FEARS that neonatal services at the Royal Gwent Hospital might be downgraded have been raised during public consultation on proposals to reorganise key NHS services across South Wales on fewer hospital sites. Health reporter Andy Rutherford reports.

GWENT’S sickest babies, and women facing difficult births, will be put at risk if neonatal services at the Royal Gwent Hospital are downgraded.

That is the warning from an unnamed representative of the neonatal directorate of Aneurin Bevan Health Board, who claims such an option is being considered as part of a shake-up of key NHS services in South Wales.

And that, according to their anonymous report – published with other comments on shakeup plans – could result in up to 3,200 Gwent mums-to-be every year facing the prospect of travelling outside Gwent to give birth.

“An option which seems to be emerging is to change the status of the neonatal service in the Royal Gwent Hospital from a Level Three to a Level Two, thus leaving only two Level Three units in South Wales,” states the report.  This, it continues, would:

● Be “potentially dangerous” to Gwent mothers, who would have to travel “great distances” to deliver.

● Massively overload other already-busy units, particularly at the University Hospital of Wales, Cardiff, requiring major investment and building there which could not be done quickly.

● Worsen rather than ease staffing problems that are a key factor in the need to reorganise services in the first place.

● Jeopardise neonatal training in Wales.

● Compromise a major component of Gwent’s proposed Specialist and Critical Care Centre.

Level Three neonatal care is intensive care for newborn babies with the most complex care needs, many of whom will be very premature. Level Two is high-dependency care, and Level One special care.

Currently the Royal Gwent, the University Hospital of Wales, in Cardiff, and Swansea’s Singleton Hospital provide all three care levels.

The option of reducing to two Level Three units is included in the report Matching The Best In The World, which advocates concentrating key services such as A&E, neonatal, obstetrics and paediatrics on fewer hospital sites, through the South Wales Programme project.

This is seen as a way of providing sufficient levels of appropriately qualified staff, and ensuring they deal with enough cases to maintain and develop skills.

Both are increasingly difficult challenges facing the NHS in Wales.

Aneurin Bevan Health Board and others across South Wales worked on the Matching The Best In The World options prior to the report’s launch for public consultation last autumn.

For neonatal services it suggests either three Level Three neonatal units, as at present, or a reduction to two.

The anonymous report from Gwent’s neonatal directorate is among hundreds of responses now published. It highlights concern among staff that a two-unit option is being considered, with Gwent the possible loser.

The implications of such a move, it argues, have not been thought through, understood, or discussed.

Services in fewer hospitals 'inevitable’

RECENT guidance recommends that health boards ensure separate rotas of consultants for Level Two and Level Three neonatal care, comprising doctors with specialist training.

This means consultant neonatal staff would be separate from consultant paediatric staff, with these services needing separate rotas of doctors in specialist training.

This, concludes the Matching The Best In The World report, “will make it extremely difficult to avoid concentrating the inpatient paediatric and neonatal services in fewer hospitals.

“It is also highly likely to mean that choices will have to be made between the number of Level Three neonatal centres and the number of paediatric units, as it seems very unlikely that there will be enough medical staff to support three Level Three neonatal centres and five paediatric units.”

No decisions have yet been made on neonatal services and other specialties under the regional spotlight. Firm proposals will be issued for further public consultation in the spring.

In Gwent, neonatal care is anyway earmarked to move with other emergency and complex care specialities to the proposed Specialist and Critical Care Centre (SCCC) on the site of the former Llanfrechfa Grange Hospital near Cwmbran, and Matching The Best In The World makes it clear the SCCC is a fundamental part of a future sustainable hospital network in South Wales, along with Cardiff and Swansea.

An Aneurin Bevan Health Board spokesman said: “We are extremely proud of the neonatal care services we deliver and we want to ensure that we continue to provide safe and sustainable services to our population within the Gwent area.

“The quality of our neonatal services is comparable to the best in Wales and we want to ensure that we maintain these high-quality specialist services within the Gwent area as part of the South Wales Programme.”

‘Royal Gwent needs more capacity’

THE anonymous report argues that the Royal Gwent’s Level Three unit needs more capacity, not a downgrade.

During January-October last year it closed to admissions 72 times because it was full, with pregnant women having to transfer to other units in Wales, and on 16 occasions, to England.

It also quotes All Wales Perinatal Study figures showing it had the lowest stillbirth and neonatal mortality rates of South Wales’ Level Three units, and among the highest satisfaction rates in the UK for neonatal training.

Mum so grateful for neonatal unit staff who saved tot’s life

FIVE-year-old Mikka Todd is too young to understand the vital role the Royal Gwent Hospital’s neonatal unit played in saving her life.

But mum Anna remembers staff fighting long and hard to keep her 12-weeks premature daughter alive back in 2007.

A precautionary hospital check-up, because Mrs Todd had not felt her baby moving in her womb for a while, developed into emergency surgery to try to save them both.

Mrs Todd was found to have pre-eclampsia, a symptom of which is high blood pressure and which, untreated, can prove fatal to mother and baby.

After an emergency Caesarian section, Mikka, born weighing just 1lb 8oz, spent three months in the neonatal unit, battling sickness and diarrhoea and requiring three blood transfusions.

Mrs Todd, from Cwmbran, said the 15-minute trip to the Royal Gwent from home every day to see her daughter was hard enough, and having to go any further would be unacceptable.

“Knowing I was right there with the neonatal unit in the same hospital, that was very important,” said Mrs Todd.

“Had I had to go to Cardiff, or Mikka been taken there after she was born, I don’t know what would have happened.

“I can’t see how anyone can even think of downgrading the unit at the Royal Gwent.

“If this is a serious idea, it should be fought all the way.

“The Royal Gwent neonatal staff are fantastic. They helped Mikka through.”