Health services across the country are being reviewed. In many urban areas we have been spoiled by having an acute hospital with emergency facilities in pretty much every town. This may well have included a maternity unit, a full range of surgery and medical care, and in patient children’s services. Changes though to the way in which these services are managed and delivered are a foot and there are a number of causes including government policy, changes to workforce and the numbers of hours they work, the training they need to perform their job etc.

My current job means I am now involved with the review of maternity and children’s services in this area. The things that we know are that for reasons of clinical safety we have already had to move children’s emergency and in patient services and that another hospital trust will probably be doing the same soon. We know that the maternity units which currently take place on two sites per acute trust will also need to change, so we will look at the birthing unit ideas. In consulting we will ask real people who might have a baby and try to find out if they would want to have a baby in a place where there is no onsite paediatrician or obstetrician, we will also work with clinicians to look at the potential models of care. But if it is not going to be viable either clinically or in terms of the number of delivers (i.e. financially) then it won’t happen and services will be centralised. People might not like this idea but unfortunately we have moved away from small is beautiful and we cannot adequately staff or indeed improve services in small is beautiful. This doesn’t mean that free birthers will be the winner and it doesn’t necessarily mean that more women who shouldn’t do so will have their babies at home but what it does mean is that other people and not just doctors and midwives will get the opportunity to give their opinion and influence the decision. Cynics may think that ‘managers’ will just make the decisions and consult with no one, or at least consult then do as they please anyway, but actually I don’t think they will. We might not like the government’s choice agenda but we have it and we have to get on with it.