Agenda item

Maternity Services

To receive an update on maternity services offered by the Royal Berkshire NHS Foundation Trust.

Minutes:

The Committee received an update on maternity services provided by the Royal Berkshire NHS Foundation Trust, from Gill Valentine, Director of Midwifery, and Sarah Philip, Lead Consultant Obstetrician and Gynaecologist, Royal Berkshire NHS Foundation Trust.

 

·       In October 2020 Healthwatch had produced a report on Experiences of Perinatal Mental Health Support in Wokingham Borough.  During the first wave of the pandemic there had been a lot of changes to maternity services and choices and access to services had been reduced.

·       The report had been divided into three sections.

·       The first section related to Care during pregnancy – choice and further support.  Some women had felt that they had not received a choice around antenatal care, and had been steered into a particular course of action, which had had a negative impact on their perinatal mental health as a result.

·       Women were provided with a choice of Antenatal care provider (RBH, Frimley or other.  Midwife or consultant led care).  There were some criteria where it would be suggested that women have consultant care.  Women were offered a choice of where they had their baby (hospital, Midwifery Led Unit, or a homebirth.  During the first wave of the pandemic the Midwifery Led Unit had been suspended as a choice because all staff had been moved to the delivery suite to cope with the anticipated increase in mothers with Covid who were in labour.

·       Women could be referred to a consultant midwife if they wanted to have more individualised plans for care, particularly if they had a complex pregnancy previously.

·       Personalised care planning was offered from the first antenatal appointment through to postnatal care, to try to individualise the care offered as much as possible. 

·       The second section of the report looked at birth experiences.  Where women had not had the experience that they had wanted or expected, this had sometimes impacted negatively on their perinatal health.

·       A Birth Reflection Service had been implemented in 2020 after a successful 12-month pilot.  Women could be referred, or self-refer to the service, and could talk about their birth experiences and how it made them feel.  As part of the service, a screen was carried out for Post-Traumatic Stress Disorder.  The Team worked closely with the Berkshire Birth Trauma Service to ensure that appropriate referrals were made.  There was high demand for the Birth Reflection Service and feedback had been very positive.

·       Themes sometimes emerged from the Birth Reflection Service which were fed back to the Intrapartum Strategy Group where service improvements were discussed and agreed.  The Group worked with the Maternity Voices Partnership and other users. 

·       The third section of the report focused on Postnatal care and infant feeding.  Lots of feedback had been received regarding post-natal care particularly hospital based.  There was a focus on making improvements in this area.  Initially during the pandemic no visiting was allowed and then it had been very restricted meaning that women had not been able to have partners with them, or later, on a time restricted basis, which had negatively impacted on postnatal birth experiences.

·       Various service improvement plans were in place.  Work was ongoing with the Maternity Voices Partnership to help prioritise where improvements were made.

·       Post-natal care plans were integrated into patient’s Electronic Records, and this included a psychological care plan.

·       A ‘Me and My Baby’ app had been introduced which women could download before discharge and which contained helpful information such as about infant feeding.

·       The Trust was working towards the UNICEF Baby Friendly Accreditation, standards around infant feeding.  A Member asked for further information as to what this would entail.

·       Sarah Philip provided an update on the unannounced CQC Inspection from 2019, the results of which had been published in January 2020.  Overall, the service had been rated Good.  However, there had been some key points under the safety domain which had been highlighted as Requires Improvement.  

·       Sarah Philip updated on the action taken to make improvements regarding safety.

Ø  The top challenge related to midwifery staffing – an Executive led midwifery recruitment and retention group had been established.  With regards to recruitment, the Trust had been attending recruitment fayres, recruitment days and University Days.  With regards to retention, consideration was being given to develop groups such as the Midwifery Support Workers.  Staff surveys and exit interviews were looked at to understand the challenges that staff were facing.  Midwifery was a very challenging environment and senior leaders were looking at more compassionate ways of working.

Ø  KPI’s not meeting the Trust’s minimum standards – joint senior midwifery and obstetric reviews were carried out where any KPI was red.  Action plans were monitored through monthly governance meetings.

Ø  IT issues with data capture – shortly after the CQC visit a new Maternity IT system had been implemented in November 2020.

·       Members were updated on staffing.  A graph showing the number of staff in post, the average amount of staff who left (there was a rolling turnover of approximately 10%), proportion of staff on maternity leave and those returning from maternity leave, was noted.  This information helped to project staff numbers.  In January there had been 165 full time equivalents posts and it was projected to increase to 178 by August.  The establishment was 183 so there would still be some vacancies.  10 full time equivalents would be starting by April and a further 8 by October.  A lot of work had been undertaken on international recruitment which had been very successful.  In addition, there was funding for another 9 full time equivalents from international recruitment.

·       It was hoped that the work on retention would help to bring down turnover and the vacancy rates. 

·       The number of student trainees at the hospital had increased, and the Trust was now working with more than one university to provide clinical placements.

·       At the end of September, the Executive Team had attended a Maternity Summit to support the senior clinical and operational teams to work on a plan to achieve an Outstanding CQC rating.  Small teams had worked on each of the CQC domains to identify quality improvements, and feedback would be provided on 10 March.

·        A Peer review had been undertaken with Frimley NHS Foundation Trust in November.  Frimley had used the CQC framework and initial feedback had been largely positive.

·       A Member asked about the number of Midwives expected for each shift and how often this was achieved.  Gill Valentine indicated that it depended on the ward and department but that there were minimum staffing numbers for each.  This was monitored on a shift-by-shift basis.  When not up to full staffing, agency or bank staff were used.  Resources were also quite flexible and there could be movement between the departments.  There were clear escalation policies.

·       In response to a Member question as to when a further CQC inspection was expected and how the Trust expected to perform, Gill Valentine indicated that an inspection was expected imminently, which was part of the reason that Frimley had been asked to undertake a peer review, to help give confidence in some areas and identify where further work was needed elsewhere.  The Trust had also undertaken a self-assessment against where it felt it was performing against the CQC standards.  Realistically as staffing was still not where the Trust wanted it to be, Safety may still be considered Requires Improvement.  Nicky Lloyd added that the Trust sought to provide a good, safe service at all times.  The Team had managed the staffing rotas well during the pandemic despite some staff being off with Covid or having to isolate.

·       Members asked about patients’ mental health.  Gill Valentine indicated that patients were asked some screening questions throughout the pregnancy which helped to assess their mental wellbeing.  Those who had significant mental health issues or who were at risk of developing them, could be referred to a joint clinic with perinatal care and obstetrics, so a detailed plan could be put in place.  Assessment continued in the post-natal period with psychological care plans which could be put in place.  Work was also undertaken with GP colleagues.

·       Members asked about international recruitment and were informed that the main success in recruitment had been in Africa.  The Trust was working with an international recruitment agency to look at recruiting from other areas such as Dubai.  There were not many midwives in Europe available currently.  Other countries were also experiencing shortages and there were some countries that it was not possible to actively recruit in.  Members were informed of the successful international recruitment programme, the Medical Training Initiative. 

·       Members went on to ask what the main barriers were to recruitment and whether they were local or national issues.  Gill Valentine commented that there was a national shortage, hence the increase in clinical placements for students and the international recruitment campaign.

·       A Member questioned whether the information on the My Baby App was available in other non-electronic formats and was informed that information was available in various forms and a range of different languages.

·       In response to a Member question around attracting new trainees and whether a new and improved bursary would help in this area, Gill Valentine stated that a lot of work had been undertaken around apprenticeships to support staff going into Midwifery training.  It was important that development opportunities were available to allow staff to have sufficient choices and training to enable them to determine which pathway they then followed.  Sarah Philip added that training in obstetrics and gynaecology was tough and around 1 in 3 trainees in this speciality did not complete the training.  More flexible working patterns were encouraged, and pursuing other interests, such as research.

·       The Friends and Family Test was used to receive feedback on care received.  Qualitative feedback was very useful as was the results of the national Maternity Survey.

·       It was noted that NHS England had dropped the 20% limit for caesarean births.  Members questioned what impact this would have on the Trust.  Sarah Philip indicated that levels had been around 30% on the last dashboard.  They welcomed the move away from the rigid target.

·       A Member questioned whether Maternity facilities would be upgraded.  Nicky Lloyd indicated that chillers in the unit had been upgraded and retrofit changes were being made to the Maternity block where possible.

 

RESOLVED: That

 

1)    The presentation on Maternity Services be noted;

 

2)    Gill Valentine, Sarah Philip, and Nicky Lloyd, be thanked for their presentation.

Supporting documents:

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