also risks in full obstetrics units.

Things can go wrong anywhere, but this happens rarely. I believe that this is due to the standards and guidelines set by the NHS, and the dedication and professionalism of the NHS staff in applying them.

Those standards - for all NHS services - are set by national regulations, protocols and guidance, including a complex medico-legal framework, which would certainly cover the design of our services.

As readers will see from the consultation material, clinical governance - the NHS phrase for risk management and safety' - is a key consideration underpinning these proposals. I think everyone has heard about the broad issues surrounding these services across Greater Manchester - too few skills spread too thinly across the region in too many units.

These proposals are not designed to save money - £6 million alone will be needed to support the envisaged development of additional community-based services. And that 'army of bureaucrats' - I don't know where they are, but I can assure Mr Isaacson that they're not at Fairfield General Hospital. The public consultation on these proposals is imminent. They represent a substantial amount of thought and work by obstetricians, paediatricians, midwives, nurses and other NHS professionals across Greater Manchester.

There has been much debate in Bury and beyond already - but the debate on these services among NHS professionals locally goes back at least 20 years, and now is time for a change, for some very good reasons.

I know everyone wants the same thing - safe, sustainable services. I urge everyone who is following this debate to make some time to read the consultation documents, consider the reasons for the proposals, and make formal responses.

CATHY TRINICK

Head of Midwifery

Pennine Acute Trust