Report to:
Planning & Commissioning Committee
Date of Meeting:
6th May 2015
Subject:
Presented by:
Maternity Services Commissioning Strategy Annual Report
2014/15
Natalie Robinson – Interim Commissioning Manager
Author:
Natalie Robinson – Interim Commissioning Manager
STATUS OF THE REPORT:
To approve
x
To endorse
To ratify
To discuss
To consider
For information
To note
PURPOSE OF REPORT:
The purpose of the annual report is to provide the Planning & Commissioning Committee with
a review of progress for Year 1 of the Hull Maternity Services Commissioning Strategy (2013
– 2018) and its associated work plan and thereby assurance on delivery of the NHS Hull
CCG strategic objectives associated with the strategy.
RECOMMENDATIONS:
It is recommended that the Planning & Commissioning Committee :
a) Note the content of this report
b) Seeks assurance on the progress of the delivery of the work streams and initiatives
within the Maternity Services Commissioning Strategy Year 1 (2014/15) work
programme.
c) Support and agree the contents of the Year 2 (2015/16) work plan and its associated
actions and objectives
REPORT EXEMPT FROM PUBLIC DISCLOSURE
If yes, grounds for exemption
(FOIA or DPA section reference)
No
x
Yes
CCG STRATEGIC
OBJECTIVE (See
guidance notes
below)
ASSURANCE
FRAMEWORK
SPECIFIC
OBJECTIVE
Short summary as to how the report links to the
CCG’s strategic objectives
(See guidance notes
below)
Short summary as to how the report adds
assurance to the Assurance Framework
The Maternity Services Commissioning
Strategy is an identified initiative within The
Children, Young People and Maternity
Programme ‘Next Generation’ which is one
of four transformational change
programmes within the NHS Hull CCG
This report provides assurance to the
Planning & Commissioning Committee on the
delivery of the Maternity Services
Commissioning Strategy work-streams and
initiatives.
IMPLICATIONS: (summary of key implications, including risks, associated with the paper ),
Resources are identified within the CCG Financial Plan for the initiatives within the
Finance
Children, Young People and Maternity Programme.
HR
None
Quality
Quality issues are addressed at initiative level.
Safety
Safety issues are addressed at initiative level.
ENGAGEMENT:
This paper presents work undertaken through the Maternity Services Forum which is
responsible for taking forward the initiatives and projects related to this programme area.
Members of the Maternity Services Forum have been consulted with and asked for input and
feedback in relation to the content of this annual report and the development of the Year 2
(2015/16) work plan.
There is an identified objective within the work plan that focuses on service user experience
and engagement.
LEGAL ISSUES: (Summarise key legal issues / legislation relevant to the report)
None
EQUALITY AND DIVERSITY ISSUES: (summary of impact, if any, of CCG’s duty to promote
equality and diversity based on Equality Impact Analysis (EIA). All reports relating to new services,
changes to existing services or CCG strategies / policies must have a valid EIA and will not be
received by the Committee if this is not appended to the report)
An Equality Impact Analysis/Assessment is not required for this report.
Tick
relevant
box
x
An Equality Impact Analysis/Assessment has been completed and approved by the lead
Director for Equality and Diversity. As a result of performing the analysis/assessment
there are no actions arising from the analysis/assessment.
An Equality Impact Analysis/Assessment has been completed and there are actions
arising from the analysis/assessment and these are included in section xx in the
enclosed report.
THE NHS CONSTITUTION: (How the report supports the NHS Constitution)
Objective
No
1
Strategic Objective
Specific Objective 2014/15
In 2020 we will work together
better to enable the people of
Hull to improve their own health,
resilience, wellbeing and to
achieve their aspirations for the
future










2
Achievement of CCG balanced
scorecard domains and strategic
performance objectives


Patients receive clinically commissioned, high
quality services
Patients and the public are actively engaged
and involved
The CCG has robust governance
arrangements
CCG plans are delivering better outcomes for
patients
The CCG has strong and robust leadership


21st Century Primary Care Workforce
Next Generation



3
Other Strategic Objectives
Integration
Implementation of Better Care Fund and
readiness for April 2015
Care closer to home
Transform and redesign pathways in high
volume (outpatient) specialties. Provide
choice of services for patients
Closer integration of services with hospital
and primary care services working more
closely together
Community Hubs
Development of a population based approach
to commissioning to support community
priorities based on x7 areas
Single Care Navigator
A principle of delivery
Thriving communities, build communities
ownership and resilience
HULL MATERNITY COMMISSIONING STRATEGY (2013 – 2018)
ANNUAL REPORT 2014/15
1. INTRODUCTION
The purpose of this report is to provide the Planning & Commissioning Committee with an
update on progress of the work being delivered through the Hull Maternity
Commissioning Strategy (2013 - 2018) and progress against the year 1 workplan
objectives, thereby providing assurance on delivery of the NHS Hull CCG strategic
objectives associated with the children, young people and maternity programme.
2 BACKGROUND
NHS Hull CCG has a strong focus on children and young people as the ‘next
generation’. ‘Children and young people and maternity’ is one of the five service
development work streams of the Hull 2020 Strategy and includes services from preconceptual care and maternity through to early years, education, learning and
employment.
The Maternity Services Commissioning Strategy sets out the strategic plans for NHS Hull
Clinical Commissioning Group for the period April 2013 to March 2018. It is identified as
an initiative within the children, young people and maternity programme.
The overarching aim of the strategy is that maternity services commissioned by NHS Hull
CCG will provide “high quality, evidence based and safe care, delivered at the right time,
in the right place, by a properly planned, educated and trained workforce. Services will be
integrated and care will be coordinated around the woman and her family, with service
users reporting positive experience of the maternity care they have received”.
The strategy has five key measurable outcomes that continue to be delivered through the
Maternity Services Work Programme.
1. An improvement in maternal health – this includes improvements in the rates of
early access to midwifery care, reduction in maternal obesity and rates of smoking.
2. A reduction in maternal mortality
3. A reduction in infant mortality
4. A reduction in infant morbidity
5. An improvement in women and their families’ experience of maternity services
The Maternity Services Forum is a multi-disciplinary, multi-agency forum that brings
together key stakeholders (commissioning, provider organisations and services and
service users) in order to: contribute to the development and provision of high quality maternity services
 secure service user engagement and involvement, ensuring that the views of
women and their families who use local maternity services are taken into
account in the commissioning, delivery and review of such related services

lead the delivery and monitoring of the NHS Hull CCG Maternity Services
Commissioning Strategy Work Programme alongside other associated groups
such as for example, the Smoking in Pregnancy Group and the Children’s
Centre Strategic Group.
To drive the delivery of NHS Hull CCG Maternity Services Commissioning Strategy Work
Programme the Hull Maternity Services Forum meets quarterly. The forum is chaired by
NHS Hull CCG.
3 INFORMATION
During the period 2013/14 to March 2015 considerable progress has been made against
the delivery of the NHS Hull CCG Maternity Services Commissioning Strategy Work
Programme (2014-2015). Appendix A sets out the progress made against each of the key
actions and objectives.
3.1 Achievements include:









Agreement and sign off of the Hull and East Yorkshire Hospitals NHS Trust
(HEYHT) maternity service specification for delivery of services up to 2017
Re-procurement of the “Doula Project” for a further four years (until 2019) which
will support the training of 40 volunteers and support 160 pregnant women per
year.
Re-procurement of the “Peer support breastfeeding project” for a further four years
(2019) which will support the recruitment of 50 volunteers and engage with
approximately 2000 women each year (antenatal and postnatal)
Implementation of CO2 monitoring at booking for all pregnant women, with direct
referral into the Smoking in Pregnancy Service.
Strengthened Perinatal Mental Health pathway through procurement of the “Let’s
Talk” service, and the training and development of the health visitor and
GP/Primary Care workforce.
Investment in the HEYHT midwifery workforce resulting in recruitment of 12
midwives, reducing the birth to midwife ratio to from 1:35 (Nov 14) to1:32 (Jan 15)
Hull City Council (CC) Public Health allocation of £100k over three years (20142017) to implement an integrated maternal healthy lifestyles plan. The plan
includes the development of an “Us Mums to Be” and “Us Mums” brand supporting
healthy eating and physical activity across the city.
NHS Hull CCG commissioned a research study delivered by The University of Hull
to determine if training assists primary care practitioners to effectively identify and
manage Peri-mental Illness (PMI), This outcomes of the study will inform workforce
development requirements and will support the development of a “Map of
Medicine”
A Protected Learning Time event which was held in March 2015 on “Bridging
Primary Care and Maternity Care” The event was attended by over 120 health
professionals and included presentations on stillbirth, managing medical elements
of maternity care, perinatal mental health and healthy lifestyles.
3.2 Progress made against 5 key measurable outcomes
1. An improvement in maternal health – this includes improvements in the
rates of early access to midwifery care, reduction in maternal obesity and
rates of smoking.
Table 1 evidences improvements in the number of women seen by a midwife or
maternity healthcare professional by 12 weeks and 6 days of pregnancy.
England
13/14 (Q1)
12/13 (Q3)
91.5%
91.8%
Hull PCT/
NHS Hull CCG
95.9%
95.9%
Table 1: Number of women seen by a midwife or maternity healthcare
professional by 12 weeks and 6 days of pregnancy.
Data Source: NHS England
The city of Hull continues to be an outlier in performance in the reduction of women
smoking at time of delivery (SATOD). Data as of Q3 of 2014/15 shows 20.3% of women
smoking at time of delivery, compared to the England average of 11.5% (Q2 2014/15).
The implementation of Breathe2025, the Still Care Bundle pilot and Hull CC’s reprocurement of Smoking Cessation services will support the drive for on-going
improvement. The Yorkshire and Humber Strategic Clinical Network as part of its work
on the development of a maternity dashboard have suggested a SATOD target of 11%
or less for achievement by the end of 2015.
Maternal Obesity continues to be of concern, in Q3 of 2014/15 24.9% of women seen at
booking clinic had a BMI>30. It is difficult to put this data into national or regional
context as reporting for this measure has not been routinely collected. The publication
of the Maternity Services Data Set (MSDS) Information Standards notice requires
Maternity Service to centrally submit this dataset which includes BMI from the 1 st May
2015.
2. A reduction in maternal mortality
Due to the very small numbers of maternal deaths it is not possible to present the
details in this report, that being said one maternal death is too many and there
continues to be a drive to prevent any avoidable maternal deaths.
Further to the recent publication of the HEYHT LSA Audit report from October 2014 and
Dr Kirkup’s “Morecambe Bay Investigation Report” assurance is required regarding the
local position and any required actions.
3. A reduction in infant mortality
Table 2 shows the latest available data for infant mortality. As can be seen, whilst
progress has been made and a reduction shown since 2008/10, Hull continues to have
a higher rate in comparison to England. To date there has been a variable trend in the
mortality rate, it is expected that the 2012/14 data set will be published in May 2015,
until then no assumptions can be made of a sustained reduction.
2009/11
2008/10
2007/09
England Kingston Upon Hull
4.4
5.0
4.6
5.5
4.7
4.9
Table 2: Infant mortality rate per 1,000 live births
Data source: HSCIC Indicator Portal
There has been improvement in the reduction in the 3 year average crude rate of
stillbirths in Hull, however the single year rate for 2013 (rate per 1,000 live births 6.4) is
considerably higher than that of the England average (rate per 1,000 births 4.6)
2011/13
2010/12
2009/11
England Kingston Upon Hull
4.9
4.7
5.0
4.3
5.2
5.3
Table 3: Still births: crude rate, 3 year average
Data source: HSCIC Indicator Portal
4. A reduction in infant morbidity
This outcome measure should be seen in the overall wider strategic context of the
maternity commissioning strategy. It is difficult to present a reduction in real data terms
for infant morbidity. Morbidity statistics are available from a range of sources and refer
to ill health within a specific population, in this case infants. A robust maternity JSNA will
allow us to explore this data in more detail highlight any areas for concern. A number of
the objectives in the work plan support an improvement in infant health and wellbeing
including: improvement in pre conceptual care, breast feeding rates, reduction in
smoking rates, increase the number of normal births etc.
For both initiation of breastfeeding at time of delivery and women breastfeeding at 6-8
weeks NHS Hull CCG continues to be an outlier in performance in comparison to the
England average.
14/15 Q2
14/15 Q1
13/14 Q4
13/14 Q3
13/14 Q2
Breastfeeding initiation %
England
NHS Hull Rank
CCG
74.4%
62.6%
161/185
74.0%
63.1%
155/185
73.8%
63.1%
117/185
73.7%
63.0%
134/185
74.2%
62.3%
150/185
Breastfeeding at 6-8 weeks %
England
NHS Hull Rank
CCG
Data quality criteria not met
Data quality criteria not met
46.2%
30.7%
65/116
45.7%
35.4%
79/116
45.7%
32.9%
88/116
Table 4: Breastfeeding rates at initiation and 6-8 weeks
Data source: NHS England
Action is required to address data quality reporting for breastfeeding at 6-8 weeks to
provide assurance on performance.
In 2013/14 (Year 1) Birth Preparation and Parent Education Services (BUMPS)
delivered sessions to 926 clients (pregnant women and their partners) averaging 77
clients per month. NHS Hull CCG are working with BUMPS to agree a service
development plan with stretch targets against all key performance indicators with the
primary goal to improve access and uptake of the service in 2015/16 .
5. An improvement in women and their families’ experience of maternity
services
There is insufficient information and data available to provide assurance in any
improvement in women and families experience of maternity care. This is highlighted as
a key area for action in Year 2 of the work plan.
There has been a continued poor response to the Friends and Family Test. Whilst the
scores achieved are high, the response rates are so poor that no assurance can be
gained. The latest results published (December 2014) show the following number of
responses:




How likely are you to recommend our antenatal service to friends and family – 78
responses
How likely are you to recommend our labour ward/birthing unit to friends and
family if they needed similar care or treatment – 12 responses
How likely are you to recommend our postnatal ward to friends and family if they
needed similar care or treatment – 12 responses
How likely are you to recommend our postnatal community service to friends and
family if they needed similar care or treatment – 16 responses
3.3 Summary and focus for year 2 (2015/16)
Further improvement is still needed against the five measurable outcomes and in
order to address the issues highlighted above.
Appendix B sets out the Draft Year 2 Work Programme (2015 -2016). This will be
continued to be led, delivered and monitored by the Hull Maternity Services Forum.
There are a number of actions and objectives which have been carried forward and a
strengthened focus on the following areas:






The development a Maternity JSNA for Hull
Reduce the number and rate of still births
Improve access and outcomes from birth preparation and parent
education services
Improve service user experience and engagement
Perinatal Mental Health
Healthy lifestyles including a reduction in maternal obesity and smoking
at time of delivery.
4. RECOMMENDATIONS
It is recommended that the Planning & Commissioning Committee:a) Note the content of this report
b) Seeks assurance on the progress of the delivery of the objectives within the
Maternity Services Commissioning Strategy Year 1 work programme.
c) Support and agree the objectives set out in the draft Year 2 Work Plan (20152016).
Appendix A
MATERNITY SERVICES COMMISSIONING STRATEGY
WORK PROGRAMME: YEAR 1 (DEC 2013 – MARCH 2015): Final Version March 2015
Outcome reference key *
1. Improving maternal health; 2. Reducing maternal morbidity; 3. Reducing infant mortality; 4. Reducing infant morbidity; 5. Improving women and families’ experience of care
Key Actions
1
2
Development and
implementation of service
specification for maternity
services
Implementation and
monitoring of maternity
tariff
Outcome
ref
Lead
Status/Outcome
Timescale for completion
Evidence of progress/update
1,2,3,4,5
Hull CCG
Service specification approved by
CCG
Ratification by Hull and East
Yorkshire NHS Hospitals (HEYHT)
Contract monitoring
February 2014
Complete
March 2014
Agreed and in contract
Meeting with HEYHT January
2014 to discuss actions required to
provide monitoring information for
2014/15.
April 2014
1,2,3,4,5
HEYHT
and Hull
CCG
Tariff requirements incorporated
into service specification for
maternity services.
April 2014
Complete
Agreed and in contract
3
4
5
Development of maternity
performance framework,
incorporating CCG
Indicators and NHS
Outcomes Framework
Indicators
1,2,3,4,5
Development of assurance
and reporting framework
for work programme
1,2,3,4,5
Maternity Protected Time
for Learning (PTL) event
for Primary Care
1,2,3,4,5
Hull CCG
Developed and incorporated into
service specification for maternity
services
March 2014
Complete
Agreed and in contract
Contract monitoring
Hull CCG
Hull CCG
Working Group to meet bi-monthly
Reporting (quarterly/six-monthly)
to:

Hull Children and Families
Board

Hull CCG Children, Young
People and Maternity
Programme Board

Health and Wellbeing Board

Health Overview and Scrutiny
Commission
January 2014
Agreement for Maternity PTL
18.3.2015
Completed
Working group established and
continues to meet
Completed
A PTL has been agreed and is planned
for the 18th March 2015. An agenda has
been agreed.
Objectives
1
2
Improve pre-conceptual
care particularly women
with:

Existing health
conditions

Previous history of
obstetric/genetic
problems

Second and
subsequent
pregnancies
Increase the number of
normal births 2013/14 to
2014/15
Outcome
ref
1,2,3,4
1,2,3,4,5
Lead
Action(s) required
Public
Health
(Rachel
Iveson)
i
HEYHT
(Janet
Cairns)
i
Needs assessment and
scoping exercise
Timescale for
completion
July 2014
Recommendations
discussed and agreed with
partners
September 2014
Establish current
status/baseline information
and set targets
April 2014
Evidence of progress/update
Ongoing
An outline for a Maternity JSNA has been
agreed,
Due to capacity and prioritisation completion of a
Maternity JSNA is to be carried over into the
Year 2 work plan.
Ongoing
Further work is needed to agree and confirm
baseline and targets.
For the period 2013/14 the normal birth rate was
reported by HEYHT to be 66.9% which is above
the national average of 62.9% national average.
ii
Ongoing
agree target (numbers and
%) for year-on-year
improvement
Further work is needed to agree and confirm
baseline and targets.
This action is to be carried over into Year 2 of
the work plan.
iii
iv
Include Quality Requirement
within service specification
for maternity services
Establish Alongside MidwifeLed Unit at Hull Royal
Infirmary site
March 2014
Completed
TBC
Agreed and in contract
Ongoing
HEYHT are still committed to establishing a MLU
at the Hull Royal Infirmary site and a number of
meetings have taken place to progress this
work.
Objectives
3
Improve breastfeeding
rates at initiation and at 6
to 8 weeks, 2013/14 to
2014/15
Outcome
reference
1,2,3,4
Lead
Action(s) required
Public
Health
(Rachel
Iveson)
i
Establish current
status/baseline
Timescale for
completion
April 2014
Evidence of progress/update
Completed
ii
Include Quality Requirement
within service specification for
maternity services
March 2014
As of May 2014 a baseline established at:
60.1% initiation
31.7% at 6-8 weeks
Completed
iii
Focus on improving
breastfeeding rates through
Life Course Approach to be
incorporated into Health and
Wellbeing Strategy
June 2014
Completed
iv
UNICEF BFI Level 3
accreditation for community
services
March 2014
Completed in November 2013.
v
UNICEF BFI accreditation
Level 3 for hospital services
March 2015
vi
Review progress against
targets
Ongoing through
2014/15
vii
Service now monitoring and maintaining
accreditation
Continue with ibreastfeed
campaign
On going
Re-tender of breastfeeding
peer support services to
ensure maximum value for
money
May 2014
Increase availability of breast
pumps for loan within the
community
May 2014
Ongoing
HEYHY continue to work towards L3
accreditation
Ongoing
Doula service awarded further 4 years funding to
support breastfeeding peer support programme
Ongoing
Completes - Tender exercise complete.
Goodwin appointed as provider, delivering to
target. Additional breastfeeding peer support
clinics commissioned within year to increase
access throughout the city.
Completed – delivered to CHCP
Objectives
4
Improving women and
their families’ experience
of care
Outcome
reference
1,2,3,4,5
Lead
Action(s) required
HEYHT
(Janet
Cairns)
i
Establish current
status/baseline and agree
areas for focused
improvement
Timescale for
completion
March 2014
Evidence of progress/update
Ongoing
Friends and family test monitored monthly
Questionnaire to replicate the CQC maternity
survey had a poor response and was reissued
again to 100 women in December 2014 received
only 38 responses. Further work is needed in
this area in Year 2.
ii
HEYHT to implement Action
Plan to address findings of
CQC maternity survey 2013
January 2014
Completed
An action plan is in place and is monitored on a
monthly basis
A survey/questionnaire was repeated in June
2014 however received a poor response and
was sent out again to 100 women in December
iii
Friends and Family Test to be
implemented
Implemented Oct
2013 and ongoing
monthly
Completed
Reported monthly: reviewed by the Hull MSF
with suggestions and actions aimed at improved
uptake
iv
Maternity Services Forum to
develop service user
engagement programme for
2014/15
Working group
established
January 2014
Ongoing
Further work is needed in this area and Year 2
of the work plan includes a number of key
actions to support this.
Objectives
Improve uptake of
5
newborn screening
Outcome
reference
Lead
Action(s) required
Timescale for
completion
Evidence of progress/update
3,4
PHE/NHS
E and
HEYHT
(Tara Cox
and
Wendy
Francis.
Jan
Cairnes)
i
March 2014
Ongoing
Identify and agree scope of
screening programmes
requiring action
HEYHT continue to monitor progress against all
new born screening programmes and report to
Public Health England as required
Identified areas for action include:
ID 2 Antenatal infectious disease
programme – timely referral of Hep B
positive women for specialist advice
ST 2 Antenatal Sickle cell and
Thalassaemia screening – timeliness
(although the trust has made in year
improvements from 18% in Q4 to 49.1% in
Q2
NB 2 Newborn Blood Spot test – avoidable
repeats
ii
Establish current
status/baseline and agree
improvement target for each
programme
March 2014
iii
Antenatal and Newborn
Screening Steering Group to
be established
January 2014
iv
Localisation of national
service specifications
TBC
Completed
Thresholds set by Public Health England and
continue to be monitored and discussed at the
Antenatal and Newborn Screening Programme
Board
Complete
Further information required on this
Objectives
6
7
Improve uptake of
vaccination /
immunisations (maternal
and newborn)
Reducing maternal
obesity
Outcome
reference
Lead
Action(s) required
Timescale for
completion
Evidence of progress/update
3,4
PHE/NHS
E and
HEYHT
(Tara Cox
and
Wendy
Francis)
i
Identify and agree scope of
Vacc/imm programmes
requiring action
March 2014
Ongoing
Action carried over into Year 2 work plan
ii
Public
Health
(Rachel
Iveson &
Claire
Farrow)
i
Establish current
status/baseline and agree
improvement target for each
programme
Establish current status and
baseline
1,2,3,4
Ongoing
Action carried over into Year 2 work plan
March 2014
Ongoing
Further work is needed to establish a baseline
Action carried over into Year 2 work plan
ii
Review pathway and service
delivery
May 2014
Ongoing
Bitesize service launched, review still required
to evaluate.
Action carried over into Year 2 work plan
iii
Identify actions from preconceptual care needs
assessment
August 2014
Ongoing
Dependent upon outcomes and
recommendations of the Maternity JSNA
iv
Work with leisure services to
develop maternity specific
interventions
September 2014
Ongoing
Progress continues to be made
Maternal healthy lifestyles
action plan to be developed
A bid has recently been submitted to Sport
England, 'Get Healthy, Get Active' fund with the
aim to increase the take up and maintenance of
pregnant women/post pregnant women taking
part in sport and physical activity. Us Mums to
Be and Us Mums brand developed (in line with
successful ‘Us Girls’ brand in the city).
Ongoing
Draft lifestyle plan has been prepared and
requires further consultation.
This action to be carried over into Year 2 of the
work plan
Objectives
8
Improve Perinatal Mental
Health (PNMH)
Outcome
reference
1,2,3,4,5
Lead
Action(s) required
NHS Hull
CCG
i
Primary Care workforce
development
Timescale for
completion
TBC
PNMH
Team
ii
Ongoing
Training has been delivered to all Health
Visitors to support early identification. This work
is supported by the Institute of Health Visiting.
Public Health workforce
development
CHCP
TBC
iii
PNMH Care Pathway
December
TBC
iv
Map of Medicine
March 2015
University
of Hull
v
Re-establish Maternal
Mental Health Advisory
Group
Deliver a Perinatal MH
conference in Hull
TBC
TBC
Ongoing
NHS Hull CCG approved a perinatal mental
health research project and training to primary
care re: PNMH from September 2014. The
study continues
The Maternity PTL on the 18th March has a
dedicated session to Perinatal Mental Health
and the research study. This action is to be
carried over into Year 2 of the work plan.
University
of Hull
Hull CC
PH
Evidence of progress/update
TBC
This action is to be carried over into Year 2 of
the work plan.
Ongoing
The ‘Let’s Talk’, Depression and Anxiety Service
Hull went live on October the 1st 2014; they are
now the lead providers for Primary Care Mental
Health in Hull.
Further work is needed in this area and will be
taken forward in Year 2 of the work plan
Ongoing
This action is to be carried over into Year 2
of the work plan.
Completed
Next meeting agreed to take place in April
2015
Ongoing
Agreement by University of Hull to develop
and deliver a city wide Perinatal Mental
Health conference/workshop in 2015
This action will be carried over into the year
2 work plan
Objectives
9
Reduce smoking in
pregnancy
Outcome
reference
1,2,3,4
Lead
Action(s) required
Public
Health
(Rachel
Iveson)
i
Establish baseline
Timescale for
completion
April 2014
Evidence of progress/update
Completed
Baseline set as of 2013 data:
Number of mothers smoking at time of delivery
= 23.1%. Aim to reduce year-on-year.
Q1 2014-15 data shows that the rate has
reduced to 20% for the first time. Attributed to
the success of the new pathway implemented
by CHCP and midwifery.
Further work is being undertaken to ensure that
this reduction is not impacted by the withdrawal
of free Nicotine Replacement Therapy
ii
Review of evidence
April 2014
Completed
iii
Implement CO monitoring
July 2014
Completed
Midwifery training commenced in May 2014 and
was completed by October 2014. Monitoring is
now in place
Appendix B
MATERNITY SERVICES COMMISSIONING STRATEGY
WORK PROGRAMME: YEAR 2 (APRIL 2015 – MARCH 2016): Version 1.1 May 2015
Key Actions – Governance
and Accountability
1
2
Lead
To monitor the
overarching contract
performance of
commissioned maternity
services, including
implementation of NICE
guidelines, LSA Audit
and response to Dr
Kirkup’s report on
Morecambe Bay
NHS Hull
CCG
To maintain and further
develop the Hull
Maternity Services
Forum
NHS Hull
CCG
Status/Outcome
Timescale for
completion
Evidence of progress/update
May 2015
Ongoing
Receipt of quarterly performance reports.
Performance managed where required by
contract board meetings.
Awaiting final report from LSA before can share
and release as public
HEYHT reported at May meeting the Trust
response to Dr Kirkup’s report
Ongoing
Regular meetings with quorum attendance
Increased scope of membership including a
service user
Service user attended May MSF meeting
3
To develop and
implement a Maternity
Joint Strategic Needs
Assessment for Hull
Hull CC
(Rachel
Iveson)
TBC
Meeting planned with NR and Vicky Harris to in
June 2015 discuss Maternity JNA
1. Research and
development
Objectives
Lead
Action(s) required
Timescale for
completion
Evidence of progress/update
December 2015
Meeting with Jan Cairns and development of proposal
by end of April 2015,
Proposal to CCG for approval by end of May 2015
HEY audit approval by June 2015: 6 month audit,
presentation of audit report by Dec 2015
Hull
University
HEYHT
To ensure that any new
maternity service
development is evidence
based and evaluated to
measure outcomes and
added value.
Jan
Cairns
1.1
To develop and deliver a
proposal for a still birth
audit in partnership with
Hull University
Julie
Jomeen
Meetings taken place, proposal in preparation
Jan
Cairns
1.2
Julie
Jomeen
Natalie
Robinson
Jan
Cairns
1.3
To develop a pilot
pregnancy telehealth
project for a period of 12
months with agreed
evaluation and outcome
measures
May 2016
Proposal to CCG by April 2015, ethics approval May
2015, commencement of project June 2015, monthly
review meetings against project milestones
To develop a pilot GP led
24 week antenatal
assessment in primary
care
September 2015
Initial discussions taken place with HEYHT to
understand scope of assessment. Building on feedback
from PTL Maternity event.
NR to prepare a proposal to go to CCG SLT for
approval, - June 2015
2. Service
Development
Objectives
Lead
Action(s) required
HEYHT
Timescale
for
completion
Evidence of progress/update
May 2015
&
ABL
Healthcare
To reduce the number
and rate of still births.
(links to work streams
1, 5)
Baseline 3 year period
2010-2012
Number of Stillbirths =
49
Rate per 1,000 total
births = 4.7
2.1
Jan
Cairns
Jan
Cairns
2.2
Jan
Cairns
2.3
HEY to carry out SANDS
audit tool and develop an
action plan to address
findings
Sept 2015
Linked to Still Birth Care Bundle work
Establish and agree
baseline and agree
improvement stretch target
June 2015
2014 27 Still births
Participate in NHS England
Still Birth Care Bundle
programme
April 2015
Work on-going, including baseline audit of C0 monitoring in
practice, improvements identified
Cardiotocography (CTG) interpretation – signed up to K2
online programme to assess CTG interpretation.
Customised Growth Chart – capacity identified as issue,
involved in SABINE project, looking at GAP programme
Looking at competencies, what happens in Antenatal Day
Unit
Jan
Cairns
2.4
Workforce development in
primary care re: education
and understanding of foetal
movement monitoring
TBC
Aligned to still birth care bundle, information leaflet being
prepared, will be shared with primary care and relevant
colleagues. Leaflet primarily for patient use
To increase the
number of normal
births
( see link to telehealth
in work stream 1)
Jan
Cairns
2.5
Establish baseline based
on three year period 2011 2014
June 2015
April 2015
61.6% Normal Birth
27.2% Caesarean Section
10.3% Instrumental Birth
2.6
2.7
2.8
Natalie
Robinson
Agree target and plan for
improvement
June 2015
Targets
Normal Birth ≥60%
Caesarean Section ≤26.3%
Instrumental Birth ≤12.8%
Establish reporting
framework for assurance to
MSF
Develop policy for elective
Caesarian, aligned to IFR
panel.
Sept 2015
On-going
Jan Cairns agreed to share trust report after each MSF
meeting.
Initial discussions taking place locally with CSU and
HEYHT, scoping current situation, capacity and
considerations for any local policy.
April 2015
Draft policy prepared for consultation with HEYHT,LMC,
GP Board Members, Public Health, Patient Ambassadors,
Commissioners and MSF
Ratification of IFR policy to go to Planning and
Commissioning Committee and LMC in July 2015
2.9
To increase the
number of home births
Jan
Cairns
2.10
2.11
Establish alongside
midwife led unit at Hull
Royal Infirmary site
TBC
Establish baseline based
on three year period 2011 2014
June 2015
Agree target and plan for
improvement
June 2015
A costed proposal has been prepared, for consideration by
HEYHT. Jan Cairns to provide feedback and update at next
MSF
Improve access and
outcomes from birth
preparation and parent
education services
Jan
Cairns
2.12
Victoria
Sharpley
Victoria
Sharpley
2.13
Develop a revised virtual
tour DVD of Maternity Unit
that is used by all required
services
Sept 2015
To agree stretch target to
increase the number of
primps attending the
BUMPs service and action
plan as a result.
June 2015
CCG commissioners and contracting have worked with
ABL to agree staged a plan to improve activity aligned to a
wider service development plan. Agreed and in contract
from May 2015
Currently providing places to all women who request a
place and have an average of 11 participants per group.
Plans are in place to raise the BUMPS profile.
ABL have in place a PR and Coms and Marketing strategy
and plan. Includes;
o promotional stands in clinics/HEY/ childrens centres
o shopping centres
o health centres
o health promotion events (i.e. PTL events)
o Monthly press releases, radio interviews (where
possible)
o Social media (paid advertising)
Targeting wards with the lowest uptake- Orchard Park,
Newington, Myton
MSF
Members
2.14
To review BUMPS booklet
and agree content for
revised version prior to
print
May 2015
Booklet raised at MSF meeting: Feb
Laura Allenby sent out with MFS minutes: 16th Feb and 6th
March by Natalie comments requested back by Monday
27th April.
No comments received.
Going to print June 5th.
3. Service User
Experience and
Engagement
Objectives
Lead
Action(s) required
HEYHT
Timescale
for
completion
Evidence of progress/update
May 2015
ABL
Healthcare
To demonstrate
continual
improvement in the
experience of care
along the maternity
pathway for women
and their families
Jan
Cairns
3.1
Victoria
Sharpley
To establish current
status/baseline and agree
areas for focussed
improvement. To include
client questionnaires,
external audit, LSA report,
Peer review, CCQ, PALS
and complaints
Sept 2015
HEYHT to provide details of PALS, complaints and service
user feedback at future MSF meetings.
At May meeting it was agreed that lessons learnt and
themes will be shared with the MSF
Carolyn Rabaud (CHCP, HV) agreed to review and
consider a reporting framework for service user feedback to
include parents of children up to the age of 1 year.
ABL currently;
 Collect anonymous feedback after each course
 Do a 6 monthly survey with additional follow up
questions i.e. “following your birth and the first few
post-natal weeks, was there anything you would
have found useful to have been included in the
classes”
 Provide a ‘you said, we did’ every quarter

Collate feedback each month and implement into
the classes, i.e. more interactive work.
 Work under CQC/ ISO registered
Jan
Cairns
Victoria
Sharpley
3.2
To develop a mechanism
for sharing service
improvements and changes
that occur as a result of
service user feedback
Sept 2015
MSF
members
MSF
members
3.3
3.4
Improve uptake and
completion of the Friends
and Family Test, giving
consideration to a city wide
media and communication
plan.
Ongoing
Maternity Services Forum
to develop a service user
engagement programme
for 2014/15
Sept 2015
NR to establish a task and finish group to look at service
user engagement and experience. Meeting to take place in
June 2015
4. Health Protection
Objectives
Lead
Action(s) required
Timescale for
completion
Evidence of progress/update
May 2015
PHE/NHS E
and HEYHT
To improve on
coverage and
timeliness of results
and required
assessments
associated with the
antenatal newborn
screening programme:
ID1 Antenatal infectious
disease programme – HIV
coverage
ID 2 Antenatal infectious
disease programme – timely
referral of Hep B positive
women for specialist advice
FA1 – Down’s syndrome
screening completion of
laboratory forms
ST1 Antenatal Sickle cell and
Thalassemia screening coverage
ST 2 Antenatal Sickle cell and
Thalassemia screening –
timeliness
ST 3 Antenatal Sickle cell and
Thalassemia screening –
completion of FAQ
NB 2 Newborn Blood Spot test
– avoidable repeats
NP 1 Newborn and Infant
Physical examination – results
entered onto database within
72 hours
NP 2 – Babies with hip referral
have ultrasound appointment
within 2 weeks
Tara Cox
4.1
Wendy
Francis
Continue to monitor,
identify and agree scope of
newborn screening
programmes requiring
action
Ongoing
CCG representation on ANNB Programme Board. Data
provided by HEYHT to MSF
Q4 2014/15
ID1 – 90.7%
ID2 – 50%
FA1 – 98.5%
ST1 – DNA
ST2 – DNA
ST3 – DNA
NB2 – 4.9%
NP1 – 96.6
NP2 – DNA
Jane
McFarlane
DNA – Data not available nationally
4.2
HEYHT to ensure that
there is a fully established
and ongoing internal HEY
ANNB group to oversee
delivery and KPIs
Ongoing
Meeting planned for 2nd June. Miss J Hingorani to chair
meetings. Terms of reference to be developed, meetings
will be held quarterly. Membership includes:
 Screening Coordinator
 Clinical leads for screening programmes eg.
Consultant Microbiologist, Cons. Neonatologist,
Radiologist, Lead Sonographer, Fetal Medicine
Lead,.
 Head of Midwifery
 PHE representation
 NHSP Coordinator
 CHRD representation
 Midwifery representation (ie Community MW sister)
4.3
4.4
4.5
4.6
Provider to ensure that
they can identify the cohort
for each programme
TBC
ID2: Improve on the timely
referral of hepatitis B
positive women for
specialist assessment to
ensure that the 70%
acceptable threshold is
met.
Ongoing
Performance for Q4 2014/15 50%
Remains an issue, have only managed to achieve once
due to hard work of infectious disease consultant. Kevin
Phillips is working with the clinical support division to
address this.
ST2: Improve on the
timeliness of antenatal
sickle cell and
thalassaemia screening to
ensure that women are
tested by 10 weeks
gestation within the
acceptable threshold of
50%
Ongoing
Q4 2014/15 Data not available (nationally)
NB2: Improve on the
number of avoidable
repeat tests for new born
blood spot screening to
ensure that the acceptable
threshold of 2% is not
exceeded.
Ongoing
Performance for Q4 2015/15 4.9%
Considerable work going on to address. E-Learning has
been mandated, midwives who have never had a repeat
are carrying out peer assessments and sharing good
practice.
From April 1st 2015 laboratory have changed
requirements in terms of amount of blood for sample.
There is an expectation that this KPI will go down as a
result until new practice embedded.
To improve uptake of
vaccination /
immunisations
(maternal and
newborn)
Maternity Flu
Pertussis
Hep B
Tara Cox
4.7
Wendy
Francis
4.8
Establish current
status/baseline and agree
improvement target for
each programme
Review delivery
mechanism of maternity flu
as part of the Yorkshire
and Humber Sub-region
Flu Strategy
31st May 2015
NR requested data from PHE – May 2015
TBC
NR requested updated from PHE – May 2015
5. Healthy Lifestyles
Objectives
Lead
Action(s) required
Timescale for
completion
Evidence of progress/update
May 2015
Hull CC
Public
Health
To reduce smoking in
pregnancy
(links to work stream3)
Alex
Norman
Baseline
Smoking status at time
of delivery for 2013/14
was 21.6% (PHE 2015).
(PHE 2014 Local
Tobacco Control
Profile).
5.1
2015-18
New Smoking Cessation Service specifies: Reduce
smoking in pregnancy; local target - to reduce rates of
smoking throughout pregnancy by 1.0 percentage point
per year to 17.6% by 2018
Current position to be reported when data available
5.2
5.3
5.4
To improve
breastfeeding rates at
initiation and at 6 to 8
weeks, 2014/15 to
2015/16
Establish current status
and agree improvement
stretch target
Rachel
Iveson
5.5
All midwives already have “Smokefree Training”
To explore the
implementation of risk
perception training
Not Applicable
Implement a localised
Baby Clear project aligned
to Stillbirth Care Bundle
Ongoing
HEY are not proceeding with the Baby Clear Project
because of the cost. HEY is a pilot site in Yorkshire and
Humber for a project to reduce still births and near natal
deaths; there are four elements to this of which one is
CO Monitoring. All midwives have CO Monitors.
Ensure NRT support is
available to all pregnant
women who wish to stop
smoking
Ongoing
NRT support to pregnant women is included in the new
Smoking Cessation Service Specification in which
pregnant women feature as a “priority group”.
NRT can also be supplied via the GPs, midwives and
consultants are aware of the value of NRT and can
prescribe as required.
Establish current status
and agree improvement
stretch target
COMPLETED
Ongoing
Breast Feeding Initiation April 2015 69%
6-8 week breast feeding rate currently at 32%, have
been national issues on the data set and acceptance of
data quality, being addressed locally.
Baseline established at:
60.1% initiation
31.7% at 6-8 weeks
5.6
5.7
5.8
5.9
To reduce maternal
obesity
Rachel
Iveson &
Claire
Farrow
5.10
Focus on improving
breastfeeding rates
through Life Course
Approach to be
incorporated into Health
and Wellbeing Strategy
TBC
UNICEF BFI accreditation
Level 3 for hospital services
November 2015
HEYHT have confirmed that the BFI assessment is due
to take place in October 2015
Maintain UNICEF BFI Level
3 accreditation for
community services
November 2015
Local work on going to support successful accreditation,
including liaison with BUMPS re: course content.
Continue with ibreastfeed
campaign
TBC
Establish current
status/baseline and agree
improvement stretch target
July 2015
Regular meetings established with HEY Maternity
Services
SLA in progress re continuation of Healthy Lifestyle
Midwife post which will agree clear targets based on
previous performance and anticipated throughput;
monitoring arrangements and qualitative and quantative
information to be collected to inform performance.
Q3 2014/15 24.9% of women at booking had BMI ≥30
5.11
5.12
5.13
Establish stretch targets for
agreement with all partners
TBC
Review pilot service
In progress and
will be
completed to
inform new SLA
by July 2015
Carry out a mapping
exercise of current service
provision of physical
activity interventions,
Completed
Additional funding has been secured through Sport
England to deliver a 3 year physical activity in
pregnancy programme in partnership with HEY. A
comprehensive programme of PA opportunities will be
classes and sessions
available to pregnant
women
developed as part of this programme linked to identified
needs/demands, supported by key workers linked to HL
Midwife and Community Midwifery Service.
COMPLETED
5.14
5.15
To improve preconceptual care
particularly women
with:
 Existing health
conditions
 Previous history of
obstetric/genetic
problems
 Second and
subsequent
pregnancies
Rachel
Iveson
5.16
5.17
Maternal healthy lifestyles
action plan to be
developed
TBC
In progress and linked to the above programme
development
Deliver a coordinated and
suitable physical activity
and healthy cooking
programme for pregnant
women “Us mums to Be”
Year one
programme to
be drafted by
end of July
2015
this will be part of the new programme and is currently
in development
CF and FR attending introductory workshop with Sport
England in May 2015, programme likely to commence in
Summer 2015.
Needs assessment and
scoping exercise
1st Draft
September
2015
Needs assessment on pre-conceptual in progress, but
waiting for further data from the acute trust. Needs
confirmation on what data will be provided by June2015.
Recommendations
discussed and agreed with
partners
October 2015
6. Mental Health
Improvement
Objectives
Lead
Action(s) required
Timescale for
completion
Evidence of progress/update
May 2015
University
of Hull
To improve Perinatal
Mental Health (PNMH)
(links to work stream
1)
University
of Hull
6.1
To reinstate the Hull and
East Riding Maternal
Mental Health Advisory
Group (MMHAG)
March 2015
First meeting held 20th April 2015.
Minutes of meeting completed – arrangements in place
for next meeting
COMPLETED
MMHAG
MMHAG
MMHAG
University
of Hull
6.2
6.3
6.4
6.5
To review and refresh the
clinical pathway for PNMH
March 2016
All relevant parties (Let’s talk, HV, PMH team, IAPT)
engaged in process of reviewing and refreshing
pathway – arrangements pathways meeting underway,
deadline for completion of pathway exercise 1st June
2015
To evidence base impact
and outcomes of service
interventions; including
establishing a performance
framework, data collation
and analysis.
March 2016
Ongoing
To develop a Map of
Medicine for PNMH to
provide primary care
practitioners with access to
advice and prescribing
information for women with
PMI
Sept 2015
This is ongoing and largely dependent on the progress
of the GP/Primary Care Practitioners research study
below
To report on findings of the
PNMH training in Primary
Care study and make
recommendations for any
further action required.
June 2015
The findings to date have been presented @ PTL event
Continuation of project reliant on agreeing on a suitable
method for delivering training – discussions still on
going with Hull CCG. Possibility of another training
event – if a clear strategy for advertising is agreed on
between research team and Hull CCG
University
of Hull
University
of Hull
6.6
6.7
To develop and deliver a
workforce development
plan that includes scoping
of an e-learning package.
Ongoing
Develop and deliver an
accredited Perinatal MH
workshop in Hull
January 2016
Linked to the work of the PNMH training project and a
package may emerge out of this project as an
alternative form of delivery. At minimum will produce a
report of workforce training need and recommendations
for training by March 2016 with proposal for training
provision and outline package.
Work will link to content of PMH workshop
Workshop planning team minutes
Confirmation of programme August 2015 and
advertising of workshop
Conference/workshop planning underway – initial discussions
taken place in March 2015 regarding suitable date, venue, and
possible speakers.