**Article originally published in The Press & Journal, 16 May 2022
The challenge of providing maternity care across the Highlands is one that has troubled the Health Board for many years. The problems that Moray face has thrust it back into the spotlight and it is vital they address the care of pregnant Highland mums as a top priority.
The biggest question of course is how Raigmore copes with the Moray redesign, which it is predicted will result in (at least) an additional 500 mothers needing maternity care. This is on top of the 2,000 Highland mothers, including those 170 odd who travel down from Caithness due to the lack of facilities there. Apparently, the option for NHS Highland to refuse to take on these extra Moray mothers remains, but realistically the Government has already decided on the outcome.
My recent visit to the Raigmore maternity unit showed a facility that was creaking at the seams, struggling with staffing and coping with over twenty years of under investment. Without doubt the determination of the maternity team makes the facility work but narrow corridors, low ceilings and cramped rooms are neither conducive to those who work there or for those giving birth. Everyone deserves better which is why the £5m promised by the central Government is enticing. It is interesting that both Highland and Grampian health boards have been offered the same sum, which seems odd unless this is to ensure neither feels left out.
During my visit I was shown exciting, but un-costed, architectural sketches of the proposed improvements. These will be expensive, take time to deliver and cause severe disruption to the existing maternity unit as they are constructed. The knock-on effect is that parts of the maternity unit will be forced to relocate as the new facilities are built which in turn will mean beds will be lost from other wards with all the knock on effects that this will create. Mothers will likely also be much further away from the obstetric theatre for emergencies and the Special Care Baby Unit (SCBU)
There are of course other issues that will need to be addressed such the duration of how long Raigmore will have to look after these additional mums, where they will find the additional staff that will be required and indeed, who will pay for them. Not to mention of course the additional ambulance cover that will be required to move patients to and from Moray or the accommodation that will need to be provided for the families that come with them. Whilst I know that these later two points are on the Boards radar they were not fully considered when the Caithness maternity cover was downgraded, which was a mistake. All these issues will have costs implications and to be fair the Government has said that they will help. Of course the costs will only be approved if they are part of an approved business case submitted by NHS Highland this summer. But I have to ask when have you known any Government to accept a business case without reducing the requested funding?
As the Board looks at delivering the instructions of the Cabinet Secretary to help look after Moray Mums, they should not be blinded by the additional investment that is being offered. They will need the support of their maternity staff, some of whom wrote to an open letter to the Cabinet Secretary on 10th December 2021 voicing their concerns. Concerns that need to be addressed if this idea is to work. Recent correspondence and calls I have received suggests that these concerns remain.
While the Health Board struggles with the issues of facilities, staffing capital and running costs and the pressures already on Raigmore as a whole, the issue of what to do with Moray mums remains a real-time issue. It cannot continue to be kicked into the long grass as it has for so long.
What is clear to me is that whilst the maternity team can rise to the challenge it is not fair to ask them to without giving them to the correct tools. It is also very clear that until we have the facilities and resources in place then there is a real chance that we will let down and potentially jeopardise the safety of both the existing and additional mums we are trying to help.
For those reasons alone I cannot, at this time, support Moray Mums coming to Raigmore. I could do when everything is in place to receive them including; the new accommodation, the additional staffing and additional funding. I say this as Raigmore is already bursting at the seams with huge waiting lists in key surgical areas. Simply displacing these patients to accommodate others is not the way forward. What I fear the most is that the Government will force the health Board to compromise in order to achieve the investment in maternity in the Highlands that has been lacking for the last twenty years.
Simply put NHS Highland cannot do everything. There is little doubt they need to address their own shortcomings in maternity care before they attempt to help NHS Grampian address theirs.
