Foetal pioneer's vision blinded by health board

In July of this year, the only dedicated foetal medicine unit in Scotland was officially opened at the Queen

Mother's Hospital, and was named after Professor Donald in the endeavour to continue his pioneering work. This tertiary referral service is for mothers with babies diagnosed to have a problem that will require immediate specialised paediatric treatment following delivery.

We believe that the referrals from throughout Scotland reflect the quality of the service provided at the Yorkhill site, as was acknowledged in Professor Reid's report. We are certain that the quality of the service currently provided is due solely to the fact that the maternity unit and sick children's hospital are co-located. This

ensures open access to the

multidisciplinary team of clinicians involved in the care of these families and their babies.

Professor Reid has recommended closure of the Queen Mother's Hospital and relocation of the foetal medicine unit to the Royal Infirmary. We feel that the implications of this statement must be clarified. Such a move may not affect the diagnosis and antenatal ultrasound surveillance of babies with abnormalities. However, it will ensure the following:

1. Families will no longer have easy access to the specialist counselling from the relevant paediatric specialties, for example neonatologists, surgeons, nephrologists and

cardiologists, and continuity of care will be disrupted.

2. Decision-making regarding complex cases will be hampered, and the wealth of established experience diluted.

3. Potentially-ill babies will have

to be transported across the city,

and even more worryingly around

the country.

4. Babies will be separated from their parents, sometimes in a critically-ill condition, and this separation may be protracted for the mother if she has a need for ongoing obstetric care.

5. What is already a very stressful time for parents will become even more so.

Other factors to consider are the recent recommendation that the Queen Mother's Hospital provide the national service for neonatal cardiology and foetal therapy, which will now be jeopardised. Fragmentation of this service will have grave implications for its continuance for Glasgow and Scotland. Moreover, the Royal College of Obstetricians and Gynaecologists' subspecialty training in foetal and maternal medicine, built around the current integrated service and recognised to be a successful programme, will be compromised.

It is hard to comprehend that disintegrating a service which has been built up over a number of years could be anything other than disadvantageous to those women and families whose babies have problems. Indeed, Professor Reid has recommended that in the long term the sick children's hospital and maternity services are once again co-located, which is exactly the situation that exists at present. This would appear to acknowledge that, with regard to foetal medicine services, co-location is the optimal situation. The fact that recommendations are being made that would result in a far from optimal service for these families in the interim is, we feel, difficult to justify.

Alan Cameron, Janet Brennand, Lena Macara, consultants in foetal and maternal medicine; Janice Gibson, RCOG

subspecialty trainee in foetal and

maternal medicine; Karen McIntosh, Sandra Whitelaw, Cindy Horan, Anne Byrne, specialist midwives in

pre-pregnancy counselling, prenatal diagnosis and foetal therapy, Ian Donald Foetal Medicine Unit, Queen Mother's Hospital, Yorkhill, Glasgow.

MAY I suggest, once again, with the proposed and probably imminent closure of the Queen Mother's Maternity Hospital, that the solution is also to close the Royal Hospital for Sick Children and relocate it beside the Princess Royal Maternity Hospital on the Glasgow Royal Infirmary site?

Although expensive, it will be cheaper in the long run and, more important, it will keep a unique

service intact.

Dr William O Thomson,

7 Silverwells Court, Bothwell.