Memorandum submitted by the Royal College of Midwives UK Board for Wales (CBPS 93)

1. The Royal College of Midwives aims to promote and advance the profession of the midwife. The College represents over 95% of the UK's midwives and is one of the world's oldest and one of the largest midwifery organisations. It is also a trade union. We have offices in London, Leeds, Edinburgh, and Belfast, as well as in Cardiff.

2. The College's evidence has a specific focus on Powys. We believe that cross-border issues have a particular importance to the maternity care provided there, not least because of the length of its border with England. We further believe that policymakers must continue to facilitate cross-border cooperation and enable it to take place, as examples like Powys demonstrate that it can have positive local effects. We have kept our evidence short to maintain its sharp focus.

3. We recognise of course that cross-border issues affect North Wales too. In that part of Wales however, transfer to England (from Bangor to Liverpool, for example) will involve a much smaller proportion of women that in Powys. Furthermore, it tends to be for neonatal reasons, rather than for childbirth; that stated, women there may also travel to England for some aspects of antenatal care as well as very specialist high-risk maternity care.

4. There is no district general hospital anywhere in Powys, so women at medium or high risk are often transferred to hospitals in England to receive that level of obstetric care. Not all such women are transferred to England; depending on where they are, they may also be transferred, within Wales, to either Gwent to the south or Ceredigion to the west.

5. What makes Powys different from North Wales is the large proportion of women who transfer for obstetric care to England.

6. These transfer arrangements allow for managers and midwives in Powys to concentrate on providing a midwifery service over a large rural area, which promotes normality in pregnancy and birth. It is the arrangement the local NHS has with the neighbouring English trusts that allows it to pursue its valuable work.

7. Midwives in Powys rotate to district general hospitals across the border to update their practice and to ensure their continuing professional development. This means that when Powys midwives accompany a woman transferring to an English hospital, they know the relevant policies and procedures, and may even know the staff, which can only have a positive impact on the experience of the woman being accompanied.

8. If barriers were to be created between England and Wales in a way that made such cross-border arrangements untenable then that would not serve the best interests of women in Powys. Barriers could be intentional, if either the UK Government or the Welsh Assembly Government sought for whatever reason (e.g. to resolve funding disputes) to limit cross-border cooperation; barriers could also be unintentional, perhaps purely as a result of 'devolutionary drift' if health policies in England and Wales were to diversify so markedly as to become incompatible.

9. If such barriers limited cross-border services to the extent that the current arrangements for Powys were curtailed, the excellent rural midwifery services currently offered to women in the county would probably have to be cut back so that funds could be transferred to pay for obstetric care locally. That would be unfortunate, especially as rural services are already under threat across the board.

10. We recommend that the UK Government and the Welsh Assembly Government actively monitor the ability of NHS healthcare providers, including NHS maternity care providers, along the border to cooperate in the provision of NHS care; we further recommend that they take no action that deliberately threatens such cooperation, and that they actively consider and assess what impact future health policies may have on cross-border cooperation, so that such impacts can be minimised.

June 2008