The pressures on Glasgow's maternity services are causing serious concerns for clinicians who have told Greater Glasgow's NHS Board that the city cannot any longer sustain three maternity hospitals.
Pressures on the midwifery, obstetric, neonatal and anaesthetic workforces are such that change is essential.
The city must now decide which is the best option for Glasgow's two remaining maternities to flourish and serve the best needs of mothers-to-be.
Obstetricians and professional health colleagues are spreading their skills too thinly over three sites to maintain round-the-clock services at a time when birth rates are dropping dramatically.
Greater Glasgow NHS Board Chairman Sir John Arbuthnott sees it as essential that a transparent and effective consultation process is taken forward with independent, expert and lay input to weigh up the options available to the Board.
Sir John said: "We want to deliver the best quality maternity services for mothers and children and to be able to retain and attract high quality staff. Over the next three months a Working Group, independently chaired will, with close involvement with the Maternity Services Liaison Committee (a group bringing together clinical, professional and consumer interests) comprehensively review and provide advice to the NHS Board on how to provide modern, safe and sustainable maternity delivery services for our population as the final stage of implementing of the Maternity Services Strategy. In October, after the NHS Board has considered the Working Group's recommendations, the formal consultation process will be fully launched.
"By early 2004 the consultation will have concluded and recommendations will come before the Board of NHS Greater Glasgow for a final decision."
Dr Kevin Hanretty, Chair of Greater Glasgow's obstetric and gynaecological sub committee, said: "Rationalisation to two sites would permit better use of the skills of consultant obstetricians, neonatologists, anaesthetists and a highly skilled midwifery workforce whose recruitment and retention is essential for the safe delivery of Glasgow's babies.
Dr Hanretty, a consultant obstetrician based at the Queen Mother's Maternity, added: "New modern maternity methods have dramatically reduced the length of hospital stay for new mums with more and more care being offered at home or in elsewhere in the community. It is necessary to deploy resources more effectively and concentrate medical resources on two sites to provide the very highest of safety standards for mothers and newborn babies."
Almost two years ago, after widespread consultation with women's groups and medical professionals, it was agreed Glasgow needed to switch to two first class modern maternity hospitals.
Dr Hanretty commented: "The case was strong then ... and it is even stronger today as the reduction in the numbers of deliveries in recent years is so great that maintaining the high staffing levels mandated by the European Working Time Directive and the New Deal for junior doctors is both expensive and potentially detrimental to training over three sites."
Since then the Princess Royal Maternity has opened. It has the potential of handling 6,500 of the current complement of around 11,000 births delivered in Greater Glasgow.
It is anticipated the birth rate will continue to fall.
Dr Hanretty said: "Today the consultation process gets underway to decide whether the Queen Mother's maternity at Yorkhill or the Southern Maternity at the Southern General is the best option.
"The current sites for safe delivery at both hospitals do not lend themselves to modern obstetric and midwifery practice and substantial modernisation is required."
There are strong clinical cases to be made for each. The Queen Mum's, as it is affectionately known, is located next to one of Britain's best children's hospitals. The Southern is beside one of the finest equipped general hospitals in the land.
The city has been waiting far too long for a total modernisation of hospitals ... perhaps the reason the people of Greater Glasgow have had to wait so long has been territorial rivalry. This is still evident as we prepare to witness the most revolutionary change in hospital provision any city in Britain has ever seen.
The city is currently modernizing all hospital and service provision with the new Royal Infirmary, massive investment in at Gartnavel General, a total re-build of Gartnavel Royal, the creation of a world-class purpose built West of Scotland Cancer Care Centre - a new Beatson - on the site of Gartnavel, new build psychiatric hospitals on the site of Stobhill, and two state-of-the-art walk-in walk-out hospitals at Stobhill and next to the existing Victoria Infirmary.
These developments represent a massive £700m investment in Greater Glasgow's health.
While modern methodology points to locating children's services, adult specialties and maternity provision on the one site, this is not an option for at least 15 years.
Irrespective of the decision which the Board finally takes about maternity services Yorkhill's Royal Hospital for Sick Children will continue to serve as a centre of excellence serving the West of Scotland for at least the next 15 years.
and published in NHS staff newsletters and publicly distributed newsletters.www.nhsgg.org.ukAll opinions and views will be made available through public involvement networks, Greater Glasgow's website