Cumbrian ambulance boss warns maternity transfer plans are 'not clinically safe'

He also claims transfer times quoted by the Success Regime have been underestimated, that the proposals fail to meet vital guidance on emergency caesareans and even states that paramedics could refuse to transport patients if they felt it unsafe.

The News & Star has seen a copy of a letter sent by Mr Cartwright, chief executive of the North West Ambulance Service NHS Trust, to the Success Regime raising these concerns.

It is dated December 19, the final day of the Healthcare for the Future public consultation over its controversial plans to cut services and beds across north and west Cumbria.

NWAS is technically part of the Success Regime, with some of its senior staff sitting on the panel during public meetings.

But Mr Cartwright's letter reveals that the ambulance service does not support all of the preferred options put forward - and has particular reservations about the plan to centralise maternity consultants in Carlisle, leaving only a midwife-led unit in Whitehaven.

In it he states: "The trust does not believe this option delivers a clinically safe transfer package for high acute cases.

"We are also concerned that the transfer times within the consultation document have been underestimated. A blue light transfer between

West Cumberland Hospital (WCH) and Cumberland Infirmary Carlisle (CIC) is, on average, 50 minutes travel time.

"This does not take into account end to end time, eg. a patient in community outside of WCH, eg. Seascale, which could take in excess of one hour, or the timing of when the midwife considers escalation is appropriate for the patient. The transport time to Carlisle is vastly greater than documented in the consultation."

He added that it also breaches national safety guidelines.

"We believe that from the moment a decision is made for a pregnant patient to be transferred, the whole process will far exceed the NICE (National Institute of Clinical Excellence) guidelines for emergency caesareans which are 30 or 45 minutes, and no risk management plans have been identified for this eventuality."

Mr Cartwright is also worried that paramedics do not have the skills to deal with the high-risk patients being transferred.

"We also have concerns that the potentially-required medical interventions will be outside of the scope of paramedics. This would be exacerbated if the correct clinical skill set was not available to travel with the patient," he said.

The Success Regime has previously used Wales as an example of a dedicated ambulance being used to transfer women in labour large distances. Mr Cartwright said his staff have visited the area but are still concerned about the use of paramedics in these cases and who would take responsibility for patients during transfer.

"It should be clearly understood throughout this exercise that if a paramedic is presented with a patient who sits outside of their scope of practice they are absolutely within their right to decline to transport them," he warned.

The rise in demand for ambulance services could also impact on emergency cover across the county.

"It should also be noted that due to the rising demand in multiple transfer requests, once a dedicated vehicle was committed, it would then impact on domestic cover and should there be a significant rise in volume, this may result in a delayed response for any additional emergency transfer requests.

"Additionally if high risk patients in deprived areas do not have transport or access to transport to self-mobilise to Cumberland Infirmary Carlisle for their birth, the trust will be asked to provide transport to the consultant-led unit which could again potentially affect domestic cover and our ability to respond," he added.

"Although work has continued to take place since the consultation document was issued, no satisfactory conclusions have yet been reached in terms of how the clinical risk or governance arrangements for this type of transfer work will be managed."

David Atkinson, of health union Unison, said the letter expresses some of the concerns members working across NWAS have raised with them and praised the chief executive for flagging them up.

"We are pleased that NWAS are recognising these concerns in this letter and hope they are being listened to," he said.

An NWAS spokesperson said: “NWAS is a supportive contributor to the Success Regime and has been fully involved in the recent public consultation exercise. The concerns contained within the NWAS consultation submission related to the clinical support arrangements for certain maternity patients being transferred from the Whitehaven site to Carlisle.

"NWAS is assured by the work undertaken jointly to address these points and will continue to fully engage with colleagues from the Acute Trust and wider Regime to work through the finer details of the various consultation options in close partnership.

“Now assured, NWAS fully supports the stated preferred approach set out in Option 2 of the consultation document in relation to maternity services.”