关闭产科病房总是 NHS（英国国民医疗服务体系）在遭遇人员编制问题时的诱惑，而这些问题很大程度上是其自找的（《英格兰多达 20 家产科病房或须关闭，NHS 领导人警告》，10 月 19 日）。在我的地区，最大的当地产科病房的护理质量已受到质疑，让孕妇去那里碰运气似乎是一种不劳而获的回报。同样，附近一家大型医疗信托机构的新生儿护理质量也受到质疑。关闭小型病房不太可能带来预期的质量提升。
The closure of maternity units is always a temptation when the NHS runs into staffing problems, largely of its own making ( Up to 20 maternity units in England may have to shut, NHS leader warns, 19 October In my area the quality of care has already been called into question at the largest local unit, and directing mothers to chance their luck there seems to be an undeserved reward. Likewise a nearby large trust has had the quality of its neonatal care called into question. Closing small units is unlikely to provide the quality gain that is sought. The problem for the is that there is a freedom of ability to employ consultant staff.
问题在于 NHS 拥有雇佣顾问医师的自由裁量权。如果你有钱，就尽管去招聘广告。这意味着所谓更好、规模更大的病房将能够网罗所有他们想要的人才。小型病房则毫无机会。
If you have the money, get on and advertise. This means that the supposedly better, larger units will be able to hoover up all the people they want. The smaller units don't get a chance.
人们想去大型中心工作的原因是，拿同样的薪水却不用那么辛苦，也不必承担同等程度的责任。政府政策在大型中心设立专科病房，基于医学界宣扬的“规模越大越好”的信念。
The reason people want to work at big centres is because for the same pay they don't have to work so hard, or have the same level of responsibility. Government policy has created specialist units in large centres with the belief, promulgated by the medical profession, that bigger means better.
1988 年我被任命为顾问医师时，医疗信托机构尚未出现，区域卫生局负责任命，并确保高级医疗人员公平分布。不可能出现一家区域综合医院（DGH）有 20 位专科医生，而隔壁一家却一个也没有的情况。
When I was appointed as a consultant in 1988, before trusts were invented, the regional health authority made the appointments and made sure that senior medical staffing was fairly spread. You could not have 20 specialists in one district general hospital (DGH) and none in the next.
将服务集中到更少的站点对当地民众是一场灾难。如果一家区域综合医院失去产科部门，儿科将立即面临威胁。这将意味着更多儿童不得不长途跋涉就医。急诊科将失去儿科医生和妇科医生的专科支持。骨折倒还好，但脑膜炎等病症就不妙了。
Centralising services on fewer sites is a disaster for local populations. If a DGH loses its obstetrics department, paediatrics would be immediately under threat. It would mean more children would have to travel. Accident and emergency departments would lose specialist support from paediatricians and gynaecologists. Fine if you have a broken arm, not so fine if you have meningitis etc.
因此，在审视产科和助产服务的未来时，不妨考虑一下生活在该地区的人们，而不仅仅是教授们的需求。
So, when reviewing the future of obstetrics and midwifery, how about considering the people who live in the area and not just the needs of professors?
不妨计划对小型医疗单位相对过度配置人员，以确保它们能够满足所服务人群的需求，并确保新获资质的人员被引导到这些岗位？毕竟，国民医疗服务体系（NHS）是由全民买单的，所以每个人都应该享受到体面质量的医疗服务，而不必在大半夜跑50英里（约80公里）外求医。保罗·戈德温·基格利医生，西约克郡
How about planning to relatively overstaff small units to make sure that they can provide for the needs of the population they serve, and ensuring that the newly qualified are directed towards these posts? After all, the NHS is paid for by everyone, so everyone should get a decent quality of care, without having to travel 50 miles in the dead of night. Dr Paul Godwin Keighley, West Yorkshire