NHS GRAMPIAN
STRATEGIC REVIEW OF MATERNITY SERVICES
Introduction
In June this year the Board discussed the Strategic Review of Maternity Services and asked for further updates as the review progressed. This is the first update.
Aim
A series of milestones in the review have now been reached and these papers aim to update the Board on them and seek specific feedback laid out below.
Discussion
1)Maternity Improvement Event
A successful four day improvement event called a Value Stream Analysis was held in late August (postponed from June) to focus much of the review’s efforts. At that event three sorts of actions were agreed:
- that a new draft maternity strategy would be compiled using the review’s preparation and discussions as the basis for its content
- an option appraisal is needed to consider how maternity services should be configured to meet the aspirations in the strategy and cope with the rising birth rate and other challenges laid out in the June Board papers
- a range of more immediate operational changes to improve safety, efficiency and the experiences of women and families.
These items are covered in more detail below.
2)Draft Maternity Strategy
In the lead up to the August improvement event, user and staff surveys were conducted and a large amount of background information was compiled for delegates. At the start of the event delegates heard about the strategic context, in particular the need to contribute to public health improvement. They then:
- identified the biggest problems in the service
- isolated the root causes of those problems
- discussed what an ideal service would look like, and
- agreed solutions which would eliminate problems and move towards the ideal service whilst living within necessary constraints.
This is a reasonably standard approach of using Continuous Service Improvement techniques to engage staff in identifying changes required. However, by tailoring the nature of the event, the outcomes covered strategic and corporate, medium and long term solutions as well as more immediate operational improvements. Key outputs of the event were therefore used to form the content of a new draft maternity strategy as well as to form improvement action plans. In a very real sense the hundreds of users and staff surveyed, and the fifty to sixty event delegates all helped create the draft strategy now before the board.
The draft strategy is challenging in its aspirations to: involve communities far more in supporting the most vulnerable; reverse trends in service delivery that have been present for decades; change public perceptions of normality; increase safety and become more responsive. The maternity review core group wish to now hold a public consultation on the draft strategy for six weeks, with the aim of bringing a final version back to the Board for approval at its December meeting.
3)Option Appraisal
During the maternity improvement event, delegates discussed the view that maternity services are not currently configured to meet the aspirations that had been laid out, anddeal with the challenges such as coping with the predicted 20%+ rise in births over the next five years. It was therefore agreed that an option appraisal should be conducted to assess how our maternity services are set up currently, looking at: what they provide, who provides them and where they are located. As it is such an important issue, this option appraisal is mentioned in the strategy. This makes it clear that any service model selected through the option appraisal must maximise the chance of delivering the aims of the strategy. The review core group hopes to draw initial conclusions during the first quarter of 2011 and intends to bring a plan of how it intends tomeet that timescale to the Board in December.
4)Operational Changes
As planned, the largest number of changes discussed at the maternity improvement event were the more immediate ones which maternity services can proceed with in order to improve safety, efficiency and patient experience. These included:
- involving communities in parent support programmes
- improving the quality of information we provide and making it available electronically
- moving to a single telephone service for women needing urgent advice
- consistent clinical management and clinical procedures across Grampian
- re-matching antenatal clinics to areas of Grampian to reduce waiting times
- reducing unnecessary interventions and improving the normal birth rate by increasing one to one care in labour at AMH and improving the information and support given to women after a caesarean section
- better management of operating theatres so that emergency operations don’t delay planned ones
Skeleton timescales and plans for these were agreed at the event.Work has started on many of them and progress will be reported as appropriate.
4.1) Routine Transfer of Care
One area we started work on before the improvement event was “Routine Transfer of Care”. This means reducing the time that women stay in hospital unnecessarily after giving birth. This was already a policy, so the focus was on removing the problems that were making it difficult to implement. In the first two months since working on this, the percentage of women transferred home from the Midwife Unit at AberdeenMaternityHospital without delay has risen from 26% to 40%. That has released staff time and over 50 bed days per month to women who need them more. Delivering these sorts of changes early is important as they not only build momentum through success, they are “enablers”, freeing up capacity for staff to move on to the other planned improvements above.
5)Informing, Engaging and Consulting People
Building on the strong foundation of involving service users and staff from the beginning of the review, a communication and involvement plan is being developed in line with national guidance, CEL 4(2010): Informing, Engaging and Consulting People in Developing Health and Community Care Services. This will help to ensure open communication and proportionate involvement continues to be integral in the review, with a particular focus around the draft strategy (including a summary of it and key questions), implementing operational changes and the Option Appraisal.
Key Risks
The service risks reported in June remain,but the outcomes of the improvement event were designed to address them. The service is now in a better position to manage them so long as it follows through on the action plans created. It will receive support to do this and as mentioned above will report progress appropriately.
The only risk reported in June which was not directly addressed during the improvement event was the dependency on Paediatrics in Dr Gray’s Hospital Elgin. That service is perceived to be in a relatively vulnerable state, so a concurrent review of working practice and alternative options has been commissioned. This should deliver conclusions in time to add value to the maternity option appraisal discussed above.
Impact Assessments
A draft Health Impact Assessment hasbeen conducted, and the draft strategy was refined as result. A more comprehensive process will be conducted before finalising. A Rapid Equality & Diversity Impact Assessment has also been conducted which also led to changes, but did not indicate the need for a full Equality Assessment.
Conclusion
The strategic review of maternity services has:
completed a significant amount of broad and detailed analysis
- involved staff and the public meaningfully
- brought together stakeholders for a successful improvement event
created a draft strategy
- committed to an option appraisal of service configuration
- created action plans and started delivering on them
There is however a long road of further engagement and improvement to carry out before we will be on track to deliver the vision laid out in the draft strategy.
Recommendation(s)
The Board is asked to:
i)note the operational improvement plans, early successes and intention to report on future progress
ii)note the intention to bring an option appraisal timescale to the Board in December 2010
iii)note the plan to continue to inform, engage and consult in line with national guidance
iv)approve a six week public consultation regarding the draft maternity strategy with the aim of approving the strategy in December.
14th September 2010
Maternity Services Strategic Review Core Group
Elinor SmithJenny McNicol
Director of Nursing and QualityActing Head of Midwifery
Peter DanielianTracy Humphrey
Consultant ObstetricianConsultant Midwife
Paul WelfordLaura Dodds
Strategic Change ManagerPublic Involvement Manager
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