Agenda Item 7

TRUST BOARD / Tuesday 27 November 2007
PAPER / Summary of the Public and Staff Engagement Report for the Maternity and Newborn Services Review
PURPOSE / The purpose of this paper is to summarise the main issues that have come out of the public and staff engagement reports which are part of the Maternity and Newborn Services Review. The paper will also explain how the Division of Women’s and Children’s plan to address or has addressed some of the concerns highlighted.
FORMAT / A one off paper
THE BOARD IS ASKED TO: / Note the contents of the paper

Background

The Maternity and Newborn Services review commenced in June 2006 and is led by Bristol Primary Care Trust. The aim of the review is to ensure the best possible experience of birth and early days for parents and babies. The objectives of the review are to:

  • Promote normal child birth
  • Provide choices for where and how mother’s give birth
  • Provide safe and effective care to national standards
  • Reduce inequalities
  • Make the best use of resources, ensuring that services are affordable
  • Attract and retain staff by offering good experience and opportunities for development.

The public and staff engagement period of the review ran from 1st December 2006 until 1st March 2007. In total 410 people took part in the meetings for the public and 159 in the meetings for staff. 100 pieces of correspondence also fed into both reports. Within the reports it is not always possible to know which comments relate to which Trust but some comments name the Maternity unit directly.

The patient engagement report

The topics covered fall into 5 main themes, ante natal care, care during birth, postnatal care, continuity of care and the role of midwives.

Ante natal care

On the whole most women thought the ante natal care received was good.

Issues raised

  • More parent craft classes specifically for teenagers
  • Parent craft refresher courses for subsequent pregnancies
  • Drop in clinics where advice on pregnancy and birth can be found.
  • Information on parent craft classes outside NHS
  • A range of times of classes to allow easier access
  • More information on home birth
  • Midwives appointments beginning earlier so that women could get advice about early pregnancy.
  • Scans offered in the Community
  • Administration staff not available to make appointments in the hospital clinic

Actions taken/to be taken

  • United Bristol Healthcare NHS Trust to appoint a teenage pregnancy midwife. Already have set up a Consultant teenage pregnancy clinic with Midwife attached - October 07
  • Already offer parent education classes to second time parents. To be re iterated within community - August 07
  • United Bristol Healthcare NHS Trust has service level agreement to provide Midwifery services and sign posting within Children’s centres. Maternity Support workers appointed in the community to help with advice and sign posting.
  • Parent craft classes’ times and locations to be reviewed - October 07
  • Ensure all Community Midwives discussing home birth as an option - August 07
  • National Institute for Clinical Excellence guidance on ante natal care implemented so all women offered an appointment at 8-10 weeks. Need to promote Midwife as first contact by posters in pharmacies, General Practitioner surgeries etc - December 07
  • Already have some dating scans in Community at Consultant Community clinics. Scan department to offer scans at SouthBristolHospital.
  • Review of administrative/reception staff in St Michaels - December 07

Care during birth

Issues raised

  • Choice of home birth
  • Birth plans
  • One to one care in labour/staffing
  • Caesarean section rate/especially from Black and Minority Ethnic communities
  • Difficulty in getting baby’s first day examination done after home delivery

Actions taken/to be taken

  • Community Midwives to be reminded to discuss with all women at booking home birth option.
  • Women to be informed about how to write birth plans and help available to help them - August 07
  • Birth rate plus (Work force assessment tool) being carried out at United Bristol Healthcare NHS Trust July-0ctober 2007. Bed management occurs daily to maximise safe staffing within the unit and community.
  • Head of Midwifery working with Public and Patient Involvement lead to engage with Somalian population. External Cephalic version offered to breech presentation.
  • Midwives in the Community trained to perform check. More midwives doing training -on going.

Post natal Care

Issues raised

  • Visiting hours for partners
  • Staffing levels/Support
  • Breast feeding
  • Post natal support at home
  • Facilities

Actions taken/to be taken

  • To re iterate to midwives to be flexible around partner visiting and staying
  • Birth rate plus (Work force assessment tool) to be commenced. More support workers on wards.
  • Have infant feeding coordinator and have achieved level 2 UNICEF. Baby friendly initiative. Level 3 assessment in October
  • Have maternity support workers in the community
  • Carpets on Level E to be replaced. Estates work plan to be developed with Assistant Divisional Manager to improve facilities and environment - December 07

Midwives roles, workforce

Issues raised

  • Shortfall in midwives
  • Skills of Midwives/rotation to the Community
  • Actions taken/to be taken
  • Birth rate plus commencing July 1st.
  • Maternity Support workers in the community
  • Teenage pregnancy Midwife and ante natal screening Midwife to be appointed - October 07
  • Investment in service from income
  • Buddying system- Midwives rotate between hospital and Community - on going
  • Band 6 Midwifery posts in the Community in place

Continuity of Care

Issues raised

  • Lack of consistent advice
  • Change of Midwives in labour
  • Different Midwife visiting postnataly

Actions taken/to be taken

  • Named Midwife in Community
  • Review of shift times on delivery suite
  • Re iterate to Midwives use of care plans.

The report highlights comments from some specific groups.

Young Mothers

Issues Raised

  • Need for extra support and Midwives who are aware of their specific needs
  • Action taken/to be taken
  • Consultant Teenage pregnancy Clinic commenced.
  • United Bristol Healthcare NHS Trust Midwife visits Meriton school for teenage mothers.
  • Teenage Midwife post to be advertised.

Parents of premature or sick babies

Issues raised

  • Lack of cots
  • Support and information
  • Action taken/to be taken
  • Neonatal Intensive Care Unit expansion by 2 cots
  • Family support role under review.

Bereaved parents

Issues raised

  • Support and counselling
  • Training of staff in bereavement
  • Lack of local paediatric pathologist
  • Action taken/to be taken
  • Family support worker role being reviewed
  • Trust bereavement training
  • Paediatric Pathology review by Jonathan Sheffield

Women from black and other ethnic minorities

Issues raised

  • Language and translation
  • High level of Caesarean Sections in this population
  • More dedicated ante natal classes for this group
  • Action taken/To be taken
  • Link workers attend St Michaels Clinics, Wards and Community settings
  • Language line
  • Some leaflets translated
  • Head of Midwifery working with Public and Patient Involvement lead to engage with Somalian population.
  • Consultant clinic starts September 07 at Charlotte Keele in Easton.
  • Midwives have done course to learn Somalian. language

Drug users

Issues raised

  • Training for staff
  • Chance for support from meeting other drug using mothers
  • Actions taken/to be taken
  • Study day held for Midwives
  • Drug liaison Midwife has held support group

Domestic violence victims

Issues raised

  • Training for staff
  • Antenataly for there to be a routine question about domestic violence

Action taken/To be taken

  • Trust training on Domestic Violence in place
  • Routine screening in place

Fathers and families

Issues raised

  • Overnight facilities for fathers
  • Lack of information for fathers
  • Longer visiting hours

Actions taken/to be taken

  • Fathers able to stay if side room available and women in early labour
  • Review visiting times/patient survey.

Information Provision

Issues raised

  • Information about National Childbirth Trust
  • Age appropriate literature for young parents
  • Hospital tours

Actions to be taken/taken

  • Ensure Community Midwives give information about National Childbirth Trust - August 07
  • Teenage pregnancy midwife to review leaflets for teenagers - October 07
  • Make a DVD about St. Michaels - December 07

The Staff engagement report

The following key topics emerged from the staff engagement exercise:

  • Normal Childbirth
  • Patient choice and provision of local services close to home
  • Physical access to facilities
  • Staffing ,resources and training
  • Relationships between professional groups
  • Continuity of care
  • Patient safety
  • Targeted services for Black and Minority Ethnic and vulnerable groups
  • Neonatal services

Normal Child birth

Issues raised

  • Hospital/Community Midwives and Obstetricians were all in agreement that high and increasing caesarean rate is wrong.
  • Increasing normality important to Midwives
  • Importance of one to one care in labour
  • Increase in patients with raised Body Mass Index, diabetes etc impacting on Caesarean section rate

Actions to be taken/taken

  • Raise profile of birthing suite on delivery suite
  • Birth rate plus workforce too

Choice/Midwife led units

Issues raised

  • Birthing unit at St Michaels needs to be more home like
  • More accessible services for vulnerable women
  • In principle most staff support Midwifery led units for low risk women
  • Some staff prefer Midwifery led units that are adjacent to main unit

Actions to be taken/Taken

  • Equipment to be purchased to make birthing unit more homelike
  • Encourage use and promote use of birthing unit at St Michaels

Staffing, Resources and Training

Issues raised

  • Concerns over Community and hospital Midwifery staffing levels
  • Importance of integrated hospital/Community Midwifery service
  • Need and use of more support staff
  • Poor access and parking
  • Concerns over neonatal nursing and medical staffing levels
  • Post natal Care on wards inadequate

Actions taken /To be taken

  • Birth rate Plus
  • Maternity Support workers in Community
  • Review of Maternity Support worker in hospital
  • New United Bristol Healthcare NHS Trust staff parking scheme
  • Review of staffing skill mix on Neonatal unit and investment in staffing

Relationships between professional groups

Issues raised

  • Interfaces between Obstetrics/Midwifery and Mental Health pathways problematic

Actions to be taken/Taken

  • To aim to reinstate the fortnightly Obstetric Mental Health Clinic at St. Michaels
  • Perinatal Mental Health group being set up Bristol North Somerset and South Gloucestershire wide
  • Liaison with Mental Health Trust to secure funding for improving services to Obstetrics

Targeted Services for black and minority ethnic (BME) and vulnerable groups

Issues raised as in public engagement

Neonatal Services

Issues raised

  • Cot Capacity
  • Neonatal nurse and medical staff levels
  • Transfer service
  • Parent accommodation

Actions to be taken/taken

  • Expansion of Neonatal Intensive Care Unit by 2 cots
  • Review of skill mix and investment into nursing
  • Local Delivery Plan bid to be submitted for transfer service
  • Scoping options for improving parent accommodation.

Summary

Many parents expressed satisfaction with the maternity services they received. Whist staff members from all groups also expressed pride and satisfaction in the services they provide for women and babies. However there are issues highlighted that can improve. The Midwifery, Neonatal and Obstetric service will operationally address the actions in this report through the relevant clinical and management working parties.

Monitoring of actions will be performed with Head of Midwifery and Matrons at monthly meetings.

Sarah Windfeld

Head of Midwifery/ Assistant Chief Nurse

14 November 2007

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