Agenda item

Report and presentation attached.

The BHRUT Director of Midwifery explained that the East London Local Maternity System (ELLMS) had put together a five year plan which aimed to halve the number of still births in the area by 2030. An increase of 1,500 births per year was predicted in North East London in the next five years. There were sufficient maternity units in the sector to cope with this but it was accepted there were workforce gaps and high staff turnover in local maternity services.

The North East London area had a very diverse language and ethnic mix and 20% of pregnant women in the area were   presenting with multiple co-morbidities. Priorities of the maternity transformation plans included establishing continuity of care in maternity and treating more women in lower risk settings such as the midwife-led unit at Queen’s Hospital.

Officers accepted that there were major challenges around maternity staffing and wished to create an environment where people wanted to work in East London. It was possible that midwives could work across providers under a programme of common training etc. It was also wished to build a culture in East London where the patient and their safety came first. It was noted that there were only two maternal deaths in East London in the previous year. There was good continuity of care at ante and post-natal stages and trajectories had been established to improve this further. Some 1,300 local women had been engaged in the plans to deliver improved maternity care.

It was planned to introduce a pilot of digital maternity services and to introduce a new estates strategy so that more maternity services could be delivered in the community. The introduction of joined up work on neo-natal safety would reduce the numbers of unnecessary admissions. A bid for £7.6m funding for maternity transformation work had been made to NHS England and the outcome of this application would be known in the next two weeks.

Officers confirmed that NICE guidelines were followed in the use of antibiotics during labour and it was emphasised that there were very few stillbirths in East London. BHRUT was funded until March 2019 to a midwife:birth ratio of 1:24 which was the best in the country. It was accepted however that attracting the workforce to fill these posts was a challenge.

It was clarified that the Secretary of State for health wished to reduce numbers of stillbirths by 20% by 2020. There was already a low rate of stillbirths in North East London. It was accepted that there was a shortage of midwives, particularly in London. The implications of Brexit had created uncertainty for midwives recruited from other European countries such as Italy or Portugal. Flexibility in work patterns could be shown for example allowing retiring midwives to switch to part time working. Work also took place with schools and colleges to recruit nurses and midwives.

It was emphasised that very few midwives were struck off the Nursing and Midwifery Council register. Officers accepted that midwives were placed under stress by for example court cases brought if a baby was born with brain damage but stress levels were lower in a midwife’s general work. Struck off midwives would not be reemployed by local Trusts.  

It was accepted that the removal of bursaries had been challenging but apprentices were also used in maternity. Training places for midwifery were still being filled although lower overall numbers were now applying. Financial incentives for trainee midwives were not currently being considered.

The Director of Midwifery supported neighbourhood midwives and this service would continue if sufficient transformation monies were received.

Post-natal care had improved across the area and it was wished to provide further post-natal support where this was needed.