Maternity services across the UK need a radical rethink, the Royal College of Obstetricians and Gynaecologists says.
It wants the number of hospital units cut to ensure 24-hour access to care from senior doctors and says more midwife-led units are needed for women with low-risk pregnancies.

The National Childbirth Trust welcomed the report but says the proposals do not go far enough.

NHS managers said maternity care desperately needed to be reorganised.

Too many babies are born in traditional hospital units, says the college, which also warns the current system is neither acceptable nor sustainable in its report on maternity care.

The college estimates there are about 1,000 too few consultants to provide adequate round-the-clock cover for hospital units.

Dr Falconer said: “There is no doubt if you look at the worst scenario of serious complications, you need the right person, a senior person, there immediately.”

Previous attempts to re-organise maternity care around a smaller number of hospital units have proved controversial, but Dr Falconer said if women could be convinced of the greater safety they would be prepared to travel to have their babies.

The need for change would be largely in cities or large towns, because in rural areas it might be more important to support smaller units.

The report estimates that across the UK there are 56 units with fewer than 2,500 deliveries of babies a year.

In order to take the pressure off busy hospitals, the college is also calling for an increase in the number of midwife-led units.

Midwives have welcomed the report, saying it could improve the experience for about a third of women who have straightforward deliveries.

The proposals for maternity are part of a wider vision of delivering all women’s gynaecology and obstetrics care in networks, similar to the model which has helped improve cancer treatments in England.

The National Childbirth Trust said the idea of having a network to provide joined-up care for women was one it could support but it would prefer care during pregnancy and maternity to be concentrated in one NHS organisation in each area.

The NHS confederation, which speaks for managers, described maternity care as a classic example of a service which desperately needed to be reorganised.

Chief executive Mike Farrar said politicians needed to be prepared to speak up for change.

“Where the case for change is clear, politicians should stand shoulder-to-shoulder with managers and clinicians to provide confidence to their constituents that quality and care will improve as a consequence of this change.”

Although Scotland has reorganised some of its maternity services, there are likely to be pressures for change elsewhere in the UK.

In North Wales maternity care across three hospitals is expected to change after an initial review recently concluded improvement was needed.

From: http://www.bbc.co.uk/news/health-14145862

Some women keep smoking through pregnancy just because they want to give birth to a smaller baby, according to British researchers.
Even though most women now understand there is “overwhelming evidence” that smoking during pregnancy is harmful to the developing child, they continue to do so, said Professor Nick Macklon of Southampton University.

He told the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Stockholm: “It is important that people who believe that a smaller baby means an easier birth take into account the increased risk of complicated deliveries in smokers, as well as the risk of disease later in life which goes with low birth weight.”

“Smoking during pregnancy is not just bad for the mother and baby, but for the adult it ill grow into.”

He and a team at the university’s department of obstetrics and gynaecology have now produced what he called the first “hard evidence” that women who stopped smoking upon discovery they were pregnant, could protect their unborn children from harm.

The study looked at over 50,000 pregnancies in the Southampton area, analysing the birth weight of the babies and comparing this to self-reported smoking behaviour.

Those who continued to smoke through pregnancy had lower weight babies.

The more women smoked the lighter their babies were: those who smoked more than 10 a day had babies weighing some 11oz (300g) less than the average birth weight from a non-smoking mother, of about 7lb 10oz (3.45kg).

However, those who ceased smoking at about the time they conceived were just as likely to give birth to a normal weight baby as those who had never smoked.

He said: “We can now give couples hard evidence that making the effort to stop smoking in the periconceptional will be beneficial for their baby.

“Stopping smoking can ameliorate these detrimental effects.”

This could help change behaviour among smoking mothers, which he said had hardly changed in Britain over the last decade.

Prof Macklon explained that smoking during pregnancy “affects the transportation of nutrients, especially oxygen, across the placenta”.

It was also “reasonable to assume” that some of the 4,000 or so toxins in cigarettes were harmful to foetuses.

http://www.telegraph.co.uk/health/healthnews/8623267/Mothers-to-be-smoking-for-smaller-babies.html

Pregnant women were denied the seasonal flu jab in some parts of the UK, before swine flu began claiming more lives, because not all GPs were aware that mothers-to-be had been made a priority group to receive the jab this winter.
Louise Silverton, deputy general secretary of the Royal College of Midwives, told the Guardian that a number of pregnant women had been refused the vaccine by family doctors in autumn.

“In October, when GPs started telling patients to come for immunisation, some pregnant women got it and some didn’t. GPs sent some of them away because they thought they didn’t need it, because no one had told them that pregnant women had been added to the list of groups of people considered ‘at risk’,” she said.

Research shows pregnant women are four times more likely to develop serious complications if they catch H1N1 swine flu, which is the main strain of seasonal flu circulating this winter. There has been concern that takeup of the jab protecting against all three strains of flu has been low among pregnant women.

Silverton also criticised the decision by the health secretary, Andrew Lansley, to cancel the usual advertising campaign intended to prompt the 16 million Britons classed as vulnerable to have the jab.

“It was short-sighted of the Department of Health not to have the usual campaign, she said. “It was done to save money. I agree with the government’s overall aim of reducing government advertising, but they should have been more selective and kept the campaign for all at-risk groups.

“Usually there are posters on buses and all sorts, but this year there was nothing. It was a wasted opportunity not to have the awareness campaign stressing the importance of people in at-risk groups being vaccinated.”

A majority of the 50 people to die from flu so far this winter had not had the three-in-one jab at least two weeks before falling ill, the Health Protection Agency said.

The outbreak has so far claimed 50 lives and left 783 people in intensive care, amid vaccine shortages and low takeup rates of the seasonal flu jab.

From:  http://www.guardian.co.uk/pregnant-women-flu-jabs-midwives

The HFEA was one of 192 quangos listed for abolition in October as one of the coalition’s flagship money saving initiatives. Three months after the formal announcement of its abolition, the authority is continuing its work and gently fighting a low-key, behind-the-scenes battle for survival.

Its office does not have the aura of a body that has been freshly culled. Staff are preparing for a general meeting in Cardiff, where the 2011-12 business plan will be agreed. Inspectors are reviewing recent inspections of IVF clinics. Employees are still pinning crayoned pictures by their children above their workstations and watering the plants.

A parliamentary committee’s withering conclusion last week that the government “botched” its mission to “reduce the number and cost of quangos” is met with no surprise by staff here, who remain bemused by the decision to close down their organisation.

News of the HFEA’s planned closure, and distribution of its functions to other organisations, has been greeted with dismay by doctors and research scientists, who warn that it threatens the government’s ability to make sound decisions about crucial ethical issues.

Of all the dull-sounding, bureaucratic bodies crossed out in a pen stroke last October, the HFEA has the least arcane function. Responsible for inspecting and regulating IVF clinics, it also deliberates on the ethical boundaries of creating life and using embryos for research, a sector that is developing with rapacious speed.

Anyone planning to undergo fertility treatment in the UK depends on the HFEA to ensure that clinics are safe. Children who have been born as a result of donated sperm or eggs may want to turn to the organisation to discover information about the donor.

Practitioners rely on the body to help set out moral guidelines: is it ethical (to give one example under consideration at the moment) to allow a woman to use frozen embryos left to her by her grandmother, which would result in her giving birth to her own aunt or uncle?

The HFEA’s chair, Professor Lisa Jardine, the high-profile and outspoken academic, has reined in any personal impulse towards protest or defiance, and is mounting a delicate campaign to ensure that the organisation can be preserved.

She insists that her job is to comply with what the government has ruled, but makes it clear that she will be working to promote an alternative, which would see the HFEA continue broadly unchanged, swept into the folds of another government-run organisation.

“It’s the most controversial area of medicine, apart from assisted dying. It’s the most morally difficult area, it’s the most carefully legislated-for area, and the most tightly regulated area. I’m totally committed to doing this job of regulating assisted reproduction, above all IVF and research on embryonic tissue,” she says. “My only aim is to keep doing that until someone else can do it properly.”

She believes the HFEA was included on the list of quangos to be abolished by accident. “I feel very passionately that this is a mistake,” she says, stressing that no steps have been made towards closure. “We’re nowhere near. We haven’t even started.”

Provisional Department of Health plans indicate that the HFEA’s functions are to be transferred and split between other DH bodies. None of the 79 staff members know whether they will keep their job when the quango is wound down, nor when that might happen. Employees, from computer technicians to policy experts, seem united in their loyalty to the organisation, and voice anxiety not only for their own job security, but for the ability of a restructured HFEA to perform the range of services it was created to provide. The staff are civil servants, not inclined towards intemperate expressions of outrage. Instead, their laments cautiously warn that the proposed course of action may prove to have been ill-advised.

In a side room in the quiet central London office, Peter Thompson, the HFEA’s director of strategy, says staff had not expected the body to be scrapped, because as recently as 2008 parliament had debated its role and there had been “almost no voices at all saying this organisation ought to be abolished”.

He says: “Having had that endorsement in 2008, from all sides of parliament, to have this decision only two years later did come as a bit of a shock”

At the last authority meeting the governing body agreed it was a “very difficult” process for staff and “asked that efforts were made to minimise their stress”. Someone has cut a slit out of an empty cardboard box, and stuck a label on it marked “Worry Box”, inviting colleagues to post their concerns.

“My job as one of the senior people here is to lead and manage people through that uncertainty. Keeping our focus on doing the job well, maintaining morale, keeping people’s spirits up,” Thompson says.

The bonfire of the quangos appeared to herald a straightforward, hard-nosed money-saving exercise. The reality is much messier. Only a few bodies are to be closed outright. The others will have their functions transferred to new bodies, at some uncertain point in the future.

Cabinet Office minister Francis Maude insisted last week that the axing would save “significantly more” than £1bn. However, the public administration select committee warns that the “current approach is not going to make significant cost savings or result in greater accountability”.

Ian Magee, a senior fellow at the Institute for Government (IFG), and co-author of Read Before Burning, a report into the closure of the quangos published last year, says that unless the functions performed by the organisations are also abolished, very little money will be saved.

“It’s not going to contribute much to the budget deficit reduction,” he says. Closing down quangos is a complex process, he adds. “You can’t just turn the tap straight off.”

Maude is confident that the correct decisions have been made. “We think the process has gone pretty well. All three parties fought the election with a commitment to reducing significantly the number of quangos. There is a uniform view across the political spectrum of the desirability of doing so,” he says.

On the decision to wind down the HFEA, he adds: “You have a very complicated landscape of health regulatory bodies. The view taken by the health minister was that there is scope for simplifying that operation and making it a much more efficient and streamlined operation.”

The government has said that the HFEA will continue working “for the time being”, but that its functions will be transferred by the end of the current parliament. Government officials are examining the “practicalities (and legal implications) of how to divide the HFEA’s functions between a new research regulator, the Care Quality Commission and the Health and Social Care Information Centre”.

But the announcement was so confused when it was made that many people – staff included – thought the closure would be immediate. On the HFEA’s website a notice states prominently: “You may have seen reports in the press that the HFEA ‘has been abolished’. This is not so.”

The notice points out that the government cannot scrap the HFEA without first introducing new legislation.

“At the moment, we have no – literally zero – idea of what the Department of Health plan is,” Jardine says.

With such a delayed death knell, staff were uncertain whether to be devastated or sanguine at the news. Paula Robinson, head of business planning, says: “The time frame was so long, I can’t say it really rocked my world. It’s not brilliant to hear that an organisation is going to be abolished, but if you hear that it is going to be a matter of years, it eases the pain. I am not sitting here wringing my hands. I am a change-friendly person.”

But one of the inspectors, who carries out regulatory checks on IVF clinics, was aghast. “I felt very worried. I have just bought my first house. My husband works for the NHS. Two jobs that are very uncertain,” she says.

In a proposal aimed at streamlining the bodies regulating medical research, the Academy of Medical Sciences today suggests that the HFEA’s research and ethical functions should be transferred to a new Health Research Agency. But any move towards splitting up its responsibilities is not welcomed by employees.

“I think that the decision ignored the fact that because all our functions are together in one body, that enables us to be a more intelligent, more efficient regulator,” Thompson says. “This body has dedicated people who know what they are doing. These are people who care about the sector they regulate and the patients. I think by having all of those functions in one place, we do a more efficient and intelligent job than by scattering those functions to other places.”

Policy manager Helen Richens leads a campaign to reduce the number of multiple births from IVF clinics. Historically, she says, doctors would transfer multiple embryos, but the health risks to the mother and the embryos were very high. Now, if the woman is under 40, doctors can transfer no more than two embryos; over 40, no more than three. The HFEA has imposed a 20% maximum multiple births target on each of the country’s 138 clinics, enforced with the threat of losing a licence.

“One of the reasons we are good at this is that we have the policy staff and inspectors, who are going and seeing what is happening; we hold all the data on all the fertility treatment in the UK, we can analyse it and monitor it, so when we make policy it is proper, evidence-based policy,” she says. “We will be moving from a world-leading model to something that is a less than gold-standard regulatory model.”

She adds: “I think I feel maybe a bit unappreciated. You do your job well, other countries look towards us … there is a collective feeling, what is the point of moving us on, breaking us up? It is not going to save money. If there isn’t a measurable benefit, what is the point of getting rid of this quango?”

The HFEA has an annual budget of £7m, only £2m of which is provided by the government; the remaining £5m is funded by the clinics, which pay to be regulated. The body charges clinics, both private and NHS, £104 for an IVF cycle and £52 for donor insemination.

Jardine, who has just been reappointed for a three-year term, hopes to be able to trim the amount needed from the government to around £1m. “There will be additional expenditure. There will certainly be no saving,” she says of the planned abolition. “We are incredibly cheap.”

Collectively, the senior management have taken a clear decision not to campaign noisily against closure. They point to the unsuccessful campaign mounted to save the UK Film Council, whose demise was announced at the same time. Despite the appointment of a PR adviser and the involvement of director Steven Spielberg, the abolition went ahead.

Instead, they set out the value of their work.

“Any couple can walk into any clinic in the British Isles and know that their IVF or other reproductive treatment has been fiercely vetted and that they will come to no harm. No person walking into a plastic surgery clinic has that assurance,” Jardine says.

Supporters of the decision argue that as IVF has become much more common in the 20 years since the HFEA has been operating, there is less need to regulate it so closely. Jardine disagrees.

“IVF is not routine. There are people out there who still think that we shouldn’t be doing any of what we are doing. Some of them have seats in the House of Lords.”

The issues are too ethically and politically explosive to be dealt with by politicians, she argues. “There are too many pressures on parliament, and civil servants are not trained to deal with those kinds of issues. I believe that these morally fraught issues must be held at arm’s length from government.”

http://www.guardian.co.uk/politics/2011/jan/10/battle-life-ivf-regulator-hfea

Nearly £200,000 in compensation has been paid to women who have become pregnant or been hurt after they were fitted with a popular contraceptive implant.

The NHS has received more than 1,000 complaints about Implanon, a device that had been hailed as the future of family planning.

The procedure involves injecting a plastic implant under a woman’s skin, which releases the “pill” hormone progesterone, guarding against pregnancy for up to three years.

The procedure is regularly given to under-16s who are not deemed responsible enough to remember to take oral contraceptives on a daily basis.

Figures obtained by Channel 4 News show that 584 women who had the hormone-filled tube inserted into their arms have reported unwanted pregnancies to the Medicines and Healthcare Regulatory Agency.

There have been a total of 1,607 complaints about scarring and other problems associated with the device, the majority made by doctors and nurses who claimed it was difficult to insert properly and could not be checked afterwards. In the most serious cases, NHS Trusts have offered settlements to seven women totalling nearly £200,000.

Some women who took Implanon terminated pregnancies and suffered the breakdown of relationships.

One woman, named as Lara, said her marriage collapsed due to the stress. “I don’t want kids at this time. It really disturbed me,” she said.

MSD, which manufactured the implant, said it was replacing Implanon with a new contractive implant named Nexplanon.

In a statement, it added that the active ingredient would remain the same but, unlike Implanon, the new implant would show up on X-rays and CAT scans. The applicator has been modified, the company said.

It added that a training programme was available for health professionals involved in fitting the devices.

Family planning clinics in England have reported rapidly increased use of contraceptive implants, from 16,000 women in 2005 to nearly 82,000 in 2010. Implanon, which cost £90 per treatment, was more than 99 per cent effective.

A spokesman for the MHRA said: “The reports we received from health care professionals and consumers played a strong role in the update of the device.”

From: http://www.telegraph.co.uk/Women-win-200000-payout-over-pill-implant-pregnancies

Midwives have criticised the postcode lottery in maternity care after official NHS figures revealed caesarean rates are twice as high in some hospitals as others.
In some cases even neighbouring hospitals have widely varying rates of caesarean section, revealing that it is not necessarily down to the characteristics of the local population.

The proportion of women having their first antenatal appointment within the first 12 weeks of pregnancy varies 11-fold, according to the data published by the NHS Information Centre.

This may be due to women recognising that they are pregnant later but also reflects on how well organised services are.

The figures show that almost nine in ten women were seen in the first 12 weeks at the Royal Cornwall Hospitals NHS Trust compared with less than one in ten at Walshall Hospitals NHS Trust in 2009/10.

Similarly more than three in ten women had a caesarean birth at Imperial College Healthcare NHS Trust, in London – twice as many as at Shrewsbury and Telford Hospital NHS Trust in Shropshire.

However the variations cannot be completely explained by deprivation as neighbouring hospitals will had large differences in rates.

At Rotherham NHS Foundation Trust 87.6 per cent were seen in the first 12 weeks, five times higher than in neighbouring Barnsley Hospital NHS Trust where 17.2 per cent were seen.

There were twice as many caesareans at Hereford Hospitals NHS Trust than at nearby Shrewsbury and Telford.

Nationally more women are being seen within the first 12 weeks in 2009/10 compared with the previous year and the caesaearan section rate has remained for the last year at around one in four of all births, the majority of which were conducted as emergencies.

The figures show that the proportion of births delivered by doctors instead of midwives has increased from less than one in four in 1989/90 to almost four in ten in 2009/10, as a result of more caesarean and instrument deliveries due to greater numbers of older and obese mothers giving birth.

Tim Straughan, Chief executive of The NHS Information Centre, said: “The figures show that the experience women have of NHS maternity care varies markedly across the country and even within regions.

“Rates of caesareans and access to antenatal assessment in the first 12 weeks of pregnancy vary according to which hospital they use.

“In some trusts, there may be specific demographic or clinical reasons that explain why they carry out, for example, more caesareans. But others will need to examine closely the full range of reasons why their rate is different from the national average of about one caesarean delivery for every four deliveries.”

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM), said: “These results show that there is a postcode lottery when it comes to maternity services, and this is worrying when those services are part of a ‘national’ health service. Women should expect and receive high quality care wherever they live, not care that is based upon chance and plain old good luck.

“Superficially the huge variations revealed in this report are a concern and further analysis is needed to find out why they are occurring.

“The variation on the first antenatal booking is astonishing and those on caesarean section rates – already widely known – are worrying in their persistence at such a level.

“Midwives are the experts when it comes to normal births and will deliver the vast majority of women having their baby in this way. The fact that midwives’ involvement in birth has decreased will be reflected in the increase in caesarean rates and instrumental deliveries over the years.

“I think some of the large variations could be linked to staffing levels; as we know one-to-one care from a midwife increases the possibility of a normal delivery but I am sure this is not the whole story. It could also be related to how services are organised.

“In the statistics around intervention, maternity units need to be looking at each other’s practice to see where they can learn from each other, and make their services better for women and their babies.”

From: http://www.telegraph.co.uk/Maternity-postcode-lottery-revealed-in-NHS-figures

The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick told its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

She said: “Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government’s promise to give us more midwives.

“We’ve just done a survey of all the heads of midwifery and they’ve got vacant posts but they’re having difficulty filling them.”

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: “As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies.”

A Conservative Party spokesman said: “The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

“People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births.”

From: http://www.bbc.co.uk/news/health-11772485

New mothers are left frightened and alone after childbirth, because midwives do not have time to care for them, a major study has warned.
The report by the National Childbirth Trust (NCT) says staff shortages have left increasing numbers of mothers feeling isolated at a time when they are desperate for reassurance.

The charity’s poll of more than 1,200 first time mothers found 59 per cent did not get the “emotional support” they felt they needed after giving birth – compared with 51 per cent in a similar survey a decade ago.

Women who had undergone a caesarean section were the least happy about their experience.

Asked about the 24 hours following birth, 66 per cent said they had not received enough support, compared to 57 per cent of those who had a natural labour in hospital, and 24 per cent of those who gave birth at home.

Mothers who had gone through traumatic labours said they had been left to cry themselves to sleep, while others said overstretched midwives had no time to offer a kind word of reassurance.

In total, 42 per cent said there were not enough midwives to care for them, compared with 33 per cent, when the question was posed in 2000.

Those who gave birth at home, or in a midwife-led birth centre, were less likely to describe shortages of midwives.

The NCT findings show that despite a large investment in maternity services, and pledges from the last Government to make care “woman-centred” with a choice of where to give birth, many women are being denied even basic care.

Among the poll of 1260 first time mothers, 44 per cent said they did not even get the physical help they needed, while 55 per cent said they did not get enough information or advice in the weeks after having their first child.

Anne Fox, the head of campaigns and public policy for the NCT, said; “It’s clear postnatal care urgently needs improvement – our report paints a dreadful, shocking picture of care in the UK – we’re letting women and their babies down.

“Many of the problems these women highlight seem to be due to staff shortages or lack of visits once they had left hospital – and this issue needs to be addressed if the quality of postnatal care is to be improved, particularly for vulnerable women.

In the report, new mothers describe being “absolutely terrified” and alone during their first night in hospital, frightened to ask for help from staff who responded to them rudely.

One mother said: “As soon as the baby was born, I felt I was on my own. I spent the first night after the birth of my son in floods of tears and unable to sleep as every time I closed my eyes the nightmare of my birth experience came flooding back.

“Nobody came to check on me to see if I was OK, even though I know I was sobbing loudly and uncontrollably.”

Louise Silverton, Deputy General Secretary of the Royal College of Midwives, described the report’s findings as “disappointing,” but said the study sent a compelling message to those in charge of NHS budgets, about the need to keep investing in maternity services.

From: http://www.telegraph.co.uk/Midwives-have-no-time-to-care-for-new-mums-report-warns

A doctor who got one of his patients pregnant and then helped to arrange an abortion has been suspended from medical practice.
Stephen Carr-Bains, 56, had sexual relationships with two vulnerable patients while working at a surgery at the University of Surrey.

When one of the women fell pregnant he arranged for a termination but failed to record the details in her medical records.

Dr Carr-Bains was suspended from medical practice for a year following a two week hearing at the General Medical Council (GMC).

But he was told he would have been struck off the medical register had it not been for 49 pages of testimonials from fellow doctors, patients and friends.

The GMC heard that Dr Carr-Bains began a sexual relationship with a woman identified as Patient A in December 1995 after she visited him at the Guildowns Group Practice in Guildford, Surrey, suffering from mental health problems.

When she fell pregnant in 1999, he arranged for her to have an immediate termination, but failed to make any record of the abortion.

The GMC hearing, which took place in Manchester, was also told that he failed to put a letter from the British Pregnancy Advisory Service in her medical file and did not refer her for post-termination counselling.

In June 2003 he began a relationship with another woman, known as Patient B, who told the GMC panel, they often slept together in her university accommodation.

Both women had been suffering from mental health problems.

Andrew Kennedy, representing Dr Carr-Bains said his relationship with Patient A was one of “deep love and friendship over a long period of time”.

He added that Dr Carr-Bains had otherwise had a “blameless career spanning 32-years with no clinical concerns and utter devotion to patients and the wider profession”.

But the GMC was told Dr Carr-Bains had “abused his position of trust” to “exploit vulnerable patients”.

The panel chaired by Dr Roger Ferguson, ruled in its findings that Dr Carr-Bains’ behaviour had been “wholly unacceptable” and that he had shown a “flagrant disregard” for the doctor patient relationship.

The report read: “You exercised poor judgement in engaging in a sexual relationship with two patients registered at your practice. To this end, the Panel concluded that you have failed to maintain appropriate professional boundaries and differentiate between the importance of your role as a GP and personal relationships.”

The report added: “Your actions have shown a flagrant disregard for the importance of the doctor-patient relationship.”

But Dr Carr-Bains avoided being struck off the medical register after a large number of testimonials were submitted describing him as a “highly competent, conscientious, hard working and respected doctor”, who was “caring” and “kind”.

The GMC panel stated that his case would be reviewed shortly before the period of suspension expired.

Dr Carr-Bains became Student Medical Officer at the University of Surrey in 1999 before resigning from his post at the Guildowns Group Practice in 2006.

A spokesman for the university said the college was “dismayed” at the “breach of trust”.

The spokesman said: “Dr Stephen Carr-Bains was employed by the GP practice that supplied services to the university and our students.

“We are dismayed by Mr Carr-Bains clear breach of trust and welcome the GMC’s ruling on the case which reflects our own determination to protect and treat student patients with respect at all times, affording their safety the highest level of priority.”

From: http://www.telegraph.co.uk/Doctor-suspended-after-getting-patient-pregnant

Britain’s top GP has launched a scathing attack on widespread reckless public behaviour towards food, alcohol and cigarettes, which he claims is causing growing levels of disease and early death.
In a dramatic intervention in the public health debate, Professor Steve Field criticises parents, mothers-to-be, the very overweight, smokers and drinkers for damaging their own health, or their children’s, through irresponsible actions.

Writing in the Observer, Field, chairman of the Royal College of General Practitioners, backs the controversial call by Andrew Lansley, the health secretary, for Britons to take more responsibility for protecting their health.

“The truth is that too many of us neglect our health, and this is leading to increasing levels of illness and early death,” Field writes. Soaring levels of diabetes, much of it caused by obesity, and the medical consequences of heavy drinking, which are affecting ever-younger people, illustrate this widespread failure, he adds.

Discussion of the harmful medical consequences of ill-advised personal behaviour is curtailed because of its sensitivity, Field argues.

“Too many people do not face up to the hard facts, as they perceive them to be an attack aimed, in particular, at the poorer members of society. But it is impossible to argue on medical or ethical grounds that such behaviour is acceptable.”

While arguing for health prevention to become an individual duty and start at home, Field makes it clear that he does not want people to be left to make lifestyle changes on their own or to see personal responsibility as a total solution. Those who seek to alter their behaviour need continuing NHS and government help, he adds.

“So please don’t take offence if we [GPs] tell you to lose weight or stop smoking or drinking. You need to face facts and take responsibility. Support is out there and it could save your life – and save the NHS a fortune.”

Anne Milton, the public health minister, said greater personal responsibility was vital. Many senior doctors also agreed, but stressed that government action was needed to help create a climate in which people could swap healthy for unhealthy behaviour, such as by monitoring big food companies.

Lansley has alarmed senior doctors by saying the coalition will use much less regulation than Labour did to tackle problems such as obesity and smoking.

GPs seek to help people live healthy lives “but every day we are confronted by the harm caused by smoking, excessive alcohol consumption and the ‘tsunami’ of obesity”, adds Field, the leader of the country’s 40,000 GPs.

Irresponsible parents are damaging their children’s health by smoking around them, feeding them unhealthy food and failing to act as good role models, he says. Mothers and fathers who smoke in cars carrying their offspring – who Field says “are committing a form of child abuse” – and at home in front of their children kill more young people than do accidental injuries.

Parents who give their children unhealthy food, or serve them large portions are storing up huge problems for them, says Field. “Unless parents exert more control over their children’s diets, they are risking a lifetime of health problems, and even premature death – death before their parents, which is almost too sad to contemplate,” he adds.

Parents’ failure to safeguard their children from sunburn and using sunbeds can also lead to them developing skin cancer, he argues. Mothers who smoke while pregnant risk causing their child’s death through cot death syndrome, asthma, lung infections or house fires. Would-be mothers and women who are already expecting need to control their weight because maternal obesity can harm the mother or her baby.

Instead of becoming obese and then asking the NHS to provide liposuction or gastric bands, “it would be better if people didn’t become fat in the first place”, by eating better and exercising more.

Agreeing with Field, Milton said: “We need a new public health movement, owned by everyone, for everyone’s benefit. A movement that transforms the way in which the public’s health is improved, but also revolutionises the way we think about it. As Field points out, personal responsibility is a key part of this.”

However, Milton added: “The government recognises that it cannot force people into behaving in a certain way. But we can help people make informed decisions and ensure that they are enabled and supported to make healthy choices.”

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, agreed some parents let down their children. “Of course paediatricians agree that people should take responsibility for their own lives. But young children cannot do that. What they eat and the environment they live in are determined by their parents. There is a role for society to protect young children from promotion of unhealthy foods and passive smoking. Would all parents strap young children into a car seat if it was left to choice rather than law?”

He urged a twin-track approach of exhorting parents to care for children well but society also intervening to help by, for example, limiting advertising of unhealthy foods.

Dr John Middleton, vice-president of the UK Faculty of Public Health, said: “A significant amount of ill-health is due to people’s lack of personal responsibility. The NHS would have fewer burdens on it if people were more physically active, cut their alcohol consumption and ate a lower-fat, lower-sugar diet. The government and the NHS cannot do everything. But someone trying to give up smoking will find it easier if they get counselling and nicotine replacement therapy on the NHS, for instance.”

The government had a key role to play in promoting health, as shown by its crackdown on smoking and its fluoridisation of water supplies, said Professor Dinesh Bhugra, president of the Royal College of Psychiatrists. People who insisted on smoking despite all the warnings about it should retain their freedom to do so, he added.

But Tam Fry, National Obesity Forum spokesman, suggested Field was being naïve. “If Professor Field wants a world where everyone assumes personal responsibility, he is living a dream. He appears to have forgotten the 35-40% of our population who live in the same obesogenic environment as he does but simply can’t cope with it or have long since given up the unequal struggle. They are the people who are quite unequipped to resist the 24/24 battering of junk food promotion and are easy prey for the marketing men.”

However, “certainly the 40% of women entering pregnancy either overweight or obese do so simply because they have never had role model lessons in parenting from either their own mothers or health professionals”, Fry added.

From: http://www.guardian.co.uk/public-health-attitudes-leading-gp