To receive updates from health officers and patient representatives on maternity services at local hospitals.
Minutes:
A. Whipps Cross
The head of midwifery for Whipps Cross advised that 4,800 babies had been born at the hospital in 2013/14. Services available through Barts Health included community midwives for home births and other specialist services including bereavement services. There were also specialist teams available for e.g. pregnant women with mental health needs.
Whipps Cross offered the full range of maternity services. Specialist scans could now be done at the Royal London Hospital meaning it was no longer necessary to travel to Great Ormond Street for these. There were a total of 158 midwives at Whipps Cross. There were not any vacancies for midwives at the hospital currently but this situation did vary. A consultant midwife had been appointed to give clinical leadership and a clinical education lead was in the process of being recruited. An infant feeding coordinator was also now in post.
Women’s experiences of maternity were very important and the Trust was working with its Maternity Services Liaison Committee. The friends and family test was used and the Trust sought to learn from complaints received. Clinical skills of midwives had been assessed and feedback from local women was also sought via the Trust’s ‘Mum to Mum’ programme.
Improvements implemented at Whipps Cross over the last 18 months included opening a new theatre suite in HDU, standardising maternity services and developing a home birth team across Barts Health. A new programme of labour induction had reduced the number of caesarean section required and 1:1 care for maternity was now at 97% - a good safety indicator.
The report from the latest CQC inspection of Whipps Cross had not yet been shared but warning notices issued from the previous inspection had since been lifted.
B. BHRUT
While all births at BHRUT now took place Queen’s Hospital, maternity outpatients appointments were still provided King George. Community midwifery and home birth teams were also available.
There were a total of around 350 midwives at BHRUT including 70 community midwives. A total of 15 midwives including two senior midwives were present on each shift. Electronic patient were used in maternity and all birthing rooms were en suite, There were approximately 20 births per day at Queen’s, making it one of the busiest maternity units in the UK. Consultants were present on the wards from 8 am to midnight and the Trust’s current rate of caesarean sections was 24.8%.
BHRUT now had low rates of use of epidurals and of labour induction, both of which were indicators. There were also now very low admissions of mothers to ITU and a very low level of brain damaged babies. There had not been any intra partum still births at BHRUT in the last two years.
Maternity HDU was staffed by midwives and trained nurses. This meant there had only been one admission needed to the hospital’s main intensive care unit so far this year. There had also been fewer post partum hysterectomies needed so far this year.
Maternity triage was open 24 hours a day for pregnant women. The antenatal ward had 16 beds and there were two post-natal wards for high risk and low risk cases. The obstetrics assessment unit was midwifery-led and open 7 days per week, 8 am to 6 pm.
Maternity clinics were held at Queen’s and King George as well as at the Fanshawe Community Clinic in Barking. The life study project had been set up to conduct research on babies over a 20 year pathway. The project was centred at King George and was currently recruiting women.
Other services provided included parenting sessions, clinics for women who had previously undergone caesarean sections and birth reflection sessions. The Queen’s birthing centre had opened in January 2013 and only 25% of deliveries had required any transfer to the main labour ward. Neo-natal services were available at Queen’s up to level two.
BHRUT was commissioned for an annual total of 8,000 births and had was projecting 7,957 deliveries for 2014/15. When the Care Quality Commission had last visited in October 2013 it had found significant improvements in maternity services at Queen’s. The Trust had been compliant with all maternity standards inspected.
Service user feedback was collected and there had been a fall in the number of formal complaints received. There were also around 240 compliments received by the service each month which scored 96-98% on the Friends and Family Test. A lot of service user surveys were also collected.
The workforce was funded at a 1:29 midwife to birth ratio and there were approximately 10% of posts vacant at present. There was a recruitment and retention plan and the Trust was also looking at training maternity care assistants as midwives. Staff were rotated through the different maternity services in order to build up their skills. The Trust was proud of the 1:1 care it could offer in labour and that its maternity services had been transformed. Moving forward, the Trust wished to increase rates of home births and to lower rates of caesarean sections and of still births.
C. Comments from Healthwatch Havering
Healthwatch Havering had undertaken and enter and view visit to maternity at Queen’s in April 2014. The visit had been undertaken by Healthwatch representatives including a senior commissioning manager from another area. This had found that a number of improvements had been made and were being built into the system. BHRIT did respond to the recommendations made by Healthwatch and included these within the Trust’s action plan. It was planned that Healthwatch would revisit maternity in order to check on progress.
Officers could provide figures for the number of births commissioned at Whipps Cross split by each borough. Around 1,400 women in the Whipps Cross catchment area also gave birth elsewhere. Work was in progress to investigate where these women gave birth. A representative of Healthwatch Redbridge added that 30-50% of Redbridge mothers delivered at Whipps Cross and that the new facilities at the hospital were very good. It was noted that the business plan for the next phase of work at Whipps Cross was awaiting approval.
D. Further Discussion
It was confirmed that BHRUT had a consultant midwife in public health who focussed on issues relating to female genital mutilation and could refer women to appropriate agencies if necessary.
BHRUT was aiming to achieve baby friendly accreditation over the next 4-5 years and needed the boroughs to work together to give breast feeding advice to new mothers. Funding was needed to support mothers in the community with breast feeding. The Committee AGREED that better joint working should be encouraged to develop breast feeding.
BHRUT officers accepted that services needed to be strengthened at the Barking Birthing Centre. The service would continue for the present but needed to be reviewed.
A Member congratulated BHRUT on how the closure of in-patient maternity services at King George had been dealt with. Figures on where maternity service users came from would also be useful as there was a lot of mobility in choice of where to give birth. Officers had not seen any change in the ration of male:female terminations carried out at the Trusts but it was noted that terminations could also be carried out in the private sector.
Consultant cover at Whipps Cross was available for 74 hours per week but this was not sufficient in the delivery suite. It was hoped to increase consultant numbers but this would cost Barts Health in the region of £1.4 million per year. It was AGREED that a letter should be sent on behalf of the Committee to Barts Health supporting Whipps Cross maternity in their for funding to increase consultant cover.
HIV screening was offered to all women giving birth at both Trusts. A specialist HIV midwife was available at Whipps Cross to develop appropriate care plans etc.
There was also a consultant psychiatrist and psychiatric nurse available at Whipps Cross who worked with the midwives. Mothers thought to be suffering from e.g. depression would be referred back to their GP those who were e.g. bipolar would be treated by the specialist service team.
It was confirmed that a maternity dashboard of 50 indicators was used at BHRUT and that a pan-London dashboard was also being developed. Figures from the BHRUT dashboard could be supplied to the Committee.
Home births currently accounted for 0.7% of BHRUT births with figures for home births across London being slightly higher at 1-2%. It was emphasised however that many women were not suitable for home births. Women’s choice of where to give birth was accommodate where this was possible and safe to do so. Home births at Barts Health were approximately 2% of the Total deliveries at the Trust and it was hoped to expand this. Patient experience questions used by Barts Health were nationally available on the internet.
Whipps Cross would also offer, at the point of GP referral, a choicer of place of birth and antenatal care, within the Trust provision. Barts Health was funded to a midwife: birth ratio of 1:32 but the current figures were in fact 1:30.4. As regards still births, audits and process reviews were undertaken for all such cases at Whipps Cross.
It was confirmed that both Trusts were happy for Members to visit their maternity services if they wished. The Committee NOTED the update and thanked the officers and Healthwatch representatives for their input.