Making it Better
Presentation to Salford OSC
25th July 2012
Making it Better
• Commitments made to improve the safety and quality
of maternity, neonatal and paediatric services across
Greater Manchester
• Maternity and paediatric changes now complete
• New maternity, neonatal and children’s unit to open
at Royal Oldham Hospital – late 2012
• Promises made to Greater Manchester residents
Care close to home
• Establishment of 10 Children’s Community Nursing Teams
involving the recruitment & training of 90 children’s nurses
• Establishment of 11Paediatric Observation & Assessment
Units to reduce number of children needing to be admitted
to hospital
•
Local routine antenatal & postnatal care continues in
community and local hospitals in all areas
•
New Antenatal Assessment Day Units established to
provide enhanced local services and reduce admissions
•
Development of Neonatal Outreach services to provide
care and support at home
Safer overnight services
• Safely relocated inpatient
maternity, neonatal &
children’s services from 4 sites
-Trafford (February 2010)
- Rochdale (June 2011)
- Salford (Nov 2011)
- Bury (March 2012)
• Local services
developed
Maternity Services
•
8 inpatient maternity units (5 new maternity units)
•
Establishment of 6 co-located Midwifery Led Units
and standalone Birth Centre in Salford
•
Improved access to tertiary maternity services
•
Achievement of BirthRate Plus midwifery staffing levels
at all 8 units, involving the recruitment of 81 midwives
•
Additional consultant obstetricians recruited
•
Improved Consultant Labour Ward Presence
Number of Hours Consultant Presence on the Labour Ward – NW Sector
2006
Current
53
99
Royal Bolton
40
98
North Manchester
22
102
Salford
40
TOTAL
155
Saint Mary’s
Salford
299
Maternity Diverts
•
Reducing the rate of temporary closures was a key driver
for change in reducing the number of overnight
maternity units
•
Work over the past three years has reduced incidents of
maternity units closing temporarily for admissions
•
Direct contribution in areas where Making it Better
changes have already taken place
Trends in Maternity Diverts across Greater Manchester
Source : NWAS
Avg Mthly Diverts in 2009 = 19
35
Avg Mthly Diverts in 2010 = 13
Avg Mthly Diverts in 2011 = 5
Trafford overnight
services relocated
Avg Mthly Diverts in 2012 YTD = 1
Bury overnight
services relocated
30
Salford overnight
services relocated
25
Rochdale overnight
services relocated
20
15
10
5
-5
Jun'12
May'12
Apr'12
Mar'12
Feb'12
Jan'12
Dec'11
Nov'11
Oct'11
Sep'11
Aug'11
Jul'11
Jun'11
May'11
Apr'11
Mar'11
Feb'11
Jan'11
Dec'10
Nov'10
Oct'10
Sep'10
Aug'10
Jul'10
Jun'10
May'10
Apr'10
Mar'10
Feb'10
Jan'10
Dec'09
Nov'09
Oct'09
Sep'09
Aug'09
Jul'09
Jun'09
May'09
Apr'09
Mar'09
Feb'09
Jan'09
0
Services for children
• 8 inpatient children’s units with critical mass to maintain &
develop specialist expertise
• 4 new children’s units to improve care environment
• Additional consultant paediatricians recruited
Newborn Services
•
8 inpatient neonatal units with critical mass to maintain &
develop specialist expertise
•
Achievement of required BAPM standards for neonatal nurses,
involving the recruitment of 79 neonatal nurses
•
Additional consultant neonatologists recruited
•
5 new neonatal units offering improved facilities for babies,
parents and staff
•
New neonatal intensive care unit at Royal Bolton Hospital,
improving access for families in north west of Greater
Manchester
•
Royal Oldham Neonatal Intensive Care Unit to open late 2012
Building capacity & improving facilities
•
5 major capital builds to increase capacity and improve facilities
for families and staff
•
New & expanded facilities for women and children at St Mary’s,
Royal Bolton, North Manchester, Wythenshawe and Royal Oldham
(from late 2012) hospitals
•
Offer choice of midwife led birth care
Services for Salford families
Children’s Services in Salford
•
Consultant-led Paediatric Assessment and Decision Area
(PANDA) offering:
- Child friendly environment in which children and young
people area treated by dedicated children’s doctors and
nurses
- Improved likelihood of avoiding an overnight stay as short
term care can be provided for longer than in an adult A&E
department
- follow up at home or in community if necessary
Children’s Community Nursing Team
•
Expansion of the Children’s Community Nursing Teams (CCNT)
across Greater Manchester – 18 nurses in Salford team
•
Treatment in the home and at local nurse-led clinics
•
Improved training opportunities means a wider range of
treatments
•
Attend afternoon and evening shifts on the PANDA to assist
with discharge and provide continuity of care
Children and Adolescent
Mental Health Service (CAMHS)
•
Significant investments made in CAMHS via Salford City
Council & NHS Salford
• Include:
- Development of community based services for older
adolescents with complex mental health needs
- Appropriate community services for young people with
mental health problems
- Investment in training primary care providers to
recognise early symptoms in children and adolescents
Maternity services in Salford
•
All routine antenatal and postnatal care continues to be
provided in Salford – at home, local clinics and at Salford
Royal
•
Routine scans, antenatal clinics and Antenatal Assessment
Day Unit provided at Salford Royal
•
Antenatal clinics provided by staff from the Royal Bolton and
Saint Mary’s Hospitals
Birth Choices
•
Saint Mary’s Birth Centre in Salford
•
Home births in Salford
•
New and expanded maternity units at Saint Mary’s, the
Royal Bolton and North Manchester General Hospitals with
capacity to accommodate Salford women
•
Women in some areas may continue to choose Warrington
Hospital
Saint Mary’s Hospital
The new Saint Mary’s Hospital in
central Manchester
• brand new hospital for women
and babies opened in July 2009
where the very highest levels of
specialist care are being
provided
• includes a midwife-led birth
centre
• new, state-of-the-art Newborn
Intensive Care Unit (NICU)
Royal Bolton Hospital
£20 million worth of investment in new,
improved and expanded facilities at the Royal
Bolton Hospital
• expansion and improvement of the maternity
unit, including additional, en-suite rooms
and new obstetric theatres
• a midwife led unit
• new, purpose built Antenatal Day Unit
• a brand new Neonatal Intensive Care Unit and
refurbished Special Care Baby Unit
(SCBU)
North Manchester General Hospital
A £35 million new women and children’s
unit opened at North Manchester General
Hospital in June 2010
• includes a new, modern and spacious
maternity unit including more single rooms
with en-suite facilities
• new neonatal unit where higher levels of
specialist care can be provided
• includes a midwife-led birth centre
Where are Salford women choosing to
have their baby?
•
What are families’ experience of the
new services?
Gaining understanding of experience by:
•
Maternity Services Liaison Committee
•
Patient Diaries
•
Maternity Services User Group organised via Maternity
Services Liaison Committee
•
Patient Complaints and PALS issues (very few)
What are families’ experience of the
new services?
•
High levels of satisfaction with services (particularly
midwifery care)
•
Issues related to:
- Ultrasound scanning
- Cost of parking
- Availability of breastfeeding information
- Approach to preparation for parenthood/birth
The Saint Marys Birth Centre
In Salford
Kathy Murphy
Head of Nursing & Midwifery
Saint Marys
Central Manchester
The Stand-Alone Service
Choosing the Birth Centre – how it works
 Booking – Community Midwife (Assess suitability)
Give Information Leaflet
 During pregnancy – Community midwife,
Ultrasound appt, ANC, AAU, Parent Education, Tours
 36 week assessment by midwife – to assess
suitability, offer Tour
 ‘Accidental’ – oops! – only 3 Impromptu
Assessment!
Tours of the Birth Centre
Work in Evolution – looking for women to shape
the format
Either using a
Tues 7pm group session 3 or 4 in first weeks
Numbers increased to 10 per week
Or
Individual – half-hour appt
Appointment Function
Tour of rooms – 6 – Lavender, Rose, Mint,
Chamomile, Sandalwood & Aqua
 Explanation re experience, training &
commitment of staff – core & community
midwives
 Give information regarding statistics & evidence
re normal birth – “safe for the baby and offer
benefits for the mother” (NPEU The Birthplace
Cohort study, 2011)
 Services not available – medical staff, epidural
anaesthesia
Appointment Function
Services available –
3 of 6 rooms en-suite, own choice of room
Equipment : pool, birth balls & mats, recliners,
music, tea & coffee-making facilities, free visiting
times , option for partner to stay, short or longer
post natal stay,
ambulance transfer with midwife if necessary,
resuscitaire & transport incubator, 1:1 care with
2nd midwife available
Appointment Function
Discussion re suitability, choice, option to
complete / update Birth Centre booking form, add
any additional information e.g. recent blood
results/blood group
 Option to discuss Birth Plan
 Ensure woman has contact number for labour or
queries
Statistics (Dec – June)
TOTAL
PARA
PG
107
86
80.3%
21
19.6%
Transfers
29 out of
136
21.3%
9
20
Length of Postnatal
Stay
12 hours
Births
Pool Use
69
50.7%
19
9
Pool Birth
45
42%
36
9
Drugs –IM
28
20%
16
12
10
6
Perineal Trauma
requiring repair
16
14.9%
Breast Feeding
73
68.2%
Transfers data
Transfers per month run from 1 in March the lowest
month to 8 in May the highest month
More primps than mulitps transfer
Reason for transfer include
Requests for an Epidural = 2
Delay in the first stage of labour =5
Delay in the second stage of labour =3
Meconium = 5
Maternal raised BP = 1
Fetal indication = 2 (one was postnatal )
Other retained placenta / suturing /pyrexia /IOL
Data at a Glance
Births
Total
Transfers
Labour
Transfers
Post
Natal
Transfers
December
2011
11
2
2
0
January
2012
February
14
5
5
0
15
4
3
1
March
12
1
1
0
April
May
16
6
5
1
21
8
4
4
June
18
3
2
1
TOTAL
107
29
22
7
Evaluating the Service
Staff very
accommodating, could
not do enough!
I’ve already
recommended it to
friends – a lot less clinical
& more relaxed.
Estelle
Jan 2012
Staff were fantastic, can’t
thank them enough. I was
really anxious about birth
but my care from start to
finish was outstanding.
Ashley
23/1/12
Couldn’t have
wished for a more
enjoyable & safe
birthing
experience.
Jenna
Feb ‘12
The facilities are
good, staff brilliant
– a great experience
& very relaxing.
Vicky
March
Very comforting, soothing &
calming, it made me feel at
ease compared with my other
births. Very professional staff
but at the same time friendly
& reassuring.
Donna
Donna
February
Homely & clean,
staff amazing,
would definitely
come again.
Angela
Jan ‘12
“Providing midwife-led care on the birth centre has given me the
opportunity to develop skills in autonomous practice, and
increased my confidence in my own skills and the process of normal
birth.”
“I have gained real job satisfaction by providing women centred
care, and caring for women throughout labour up until discharge
home.”
“I feel extremely grateful to have had the privilege of practising
true midwifery in a positive environment that is conducive to
normal birth.”
“Practising in a stand-alone birth centre has allowed me to
reclaim autonomy, promote normality and further empower
women, and myself.”
Birth Centre Midwives
March 2012
AQUA ROOM
LAVENDER ROOM
THE MINT ROOM
SANDALWOOD ROOM
THE ROSE ROOM
THE ROSE ROOM (2)
Any questions?