Harrogate and Rural District Clinical Commissioning Group
Hambleton, Richmondshire and Whitby Clinical Commissioning Group
Scarborough and Ryedale Clinical Commissioning Group
Vale of York Clinical Commissioning Group
Report Title: / One to One Midwives – Position Statement
Report From: / Helen Billson, Senior Commissioning Specialist (Children and Maternity), 03.04.14
Report Status: / Open
1.0Purpose
The purpose of this position statement is to ensure the Clinical Commissioning Groups are aware at a Yorkshire and Humber level of the ongoing quality and safety concerns regarding One to One Midwives.
It is not intended to supersede any of the previous legal interpretation provided by North Yorkshire and Humber Commissioning Support Unit regarding One to One Midwives challenges on grounds of patient choice, non contracted activity and payment of invoices.
2.0One to One Midwives
2.1One to One midwives (Northwest) Ltd are an NHS provider of antenatal, birth and postnatal midwifery services accredited by Wirral CCG and the CQC. The service was founded by a midwife and manages ‘all risk’ women in partnership with health and social care. This service is currently a choice option for all women on Wirral. The service can also be accessed through patient choice by any NHS referrer who feels this model of care would meet the individual’s needs better compared to what is locally available. [1]
2.2The service has been commissioned by NHS Wirral since August 2010. This service is being delivered at 13/14 tariff. The model of care provided by One to One Midwives offers an enhanced community based case loading midwifery service with a clear focus on normality of pregnancy through measureable outcomes.
2.3The service has been reviewed as meeting all national standards by The Care Quality Commission (CQC) for care provided at Birkenhead Medical Building (appendix 1).
3.0Local Position
3.1Using the Choice agenda and Non Contracted Activity guidance as ‘levers’, One to One Midwives havebeen actively recruiting women within Yorkshire over the last 12 to 18 months, particularly in West Yorkshire (Airedale/Bradford area). There have been a small number of women within North Yorkshire and York who have been ‘recruited’ viaself referral to the service.
3.2One to One Midwives is not on the Any Qualified Provider list of any of the 4 North Yorkshire CCGs. Women within North Yorkshire and York do have a choice of provider from the commissioned maternity services at Harrogate and District NHS Foundation Trust, York Teaching Hospital NHS Foundation Trust (Scarborough and York hospitals) and South Tees Foundation NHS Trust (Friarage Hospital).
3.3The PCU has indicated that as part of the maternity work programme a commissioning strategy for maternity services will be produced. This will involve engagement with all stakeholders including service users/potential service users. This would seem a sensible time to address whether the CCGs wish to commission additional patient choice.
4.0Quality, Safety and Governance
4.1Whilst the focus of discussion between the 4 North Yorkshire CCGs has been around non contracted activity and CCG decision to dispute payment. There are concerns reflected across Yorkshire and Humber regarding patient safety, quality, governance and effective integration with local services.
4.2These issues have been a standing agenda item at the North Yorkshire and York Maternity Network, of which the CCG Maternity Leads are a member. The consensus of the network discussion has been that it should maintain the link into the Regional Maternity network to seek further information from other providers and commissioners, and that it will await the outcome of the test case between Monitor and some of the West Yorkshire CCGs.
4.3The Yorkshire and Humber Maternity Network is proposing to formally write to the Local Supervisory Authority Midwifery Officer (LSAMO) with the network concerns around the clinical and patient safety issues. Providers and commissioners have been asked to feed in examples of local incidents to support this. In addition the LSAMO will be requested to support the identification of serious incidents from the LSAMO database.
4.4In addition it is proposed to write to CQC to raise specific concerns, particularly as the CQC accreditation is based solely upon care provided within a single medical centre which is within the commissioned geographic area.
4.5The previous Yorkshire and Humber LSAMO post holder reported to the Yorkshire and Humber Maternity Network that the One to One Midwives employees are in receipt of statutory supervision.
5.0Conclusions
5.1The CCGs have a non-delegable duty of care to their patients. At this point in time, the PCU would suggest that CCGs are not fully assured that the care provided by One to One Midwives would meet the standards required. On a regional level proposals are underway to further investigate concerns around patient safety, quality and governance. The North Yorkshire and Humber Maternity Network, and the CCG lead members, need to be mindful of this work and support the regional network and base any future commissioning intentions on these findings and that of the planned stakeholder engagement.
5.2The impact on local commissioned services should also be considered at that stage. In addition NHS England Refreshed Business Plan 2014/15 and 2016/17 indicates that new commissioning guidance for CCGs is expected in September 2015 and that there will be support for CCGs in offering choice where appropriate.
5.3CCGs may wish to consider these issues in the context of these developments.
6.0Appendix 1
[1] Service Overview accessed at