Bigger does not always mean better in hospital care

For some medics, working at a large centre means for the same pay you don’t have to work so hard, writes Dr Paul Godwin

The closure of maternity units is always a temptation when the NHS runs into staffing problems, largely of its own making (Up to 20 maternity units in England may have to shut, NHS leader warns, 19 October).

In my area the quality of care has already been called into question at the largest local unit, and directing mothers to chance their luck there seems to be an undeserved reward. Likewise a nearby large trust has had the quality of its neonatal care called into question. Closing small units is unlikely to provide the quality gain that is sought.

The problem for the NHS is that there is a freedom of ability to employ consultant staff. If you have the money, get on and advertise. This means that the supposedly better, larger units will be able to hoover up all the people they want. The smaller units don’t get a chance.

The reason people want to work at big centres is because for the same pay they don’t have to work so hard, or have the same level of responsibility. Government policy has created specialist units in large centres with the belief, promulgated by the medical profession, that bigger means better.

When I was appointed as a consultant in 1988, before trusts were invented, the regional health authority made the appointments and made sure that senior medical staffing was fairly spread. You could not have 20 specialists in one district general hospital (DGH) and none in the next.

Centralising services on fewer sites is a disaster for local populations. If a DGH loses its obstetrics department, paediatrics would be immediately under threat. It would mean more children would have to travel. Accident and emergency departments would lose specialist support from paediatricians and gynaecologists. Fine if you have a broken arm, not so fine if you have meningitis etc.

So, when reviewing the future of obstetrics and midwifery, how about considering the people who live in the area and not just the needs of professors?

How about planning to relatively overstaff small units to make sure that they can provide for the needs of the population they serve, and ensuring that the newly qualified are directed towards these posts? After all, the NHS is paid for by everyone, so everyone should get a decent quality of care, without having to travel 50 miles in the dead of night. Dr Paul Godwin Keighley, West Yorkshire