Britain's already pathetic maternity services to be cut even further

Plans to downgrade maternity units in four London boroughs and other parts of the country are unacceptable and will deny women choice in how and where they give birth, leading midwives have said. Maternity services in Bexley, Bromley, Greenwich and Lewisham are underfunded and shortstaffed, with an overspend predicted to be 57 million pounds a year by 2010-11.

However, the Royal College of Midwives said that it has “significant reservations” over plans to cut costs by closing at least one – and probably two – maternity units and providing more home births and deliveries by midwives. The planned changes mirror proposals in other parts of the country, with maternity units in Greater Manchester, Teesside, and Oxfordshire already earmarked for radical overhauls.

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Complaints against doctors to go public in NSW (Australia)

Long overdue. Better something than nothing. The public have had only the illusion of protection so far

Complaints against doctors will be aired at open hearings chaired by lawyers under landmark legislation to smash the code of secrecy surrounding rogue operators such as the "Butcher of Bega". In the fallout from the Bega case, where Dr Graeme Reeves is accused of mutilating hundreds of women, the NSW Government will today announce an unprecedented overhaul of the medical regulatory system. It means doctors will no longer be able to escape scrutiny by appearing at closed and confidential hearings presided over by fellow medics. The laws will include:

* A "guillotine provision" that automatically bans any doctor who breaches conditions on their practice;

* New powers for the NSW Medical Board to urgently suspend a doctor to protect the lives or health of patients;

* Making Professional Standards Committee (PSC) hearings open to the public and publishing findings;

* Employing non-medical personnel to help decide on disciplinary action against doctors, with a legal representative as chairperson;

* Forcing doctors by law to report colleagues they believe have engaged in sexual abuse, drug or alcohol intoxication or other serious misconduct;

* Requiring the NSW Medical Board and the Health Care Complaints Commission (HCCC) to consider all patient complaints, even after a doctor has been struck off;

* Ordering professional disciplinary bodies to examine doctors' overall "patterns of conduct" rather than on an individual complaint basis.

In an exclusive interview with The Sunday Telegraph, NSW Health Minister Reba Meagher said doctors will face more scrutiny than ever before. The new legislation will be presented to parliament early next month. It comes in the wake of revelations about Reeves, the disgraced ex-gynaecologist and obstetrician who allegedly mutilated and abused hundreds of women across NSW without detection by authorities for more than a decade. "The Reeves case challenged public confidence in the way the medical profession was being regulated and disciplined," the minister said.

But the proposals have met a lukewarm response from the medical profession. Dr Andrew Keegan, president of the Australian Medical Association (NSW), doubts they will make a lot of difference and is concerned about practicalities. "Frankly, lay people and legal people are not going to understand (medical details at PSC hearings), so you need a medical person there," he said. "Doctors need to have guidance on reporting colleagues - you can't work on hearsay. "The other thing we know is what we are told by patients is not always reliable." But Dr Rosanna Capolingua, president of the Federal AMA, supported the laws, which she said "enshrine existing professional and ethical obligations".

For the first time, anyone will be able to attend PSC hearings into alleged professional misconduct by doctors. "At the moment, it's assumed the (hearings) will be heard in private - we say it's going to be the other way around," Ms Meagher said. Legal and non-medical representatives will be introduced in a bid to overturn the system of "doctors regulating doctors" and improve objectivity.

Doctors who fail to raise the alarm about colleagues who have committed serious misconduct may face "failure to report" penalties themselves,ranging from counselling to being suspended or struck off. Those who make a report must have good grounds and will be granted immunity from defamation but will not gain anonymity. Under the "guillotine provision", the Medical Board will be able to immediately suspend or deregister a doctor who breaks rules of practice. It took the Board 20 months to deregister Reeves after discovering he was breaching an obstetrics ban - during which time he was able to treat other patients.

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