Richard Hallett and Linda Turner, UK trustees of the National Childbirth Trust who are both on the steering group of Birth Centre Network UK, which represents community midwife-led maternity units, give a personal view on the threat to the maternity units.

THE announcement that Kennet and North Wiltshire Primary Care Trust want to close the Devizes and Malmesbury maternity units is the result of several years of their hidden centralisation agenda.

Distant desk-based directors have finally shown their antagonism to these precious community services that local women value because they are just that local.

Maternity users and experts elsewhere will look on in disbelief as a flagship service is brutally dismantled.

These local community units are the envy of Britain, receiving national and international acclaim, but successive local health managers totally fail to appreciate them and continue to undermine them.

Other small units in the country that had low numbers have positive and active commissioning trusts that made local units widely known and encouraged their use.

With the growing popularity of midwife-led care, similar units managed to double or even quadruple activity levels, but no effort has been made by Kennet and North Wiltshire PCT who have preferred to run these units down.

Already a senior midwife from Malmesbury has left to work elsewhere simply because of the uncertainty created by the PCT over the future of the unit.

They then claim they have to close for economic reasons. And they do not even get the economics right.

Are they totally oblivious to the recent work on maternity costing by the NHS Confederation? Why do they rely on bed occupancy as a measure of efficiency? Bed occupancy is relevant only when providing for sick people who are bed-ridden. Pregnancy is not an illness. Nowadays women deliver their babies almost anywhere, except on a bed.

If beds are too costly and they need to increase bed occupancy (which is what they say) then they should be removing two or three in-patient beds (and using them for other hard- pressed services!) rather than using cost as an excuse to close the whole local service.

Unbelievably they have allocated other unspecified costs to these small units in order to ensure they look uneconomic. These other unspecified costs are £228,300 for Malmesbury and £255,100 for Devizes per year.

No-one at the units knows what these costs represent and when challenged the trust have been unforthcoming except to say that it includes such things as management and shared services consortium charges. Most of this is an allocation of central costs to the local units and, not surprisingly, the trust are unprepared to provide a detailed breakdown.

Small maternity units are by their nature inexpensive, being simple, uncomplicated, needing minimal facilities. The Department of Health's midwife-led care pilot project at Edgware in London was significantly cheaper than large hospital care.

The largest cost in a midwife-led unit is midwife salaries. In both Malmesbury and Devizes the trust shows nursing and midwifery staffing costs are 94 per cent of the total direct costs.

The nationally used BirthRate Plus evaluation shows that Wiltshire units are not over-staffed.

What the PCT don't want to tell us is that, to cut costs, midwife jobs will go. If they deny that, well then let midwives work where women are in local units!