Closure of the Albany Midwifery Practice

The contract between King’s College Hospital NHS Foundation Trust and the Albany Midwifery Practice was terminated without consultation, either with the midwives or with the women and families who would be affected by the closure of the service. The reasons given by King’s were ‘patient safety’ and ‘to ensure effective governance of the services it provides’. Whilst we can make no comment about the governance issues, the Albany is very concerned about the use of patient safety issues to terminate this service. In a report on the outcomes during the first ten years of the service, perinatal mortality rates were shown to be less than half those in the local borough, and other outcomes (eg Caesarean section rates, breastfeeding rates) compared extremely favourably with both local and national figures.

King’s became concerned about the Practice’s morbidity statistics, following a ‘case series’ put together in late 2008, covering a 31-month period from March 2006 to October 2008. During this period King’s claimed to have shown that the Albany’s morbidity figures were ten times those of the Trust overall. A denominator of Hypoxic Ischaemic Encephalopathy (HIE) was used to define the morbidity figures, although this is widely known to be a concerning definition because of its complex aetiology. While being aware of all of the poor outcomes during that time, the Albany has always disputed the accuracy of the statistics, and called for greater transparency about how they were collected. One of the obstetricians at King’s claimed in a Maternity Services Liaison Committee meeting that the data was ‘hand-picked’, causing great alarm amongst the users of the service who were present. Alison Macfarlane, an independent statistician, has done a critique of the case series and concluded that it would be ‘impossible to draw any inferences’ from the data presented.

King’s commissioned a report into a selected number of cases in early 2009 from CEMACH (which became CMACE in July 2009). At great expense to the tax payer, this report was finally delivered to King’s at the end of November 2009. There are some concerns that King’s also had some input into what was always intended to be an independent and confidential report. The report did not recommend closing the service, and all its recommendations were around management issues. However, almost immediately following the delivery of the report to King’s, the AMP was told that their contract was being terminated. It is important to note, however, that in spite of the termination of the contract on grounds of patient safety, jobs were offered at King’s following closure of the Practice to all of the midwives in the AMP.

Please see Articles for coverage and critiques of the closure.