A health watchdog warned Northern Devon Healthcare Trust that urgent action needed to be taken to guarantee the long term safety of Barnstaples maternity unit. A letter from the Royal College of Obstetricians and Gynaecologists (RCOG), which the Gazette has seen, was sent to the trust in October following an inspection of the unit at North Devon District Hospital. The trust had invited the RCOG to review recent clinical incidents at the unit and it made a series of recommendations, which the trust says were implemented immediately. No details were given about the incidents. In the letter to medical director Dr George Thomson, the RCOG said: During the interviews staff made frequent reference to two further incidents, one of which has occurred very recently and had not yet gone through the formal review process. This raised questions regarding decision making and clinical competency. But the RCOG praised labour ward midwives, saying they constantly championed patients and it praised them for their dedication, passion and pride. But it criticised medical staff at consultant and middle grade level, saying they appeared demotivated and over-reliant on a single colleague. It said they seemed to be more interested in gynaecology and less in the unit obstetric guidelines and referred to poor attendance at training sessions. It warned: Due to the nature of the unit, where a small number of deliveries are undertaken each year, such a situation is likely to continue to deteriorate. The letter recommended an external obstetric adviser as well as two or three new consultants to inject new ideas and enthusiasm. In a statement, Mr Thomson said: We do everything within our power to ensure we maintain safe services. We monitor our services continuously and whenever we identify any concerns, we take immediate action to ensure we continue to deliver safe care. We cannot go into individual details of cases or staff members, but the action we have taken in response to the RCOGs recommendations is appropriate and proportionate. I can confirm that no members of staff have been suspended as a result of the recommendations from RCOG. We understand the anxiety this might cause. However, I would like to reassure people that this has been a rigorous process, where we have actively identified concerns, acted on them and learned from them. Our top priority has always been and will continue to be ensuring the safety of all of our services. The full and final report is not due until the new year.