Business case approval for new £210m maternity unit at Antrim Area Hospital

A business case for a new £210m maternity unit at Antrim Hospital was approved at a meeting of the Northern Health and Social Care Trust board on Thursday morning.

The application comes as the Trust seeks a “longterm solution” for its maternity service and launches a public consultation to seek the views of the community.

Maternity services are currently provided at Antrim Hospital and Causeway Hospital in Coleraine for approximately 4,000 women annually.

The Trust has stressed there are a number of options to be considered and this proposal “does not represent the views of the Trust” and is “an exercise in future-proofing service configuration which is the subject proposal of a public consultation and further to ministerial approval”.

“We do need to move ahead as it is a relatively long process,” said finance director Owen Harkin.  “It is important to move quickly to get the unit in place in Antrim.”

It is not expected to be available until 2029.

The business case will now be presented to the Department of Health.  Members also heard the cost has risen from a projected £150m six months ago.

Members were told the current model for maternity services is “both fragile and vulnerable and due to concerns in relation to workforce, safety and sustainability, service reform is required to provide a safe and sustainable interim solution in advance of the new build”.

“In Causeway, the number of births has been decreasing each year and the number is expected to fall below 900 by the end of 2022. That equates to approximately 2.5 births per day and raises serious concerns about how medical and midwifery staff can maintain their skills in relation to complex care.

“NISRA figures suggest that over the next 20 years, the number of births in the Causeway area will fall by 11%.

“The maternity unit at Causeway is currently a consultant-led unit. One consultant has recently retired and another has left the obstetrics department meaning that at least 40% of on-call activity now relies on locum cover.

“A recent attempt to recruit two new consultant obstetrician/gynaecologist posts failed to attract any applicants. This is unprecedented and anecdotal feedback suggests that medical recruitment to Causeway is an unattractive option, in terms of on-call frequency and the lack of opportunity for skills enhancement. In practice this means that any unplanned absence may result in an inability to provide 24/7 consultant cover.”

In addition, Causeway has “historically struggled to recruit and retain midwives with feedback indicating that the lack of opportunity for learning and the lack of activity is unappealing to midwives.

“Causeway does not have a neonatal facility and in any pregnancy or birth which has a higher risk of the baby requiring admission to a neonatal unit, themother is transferred to Antrim for intrapartum care and birth.

“This means separation of mother and baby which can create issues with bonding and attachment, establishment of breastfeeding, anxiety and post-partum depression.

“The Northern Ireland Specialist Transport and Retrieval Team (NISTAR)transfers the baby to Antrim (or Altnagelvin). If NISTAR is unavailable (theyare experiencing gaps in their rota) then the Northern Ireland AmbulanceService (NIAS) provides the ambulance and it is necessary for a midwife anda paediatrician to accompany the baby during transfer. This requires a secondpaediatrician to be available to cover at Causeway.

“The Trust has carefully considered the situation over the past months and hasnow identified two clinically deliverable options that it believes will providebetter outcomes and quality of care for women living in the Trust area.

“The first option would move all consultant-led births to the Antrim site, whichwould as a result provide intrapartum care for an additional 600-700 births per annum.

“Also included in this option would be the development of a free-standing midwifery unit in Causeway for approximately 200-300 women who would be suitable for low intervention midwifery-led care and birth.

“The Trust would also retain and enhance early pregnancy assessment units,antenatal and postnatal clinics and scheduled ambulatory services on theCauseway site.

“The second option would move all births to the Antrim site, resulting in Antrim providing intrapartum care for an additional 900 births per annum. With this option, the Trust would also be retaining and enhancing early pregnancy assessment units, antenatal and postnatal clinics and ambulatory services on the Causeway  site.

“With both options, the Trust would also propose to explore the possibility ofproviding an interim alongside midwifery unit in Antrim, pending thedevelopment of the new purpose-built Women and Children’s Unit.

The Trust has stressed that with any required service change, its“preference will always be to go out to full public consultation” which commenced today (Thursday) and will continue for 14 weeks until March 3.

Jennifer Welsh, the Northern Trust’s chief executive said: “There will be a period of a couple of weeks from 3rd March to consider the outcomes.”

She went on to say that the outcomes of the consultation will be brought back to a meeting of the Northern Trust board on March 23.

The Trust will need final approval for any proposed changes from the Department of Health/minister.

Michelle Weir, Local Democracy Reporter

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