Croydon Maternity Services Liaison Committee (MSLC) annual activity
report 2012/13
Background – governance
The government document, Maternity Matters: choice and continuity of care in a safe
service states that maternity services should be:
‘Using the Maternity Services Liaison Committees (MSLC) or similar fora* to agree on a
common set of objectives for maternity services, set the service specification for maternity
services and to be the local voice in the production of the PCT prospectus.'
*If such a forum does not exist, then this should be established’.
MSLCs include commissioners, providers and representatives of service users sometimes women or men, who have had a baby or become a parent recently, sometimes
experienced maternity services user advocates.
The Department of Health supports the establishment of MSLCs and expects that PCTs
(to 31st March 2013) will facilitate their operation locally.
To ensure continuity post 1st April 2013 the guidance has been adapted to meet the
transition structure set out in the Health and Social Care Act (2012) in a new document
‘Maternity services liaison committees: a consensus statement from NCT, RCM and
RCOG (2013)’
http://www.nct.org.uk/sites/default/files/related_documents/MSLC%20document%20FINA
L%202013%20V2.pdf
When was the Croydon MSLC started?
The Croydon MSLC was originally set up in the early 1990s and has been active
intermittently between then and now.
There was a period of 16 months from November 2010 when the MSLC was not
convened. In March 2012 the MSLC was reinstated with a refreshed membership. It is
currently co-chaired by a lay member and the public health midwife.
Membership
The constitution of the MSLC is made up of about 60% professionals: midwives, including
the Director of Midwifery, public health, , GPs, HV, Children’s Centre manager, breast
feeding manager and neonatal unit representation, and 40% user and voluntary sector
representation from a variety of backgrounds including: recently delivered teenage mother
and ethnic minority mother, BME forum, Off the Record (local young people’s mental
health organisation), National Childbirth Trust (NCT), independent baby and birth class
trainers, a doula, breast feeding advisor and representation from the local patient user
committee. To date we have been unable to attract representation from the obstetric team
or commissioners, but continue to invite these specialties.
Meetings held – time and frequency
1
During 2012/13 the MSLC has convened on six occasions. The meeting lasts for 2 hours
and are held mid-day to enable users to attend and encourage good attendance by
professionals.
Currently no crèche facilities are available, though babes in arms are welcomed.
Meetings have been held within the maternity department, although this is being reviewed
to encourage more user representatives to join the committee, who may feel more
comfortable attending a less formal, community venue e.g. Children’s Centres or voluntary
organisations’ premises.
Action plan priorities (Appendix 1)
The MSLC has developed and agreed an action plan to ensure the committee has a
purpose with measurable outcomes aimed at improving the experience and high quality
service for all women and their families.
There are 6 main priority areas identified by the committee:
1. Improving Woman’s Experiences
1a. Improving effective communication
1b. Improving choice of birth setting
1c. Improving environment and facilities
2. Reducing Inequalities
2a. Decreasing Maternal Mortality
2b. Reducing low birth weight (< 2.500g)
3. Ensuring Safety and Quality
3a. 1:1 midwifery care should be provided for all women during established labour
4. Public health
4a. Booking for maternity care <13 weeks’
4b. Improving protection of, support with and information about breastfeeding
4c. Promoting normality in a high risk birthing environment both for low risk and
high risk women
4d. Infant and maternal mental health pathways
5. Improving data
5a. Standardised collection and threshold criteria of three to six dash board
indicators across London
6. Contribution by MSLC to the wider agenda
6a. Patient Experience Committee
6b. Promotion of MSLC
Actions achieved to date (2012/13)
•
MSLC review of signage and posters
•
Walk the patch introduced: reviewed after 4 activities and questions
incorporated to identify what communication needs to improve
•
MSLC members visited parenting classes to enable MSLC feedback and review
of programme
2
•
•
•
•
•
•
MSLC provides a regular opportunity within its agenda to promote positive
experiences and outcomes and agrees a method for sharing and promoting
these widely with staff and users
Tour of unit to identify areas for improvement
Monitor and contribute to refurbishment plans*
Advocate for birth centre equipment and environment to ensure it meets the
needs of women physically and mentally
Progress made on perinatal mental health pathway – first draft currently under
revision
Improvements in user experience:
o Our January 2013 Picker Maternity Survey showed an improvement in the
following area compared with 6 months previously: Antenatal care: % women not given the choice of home birth (28%
(current) v 36% (previous))
o And our results were significantly better than the national Picker average for
the following: Antenatal check-ups: not given the choice where to have check-ups
(CUH 61% v National 73%)
 Postnatal care: mother did not have a health check-up (CUH 4% v
national 10%)
*The unit won a bid for funding towards refurbishment of maternity units put forward by the
Department of Health. Stipulation within the success of the bid was that there must be
user involvement, which has been provided by the MSLC.
Additional activities where the MSLC has been represented:
•
Contributed to the annual LSA audit giving user perspective and input
•
NHS London feedback session on review of maternal deaths in London
Future work plan (2013/14)
 Presentations to be provided to enhance the normality in birth in high risk
environment both for low risk and high risk women. For example exploring
introduction of study days for midwives and obstetricians to enhance their
knowledge and ability to support women and promote normality for high and low
risk women

Development of a clear route for women to discuss their birth experience with
midwifery supervision team in cases where they feel care was inadequate or they
feel traumatised by the birth. Equally, this is a route for positive stories to be
shared. http://www.infantmentalhealth.com/

Promotion of MSLC through CUH website and leaflets; available at hospital and
GPs Practices and in notes for every pregnant woman

Monitor support of breast feeding by professionals and additional opportunities to
support women. Ensuring consistent and evidence based advice is being provided
by all staff and support workers in line with Baby Friendly status.
Resources
3
During 2012/13 funding was secured to reimburse lay members with expenses for
travelling and child care. This funding will, in the interim, be provided by the Health and
Wellbeing Board until formal agreement is reached as to which organisation will take
responsibility for resourcing the MSLC in the future.
Future risks
MSLC no longer nationally/locally supported by commissioning services and therefore
cannot attract and support high quality user involvement.
Resource to be identified to service the MSLC, as public health (PH) has now moved to
local authority which, whilst supporting PH membership, may not support the current
resource provided to co chair and service the committee.
Recommendations of the Croydon MSLC support, and are consistent with, those set
out in the NCT, RCM, RCOG consensus statement (2013)
- It is recommended that MSLCs:






Continue to exist under the auspices of an appropriate body in the local health care
structure
Continue to be the main means of giving service users an influence over maternity
strategy and delivery of the service
Are provided with a ring-fenced budget to make sure that they can meet regularly in
suitable settings and that chairs and members have appropriate training and
support
Continue to act as strategic advisory groups that help create and maintain high
quality maternity service, defined as those where women and their partners have a
safe transition to parenthood and an experience that is positive and life enhancing
Are consulted as at present and chaired or co-chaired by a lay user
Continue to have responsibility for creating mechanisms to elicit and collate both
qualitative and quantitative input form users.
Alison Miller
May 2013
4
Appendix 1
Croydon Maternity Service Liaison Committee
Improving maternity care in Croydon - Action Plan Priorities for MSLC 2012/13
Priority
Performance/Survey Score
Service Requirements:
MSLC Action
Were you involved as much as you
wanted to be in decisions about
your care and treatment?


Sub
grou
p
Update
1) Improving woman’s
experiences and
views
1a) Improving effective
communication

CHS patient feedback score 7.6/10

Did hospital staff tell you who to
contact if you were worried about
your condition or treatment after
you left hospital?
CHS patient feedback score 6.0/10

Improve
accessibility of
information.
Improve
communication skills
Review and
implement
accessible for all
parenting classes
Review of team
midwifery
On-going as
require 2x
leaflets
reviewed to date
Process in place to ensure
new leaflets and patient
information to be reviewed
by MSLC
MSLC review of signage and
posters
Walk the patch introduced
Following review questions
incorporated to identify what
communication needs to
improve
MSLC member to visit current
parenting classes available
and review, other members of
MSLC who want to, also do
the same
5
Walk
the
Patc
h
Reviewed after
4 sessions
RAG
1b) Improving choice of
birth setting -
Did you get enough information
from a midwife or doctor to help you
decide where to have your baby?
Review of low risk and
community birth options
Ensure MSLC provides a
regular opportunity within its
agenda to promote positive
experiences and outcomes
and agrees a method for
sharing and promoting these
widely with staff and users
MSLC contribution to review of
community birth options
68% responded positively in 201112
1c) Improving
environment and
facilities
Too many inpatients say the toilets
or bathrooms are dirty.
CHS patient feedback score 7.9/10
2) Reducing
Inequalities
2a) Decreasing
Maternal Mortality
Investment in
refurbishment and
management regularly
‘walk the patch’
Implementation of
Independent review
recommendations
6

Tour of unit to identify
areas for improvement.

Monitor and contribute to
refurbishment plans

Advocate for Birth centre:
Birth balls big enough to
ensure hips higher than
knees? Adequate
pillows/mats/ hanging
facilities and first stage
gym to encourage mobile
labour?
Attendance at dissemination
event of NHSL review of
maternal deaths in London
DoM carried out
review of
services and is
implementing
changes.
DoM secured
funding for
recruitment of
Consultant
Midwife for
normal birth
DH funding
secured for
refurbishment,
with MSLC
contribution.
Refurbishment
commenced
March 2013
(2010)
2b) Reducing low birth
weight
(< 2.500g)
3) Ensuring Safety
and Quality
3a) 1:1 midwifery care
should be provided for
all women during
established labour:
A woman in established
labour (NICE
definition1, as modified
by clinical judgement)
receives care from a
designated midwife for
the whole of that labour,
or the midwife's whole
shift, whichever is the
shorter. This midwife
will be available to care
for the woman 100% of
the time. (NSF 2011)
4) Public Health
4a) Booking for
maternity care <13
weeks’
Implementation of
reducing infant mortality
action plan (2012)
Were you (and/or your partner or
a companion) left alone by
midwives or doctors at a time
when it worried you?
Increase in midwife to
birth ratio
65% responded positively in
2011-12
report. MSLC to continue to
review implementation of
recommendations
Awaiting introductory
presentation
Clear route for women to
discuss their birth experience
with midwifery Supervision
team, in cases where they feel
care was inadequate or they
feel traumatised by the birth.
Equally, this is a route for
positive stories to be shared
To be presented
2013/14
following which
MSLC can
identify any
appropriate
actions
Midwife to birth
ratio improving.
Discussions
held regarding
improved
direction to SoM
where
requested.
Listening in
Action (LiA)
project funded
to include
maternity
83% (2011/12 performance)
Promote early booking
amongst all
communities.
7
MSLC members to promote
importance of early booking
within their ‘communities’
Referral form
reviewed and
amended.
4b) Improving protection
of, support with and
information about
breastfeeding
Teenage and other
specific services for
women with complex
social needs
Input into review of services
On-going
Enabling privacy and
encouragement to be
provided would help
mothers who are
intending to breastfeed
to carry out that choice
and thus protect
breastfeeding.
Input from members into
review of breast feeding
policies and pathways; both
within CUH and community
services.
On-going
4c) Promoting normality
in a high risk birthing
environment both for
low risk and high risk
women
4d) Infant and maternal
mental health pathways
5) Improving data
5a) Standardised
Dedicated midwifery and
obstetric team for
women with mental
illness
SWL Dashboard and maternity
Contribution to developing BF
peer support services
Review materials and
equipment available to
enhance environment for high
and low risk women.
Explore introduction of study
days for midwives and
obstetricians to enhance their
knowledge and ability to
support women and promote
normality for high and low risk
women
Membership of mental health
representatives Off the Record
and BME forum. Awareness
raising of preventative and
supportive measures for
midwives. Participation by Off
the Record member
Input into
refurbishment of
birth centre,
delivery suite –
including new
pool room,
reception and
triage
On-going review
and contribution
to service
planning
2013/14
8
collection and threshold
criteria of three to six
dashboard indicators
across London.
quality and choice data
6) Contribution by
MSLC to the wider
agenda
6a) Improving Patient
Experience Committee
Patient Experience Committee
(PEC) membership invited to
MSLC
6b) Promotion of MSLC
Develop promotion materials
for staff and users so they can
access the MSLC and use it to
ensure a consistently high
quality service for all.
9
DoM attends
and provides
MSLC
representation
On-going
2013/14