To receive an update from Barking, Havering and Redbridge University Hospitals NHS Trust and from Barts Health NHS Trust on maternity services in Outer North East London.
Minutes:
Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT)
Officers explained that there had been a lot of commissioner led changes to maternity services including the transfer of some births from BHRUT to Newham and Whipps Cross hospitals. A fortnightly teleconference was held to look at birth numbers across the five local hospitals.
Deliveries at King George Hospital had closed in March 2013 but scans, ante-natal clinics etc still took place there. The Queen’s birthing centre had opened on 8 January 2013 and there had been a total of 375 births at the facility to date. Of these, 65% had been water births and natural methods of pain relief were used at the centre.
Numbers of mothers using the birthing centre at Queen’s Hospital were increasing in line with the planned trajectory. It was hoped to increase the proportion of Queen’s Hospital births taking place at the birthing centre to 15% and then 20%.
Numbers of birth bookings were continually reviewed and busy times were planned ahead for at each hospital. Officers felt there was still capacity in the system for future growth in birth numbers. An unannounced Care Quality Commission (CQC) visit in December 2012 had given a good report on Queen’s maternity and the unit had also been audited in May 2013 by the Local Supervisory Authority.
Numbers of complaints concerning BHRUT maternity had decreased from 118 to 1 in the last two years and there had also been a rise in compliments received. There was a total of 98 hours per week of consultant presence on the labour ward covering the period 8 am to 12 pm, 7 days per week. The Trust wished to increase this to full 24:7 consultant cover. Maternity nurses and a matron had recently won BHRUT wards and the maternity domestic violence and bereavement teams had won national awards.
Feedback on maternity services was received from PALS and from the Maternity Services Liaison Committee. The Directors of Nursing and Midwifery also regularly walked the wards. All women who delivered were given a survey to complete prior to discharge. There was still some negative feedback recorded on women being left alone and not giving wards the ‘very clean’ rating. From 1 July, all maternity users would be asked for their views at 36 weeks pregnant, before discharge and once they were back home in the community. The questions in the survey were based on the CQC national survey although it was possible these could be revised once the results of the latest CQC inspection had been published. It was the case that several results in the survey had plateaued but results remained above the national average.
All women were given a choice of where to have their baby and asked for first, second and third choices of venue when booking their births. Any instances where preferences could not be met would be discussed with individual mothers. Any mothers making serious complaints would be visited personally by the Director of Midwifery.
BHRUT was funded for a total of 275 midwives to give a 1:29 ratio for 8,000 births. The transfer rate from birth centres to labour ward (for example when an epidural was required or midwives had concerns) was 21-22%. This was lower than most birthing centres where this figure was nearer 40%.
The BHRUT officers agreed to supply the Committee with a breakdown of births at Queen’s Hospital by home borough or district of Essex, from March 2013 onwards. It was also clarified that there had been no maternity transfers from BHRUT since King George had closed. It was also agreed that the Clerk to the Committee should obtain the patient choice leaflet for mothers and circulate this to the Committee.
Home births constituted approximately 1% of the total at BHRUT and this had declined since the opening of the birth centre at Queen’s. The Trust wished to encourage more women to give birth at home. The maternity mortality rate at BHRUT was below the London average and officers would share data on quality indicators.
Four additional consultants were required to establish 24:7 consultant cover in maternity and a business plan for maternity had been established for this. The existing consultant cover level of 98 hours per week was itself one of the best in London. Blood tests were carried out throughout pregnancy and were usually analysed at King George Hospital. Only a few specific tests would be sent outside the local area for analysis, sometimes at Great Ormond Street Hospital.
Barts Health NHS Trust
Barts Health maternity covered Whipps Cross, the Barking and Barkantyne stand-alone birthing units, Newham Hospital and the Royal London Hospital. The Barkantyne unit saw approximately 400 births per year and around 60 births had taken place at the Barking centre since it had opened.
Approximately 17% of births at Whipps Cross took place in the birthing centre. An induction of labour suite had also been introduced at the hospital. A triage facility at Whipps Cross also ensured maternity decisions were made very promptly. Transitional care had also been introduced which took place at a mother’s bed side. A new obstetrics theatre at Whipps Cross was due to open in the next two weeks although the total number of deliveries at the hospital would not exceed the 6,000 per year cap. A separate bereavement area with its own exit had also been introduced.
Rates for Caesarean section deliveries across Barts Health were approximately 25% which was in line with the national average. Work had also been undertaken with mothers with diabetes which had improved outcomes. At the Royal London, pregnant mothers suffering from diabetes were now monitored in the community. A Great Expectations project had also been launched to look at the behaviour and attitudes of staff.
There was not currently the capacity at Barts Health for any excess above 6,000 deliveries per year. Consultant cover at Whipps Cross was currently 72 hours per week which was the highest level of the Barts Health sites. The Trust wished to increase this to 96 hours per week. Parent choice was available as regards where to give birth and this was explained in the leaflets given by GPs to expectant mothers. People’s first choice of hospital would usually be accommodated if for example they had given birth to previous children at the facility. There would need to be in excess of 8,000 births per year to have 24:7 consultant cover at Barts Health and this would require the approval of the building plans at Whipps Cross.
The improvements to the maternity buildings at Whipps Cross had to be undertaken in stages and so would take longer to complete. The next phase would see improvements to the neonatal and antenatal areas. There was not a definitive timescale for the works and Members wished to receive further details of the redevelopment proposals. Officers felt that the condition of the maternity building was the biggest challenge facing maternity at Whipps Cross. It was also suggested that a breakdown of births by home borough and Essex district could be supplied to the Committee.
The Committee NOTED the updates from both Trusts.