Sir, Amid continuing NHS reconfiguration and the proposed closure of maternity units, we are asking the Department of Health urgently to consider the recommendations in the joint report Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour released tomorrow. These recommendations have been agreed by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Royal College of Anaesthetists and Royal College of Paediatrics and Child Health.

There are increasing pressures on NHS maternity services as a result of social trends such as delaying pregnancy until a later age, increasing numbers of mothers from ethnic minorities and increasing levels of obesity among women. The birthrate has risen to its highest level since 1980. Existing resources for maternity services are inadequate and, while some local reconfigurations may be justified in the longterm, urgent action is needed to address staffing and skill shortages at a local level in current units.

A rapid response is needed to ensure that our maternity units are safe and have the expertise and resources needed to deliver high quality services. The joint report sets out the standards needed to run labour wards efficiently and effectively. We draw particular attention to the recommendation that multidisciplinary teamworking among well-trained professionals improves standards of care and women’s experiences of childbirth.

All women should have one-to-one midwifery care through labour, but many will also need urgent assistance from other members of the maternity care team such as obstetricians, anaesthetists and neonatologists.

We, as hospital consultants, want to make childbirth ever safer for mother and baby. We have the intent and the will but we also need the NHS to provide the systems and funding to do our jobs effectively.

Peter Blakeman
Bishop Auckland General Hospital, Durham
Laura Cassidy
Royal Alexandra Hospital, Paisley
Professor James Drife
Leeds General Infirmary
Paul Fogarty
Ulster Hospital, Belfast
Andrew Drakeley
Liverpool Women’s Hospital NHS Trust
Roger Giles
West Suffolk Hospital
Ashwani Monga
Princess Anne Hospital, Southampton
Patrick O’Brien
University College London Hospital
Philip Owen
Glasgow Royal Maternity Hospital
Anthony Roberts
Queens Hospital, Burton upon Trent
Philip Robin Vlies
Wrexham Mealor Hospital, Wales
Professor James Walker
St James’s University Hospital, Leeds

Sir, Nigel Hawkes is right when he comments on the interim report by Lord Darzi that the “NHS may be sick, but this won’t solve it” (Oct 5). Though the report offers hope that in future patients will receive prompt treatment from physiotherapists, today too many people do not have access to physiotherapy services at all. Those that do often have to wait weeks and months, debilitated and in discomfort or pain.

Physiotherapists have a vital and cost-effective role in delivering rehabilitation services, improving quality of life for people with longterm conditions and preventing others from developing chronic conditions which would render them unable to work and dependent on benefits. Yet there is no target to be met for physiotherapy, no measure of the value of pain relief, or of regaining independence and not having to rely on the support of family, carers or social services.

This is at a time when we have up to 2,000 unemployed physiotherapy graduates. The NHS has already paid for their education and training, and yet there are patients suffering for want of treatment by a physiotherapist. The Government needs to address these issues now, not later.

Phil Gray
Chief Executive Chartered Society of Physiotherapy

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