NHS GRAMPIAN

Maternity Services Strategic Review

Aim

This paper:

  • reports on the recent public consultation regarding the draft NHS Grampian Maternity Strategy
  • brings an amended Maternity Strategy, for which it seeks the Board’s approval
  • brings a time scale for the first stage of the Option Appraisal of maternity services, for which it also seeks the Board’s approval
  • updates the Board on the continuing progress in implementing improvements agreed through Strategic Review of Maternity Services, and alignment of those actions to the Maternity Strategy

Strategic Context

The Strategic Review of Maternity Services seeks to improve maternity services in line with:

  • NHS Scotland’s: Quality Strategy; Maternity Services Framework: Maternal and Infant Nutrition Framework and Equally Well report
  • NHS Grampian’s: Health Plan and Health Care Framework

Discussion

i. Background

At its last meeting in October 2010 the Board:

  • received a progress report on the Strategic Review of Maternity Services
  • approved a public consultation on a draft NHS Grampian Maternity Strategy with the aim of seeking approval at the December meeting
  • noted the intention to also bring a time scale for the Option Appraisal of maternity services

ii. Public Consultation

The public consultation ran for six weeks from 12th October to 22ndNovember and was wide ranging. The process, results and subsequent actions are described in detail in a report supporting this paper. In summary well over 150 people took part and the responses were overwhelmingly positive in regard to the existing content of the strategy.Many very positive suggestions regarding additions and changes to the strategy were also made.As a result: appetite for the direction and most of the detail of the strategy has been confirmed; most of the suggested changes have been incorporated, and the strategy has been significantly improved. For those comments which were not incorporated, a significant number will inform operational effort to implement the strategy. The nature of the remaining few which were neither incorporated nor likely to inform implementation are described in the supporting paper along with other details.

iii. Amended Maternity Strategy

There are many changes to the draft maternity strategy and all significant changes are listed in the consultation report but themost important of these are:

  • inclusion of many potential examples of community involvement all of which came from the public and community groups which both enhance and add to current approaches
  • greater emphasis on the importance of supporting informed choice, but constraining that emphasis to:i) choices we can support in contexts such as safe and sustainable services, and ii) deprived communities not being as free to makeunconstrained choices as others
  • more acknowledgement of the important role of partners and wider families
  • more reference to the importance of maternal health such as healthy weight, better mental health and reduced smoking, along with more emphasis on the importance of these changes in improving health across the population and over generations
  • refining the above targets due to further review of evidence regarding available interventions
  • better acknowledgement of the high quality service delivery and improvement work already done by staff, along with commitment to continue to improve the way they are involved in improvement work
  • more clarity that inappropriate variation in service delivery must be eliminated but not at the expense of high quality individualised care which meets agreed standards

A version showing tracked changes as a result of the consultation is also included as a supporting paper for completeness.

iv. Option Appraisal Time Scale

In the strategy is a commitment to conduct a full Option Appraisal on what maternity services should be delivered from which locations by which people. Plans have been drawn up for this based on:

  • the Scottish Capital Investment Manual’s “Option Appraisal Guide”
  • the Scottish Health Council’s Guidance on “Involving Patients, Carers and the Public in Option Appraisal for Major Health Service Changes”
  • the maternity services review acting as one of the pathfinder projects for NHS Grampian’s Health and Care Framework
  • the timing of the Scottish Elections
  • the need for maternity services to gain clarity on future plans as soon as possible
  • the need to manage interdependencies with other significant change projects

As a result, the proposal for Stage 1 of the Option Appraisal is to hold a series of meetings from the last week of January 2011 to the last week of March 2011. These will take 4.5 days and involve the members of the Maternity Leadership Group and additional lay representatives. The outcomes of Stage 1 will dictate the time scale for the following stage. Results will be written up during April and if appropriate,an Outline Business Case wouldbe drawn up during May. However the interdependencies on other change projects such as the other pathfinders projects in the Health and Care Framework may mean further stages are necessary before a final proposal can be brought to the Board. In any event a progress report will be brought to the Board in June 2011.

v. Implementation of Strategic Maternity Review Improvements

Planning the above Option Appraisal is one major part of implementing the strategy, but many other work streams of the strategic maternity review are also under way. These are collated, prioritised and monitored in a single implementation work plan, the current version of which accompanies these papers. Points of note are:

  • the sections of the implementation plan are now aligned directly to the sections of the strategy to allow future scrutiny of progress and success
  • the plan is by necessity a work in progress changing weekly in: completeness; the degree to which it reflects progress; the amount of progress actually made
  • some of the most important changes are working towards the public health targets. By their nature they will take the longest, and are affected by a great deal of complex factors. Rather than setting up specific work streams dedicated to themall at this stage, the plan shows which other work streams contribute. The maternity strategic review core groupare in the process of ensuring that such streams aim for and make those contributions explicit. For example when staff time is released through more productive working it will be explicitly re-directed at work which helps these longer term aims
  • the shorter term actions have already released significant time, improved care, avoided at least £0.5m unnecessary annual expenditure and identified much further waste which will be readily avoided

Impact Assessment

i. Equality Impact Assessment

A rapid Equality Impact Assessment was conducted on the draft maternity strategy and refinements were made as a result before submission to the Board. There was no indication of need for a full Equality Impact Assessment.A further rapid assessment against the changes made due to the public consultationhas been conducted and further minor changes made.

ii. Health Impact Assessment

A draft Health Impact Assessment was conducted on the draft strategy and refinements were made as a result before submission to the Board. A full Health Impact Assessment has now been conducted by the Maternity Services Strategic Review Leadership Group and further refinements made.

Resource Implications

The strategy’s aims are all designed to be delivered within the resources available. The Option Appraisal’s main aim is also to consider how best maternity services should be configured within the resources available. The Option Appraisal could propose significant changes to workforce, financial allocation, property and equipment, but it could also recommend the status quo. Any significant implications will be handled by the Health and Care Framework processes in the first instance.

Key Risks

All of the risks laid out in the Maternity Review’s June 2010 report to the Board continue to be better managed due to the actions being taken under the review. Work focussing on the sustainability of paediatrics services at Dr Gray’sin Elgincontinues, but there is still a risk of a negative impact to maternity services. In addition the maternity review contributes to the management of thirteen of the sixteen strategic risks in NHS Grampian’s risk register. These contributions are laid out at Appendix 1.

Conclusion(s)

The Maternity Services Strategic Review has made good overall progress since the report at the October 2010 Board meeting by:

  • conducting a meaningful public consultation
  • laying out the strategic direction for services
  • planning Stage 1 of an Option Appraisal time scale for 2011
  • delivering significant immediate operational benefits
  • bringing new work streams on line
  • aligningall improvement work to the strategy
  • deliveringprogress towards public health benefitsfor the medium and long term

involving front line staff in the work streams so as to foster a continuous service improvement culture

involving interested lay groups, agencies and communities so as to foster a more responsive service and “co-produce” services in partnership with them

In the course of doing this tensions are inevitably created as some people naturally find change challenging, but these tensions are being managed.

Recommendation(s)

The Board is asked to:

  1. Note the positive results of the public consultation
  2. Approve the amended Maternity Strategy
  3. Approve the proposal to create a shorter more “public friendly” version of the strategy for future circulation
  4. Approve the proposed Stage 1 Option Appraisal time scale, specifically the intention to report progress and potentially more to the Board in June 2011
  5. Note the continuing progress in implementing improvements agreed through theStrategic Review of Maternity Services and alignment of those actions to the Maternity Strategy

Supporting Papers

  • Report of public consultation on the Draft Maternity Strategy
  • Final Draft Maternity Strategy for Board Approval
  • Final Draft Maternity Strategy showing tracked changes
  • Strategic Review of Maternity Services Implementation Work Plan v3.1

Executive Lead

Elinor Smith

Director of Nursing and Quality

Authors

Paul WelfordLaura DoddsJenny Smith

Strategic Change ManagerPublic Involvement ManagerActing Head of Midwifery

23 November 2010

  • Appendix 1 – Contribution of maternity review to NHS Grampian’s Strategic Risks

Format

Risk ID: Risk Title – maternity review contribution

  • 607: alignment of strategy with intelligence, learning and resources – by drawing together as much of these as possible to inform strategic effort
  • 610: not fully involving others with change – by meaningfully and proportionately involving public and interested parties in the review’s activities at all levels
  • 749: new PMS system and ways of working are not successfully implemented – by including the maternity related PMS activity in the implementation plan
  • 752: staff welfare, safety and health – by meaningfully and proportionately involving staff in the reviews activities at all levels
  • 851: delivery strategies are unrealistic given the resource position of NHS Grampian – by ensuring the maternity strategy is resource neutral
  • 853: patient safety is compromised and is not evidence in practice – by striving to improve the quality of services and as a by-product make them inherently both safer and cheaper
  • 854: there is not a culture of continuous improvement across the organisation - by using continuous service improvement techniques to create the capacity to implement the strategy and the review aims
  • 855: the asset base is not fit for purpose – by including the best configuration of assets in the option appraisal
  • 856: partnership working with public sector and other organisations will be stretched due to existing and future financial climate – by articulating the need for partnership working to focus on areas with highest potential for health gain and inequalities reduction
  • 858: promotion of success within NHS Grampian is not proactive or co-ordinated – by working closely with corporate communications to plan internal and external communications
  • 859: loss of medical training in Grampian – by managing the planned reduction in trainee numbers
  • 1115: alignment of service delivery to the Health and Care Framework – by acting as a pathfinder for the Health and Care Framework
  • 1116: meeting expectations of the health plan – as above

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