Agenda Item 7
TRUST BOARD
Tuesday 27 November 2007
PAPER
Summary of the Public and Staff Engagement Report for the Maternity and
Newborn Services Review
The purpose of this paper is to summarise the main issues that have come out of
the public and staff engagement reports which are part of the Maternity and
Newborn Services Review. The paper will also explain how the Division of
Women’s and Children’s plan to address or has addressed some of the concerns
highlighted.
A one off paper
PURPOSE
FORMAT
THE BOARD IS
ASKED TO:
Note the contents of the paper
Background
The Maternity and Newborn Services review commenced in June 2006 and is led by Bristol Primary
Care Trust. The aim of the review is to ensure the best possible experience of birth and early days for
parents and babies. The objectives of the review are to:
 Promote normal child birth
 Provide choices for where and how mother’s give birth
 Provide safe and effective care to national standards
 Reduce inequalities
 Make the best use of resources, ensuring that services are affordable
 Attract and retain staff by offering good experience and opportunities for development.
The public and staff engagement period of the review ran from 1st December 2006 until 1st March
2007. In total 410 people took part in the meetings for the public and 159 in the meetings for staff.
100 pieces of correspondence also fed into both reports. Within the reports it is not always possible to
know which comments relate to which Trust but some comments name the Maternity unit directly.
The patient engagement report
The topics covered fall into 5 main themes, ante natal care, care during birth, postnatal care, continuity
of care and the role of midwives.
Ante natal care
On the whole most women thought the ante natal care received was good.
Issues raised
 More parent craft classes specifically for teenagers
 Parent craft refresher courses for subsequent pregnancies
 Drop in clinics where advice on pregnancy and birth can be found.
 Information on parent craft classes outside NHS
 A range of times of classes to allow easier access
 More information on home birth
 Midwives appointments beginning earlier so that women could get advice about early
pregnancy.
 Scans offered in the Community
 Administration staff not available to make appointments in the hospital clinic
Actions taken/to be taken
 United Bristol Healthcare NHS Trust to appoint a teenage pregnancy midwife. Already have
set up a Consultant teenage pregnancy clinic with Midwife attached - October 07
 Already offer parent education classes to second time parents. To be re iterated within
community - August 07
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Agenda Item 7
United Bristol Healthcare NHS Trust has service level agreement to provide Midwifery
services and sign posting within Children’s centres. Maternity Support workers appointed in
the community to help with advice and sign posting.
Parent craft classes’ times and locations to be reviewed - October 07
Ensure all Community Midwives discussing home birth as an option - August 07
National Institute for Clinical Excellence guidance on ante natal care implemented so all
women offered an appointment at 8-10 weeks. Need to promote Midwife as first contact by
posters in pharmacies, General Practitioner surgeries etc - December 07
Already have some dating scans in Community at Consultant Community clinics. Scan
department to offer scans at South Bristol Hospital.
Review of administrative/reception staff in St Michaels - December 07
Care during birth
Issues raised
 Choice of home birth
 Birth plans
 One to one care in labour/staffing
 Caesarean section rate/especially from Black and Minority Ethnic communities
 Difficulty in getting baby’s first day examination done after home delivery
Actions taken/to be taken
 Community Midwives to be reminded to discuss with all women at booking home birth option.
 Women to be informed about how to write birth plans and help available to help them - August
07
 Birth rate plus (Work force assessment tool) being carried out at United Bristol Healthcare
NHS Trust July-0ctober 2007. Bed management occurs daily to maximise safe staffing within
the unit and community.
 Head of Midwifery working with Public and Patient Involvement lead to engage with Somalian
population. External Cephalic version offered to breech presentation.
 Midwives in the Community trained to perform check. More midwives doing training - on
going.
Post natal Care
Issues raised
 Visiting hours for partners
 Staffing levels/Support
 Breast feeding
 Post natal support at home
 Facilities
Actions taken/to be taken
 To re iterate to midwives to be flexible around partner visiting and staying
 Birth rate plus (Work force assessment tool) to be commenced. More support workers on
wards.
 Have infant feeding coordinator and have achieved level 2 UNICEF. Baby friendly initiative.
Level 3 assessment in October
 Have maternity support workers in the community
 Carpets on Level E to be replaced. Estates work plan to be developed with Assistant
Divisional Manager to improve facilities and environment - December 07
Midwives roles, workforce
Issues raised
 Shortfall in midwives
 Skills of Midwives/rotation to the Community
 Actions taken/to be taken
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Agenda Item 7
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Birth rate plus commencing July 1 .
Maternity Support workers in the community
Teenage pregnancy Midwife and ante natal screening Midwife to be appointed - October 07
Investment in service from income
Buddying system - Midwives rotate between hospital and Community - on going
Band 6 Midwifery posts in the Community in place
Continuity of Care
Issues raised
 Lack of consistent advice
 Change of Midwives in labour
 Different Midwife visiting postnataly
Actions taken/to be taken
 Named Midwife in Community
 Review of shift times on delivery suite
 Re iterate to Midwives use of care plans.
The report highlights comments from some specific groups.
Young Mothers
Issues Raised
 Need for extra support and Midwives who are aware of their specific needs
 Action taken/to be taken
 Consultant Teenage pregnancy Clinic commenced.
 United Bristol Healthcare NHS Trust Midwife visits Meriton school for teenage mothers.
 Teenage Midwife post to be advertised.
Parents of premature or sick babies
Issues raised
 Lack of cots
 Support and information
 Action taken/to be taken
 Neonatal Intensive Care Unit expansion by 2 cots
 Family support role under review.
Bereaved parents
Issues raised
 Support and counselling
 Training of staff in bereavement
 Lack of local paediatric pathologist
 Action taken/to be taken
 Family support worker role being reviewed
 Trust bereavement training
 Paediatric Pathology review by Jonathan Sheffield
Women from black and other ethnic minorities
Issues raised
 Language and translation
 High level of Caesarean Sections in this population
 More dedicated ante natal classes for this group
 Action taken/To be taken
 Link workers attend St Michaels Clinics, Wards and Community settings
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Agenda Item 7
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Language line
Some leaflets translated
Head of Midwifery working with Public and Patient Involvement lead to engage with Somalian
population.
Consultant clinic starts September 07 at Charlotte Keele in Easton.
Midwives have done course to learn Somalian. language
Drug users
Issues raised
 Training for staff
 Chance for support from meeting other drug using mothers
 Actions taken/to be taken
 Study day held for Midwives
 Drug liaison Midwife has held support group
Domestic violence victims
Issues raised
 Training for staff
 Antenataly for there to be a routine question about domestic violence
Action taken/To be taken
 Trust training on Domestic Violence in place
 Routine screening in place
Fathers and families
Issues raised
 Overnight facilities for fathers
 Lack of information for fathers
 Longer visiting hours
Actions taken/to be taken
 Fathers able to stay if side room available and women in early labour
 Review visiting times/patient survey.
Information Provision
Issues raised
 Information about National Childbirth Trust
 Age appropriate literature for young parents
 Hospital tours
Actions to be taken/taken
 Ensure Community Midwives give information about National Childbirth Trust - August 07
 Teenage pregnancy midwife to review leaflets for teenagers - October 07
 Make a DVD about St. Michaels - December 07
The Staff engagement report
The following key topics emerged from the staff engagement exercise:
 Normal Childbirth
 Patient choice and provision of local services close to home
 Physical access to facilities
 Staffing ,resources and training
 Relationships between professional groups
 Continuity of care
 Patient safety
 Targeted services for Black and Minority Ethnic and vulnerable groups
 Neonatal services
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Agenda Item 7
Normal Child birth
Issues raised
 Hospital/Community Midwives and Obstetricians were all in agreement that high and
increasing caesarean rate is wrong.
 Increasing normality important to Midwives
 Importance of one to one care in labour
 Increase in patients with raised Body Mass Index, diabetes etc impacting on Caesarean section
rate
Actions to be taken/taken
 Raise profile of birthing suite on delivery suite
 Birth rate plus workforce too
Choice/Midwife led units
Issues raised
 Birthing unit at St Michaels needs to be more home like
 More accessible services for vulnerable women
 In principle most staff support Midwifery led units for low risk women
 Some staff prefer Midwifery led units that are adjacent to main unit
Actions to be taken/Taken
 Equipment to be purchased to make birthing unit more homelike
 Encourage use and promote use of birthing unit at St Michaels
Staffing, Resources and Training
Issues raised
 Concerns over Community and hospital Midwifery staffing levels
 Importance of integrated hospital/Community Midwifery service
 Need and use of more support staff
 Poor access and parking
 Concerns over neonatal nursing and medical staffing levels
 Post natal Care on wards inadequate
Actions taken /To be taken
 Birth rate Plus
 Maternity Support workers in Community
 Review of Maternity Support worker in hospital
 New United Bristol Healthcare NHS Trust staff parking scheme
 Review of staffing skill mix on Neonatal unit and investment in staffing
Relationships between professional groups
Issues raised
 Interfaces between Obstetrics/Midwifery and Mental Health pathways problematic
Actions to be taken/Taken
 To aim to reinstate the fortnightly Obstetric Mental Health Clinic at St. Michaels
 Perinatal Mental Health group being set up Bristol North Somerset and South Gloucestershire
wide
 Liaison with Mental Health Trust to secure funding for improving services to Obstetrics
Targeted Services for black and minority ethnic (BME) and vulnerable groups
Issues raised as in public engagement
Neonatal Services
Issues raised
 Cot Capacity
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Agenda Item 7
 Neonatal nurse and medical staff levels
 Transfer service
 Parent accommodation
Actions to be taken/taken
 Expansion of Neonatal Intensive Care Unit by 2 cots
 Review of skill mix and investment into nursing
 Local Delivery Plan bid to be submitted for transfer service
 Scoping options for improving parent accommodation.
Summary
Many parents expressed satisfaction with the maternity services they received. Whist staff members
from all groups also expressed pride and satisfaction in the services they provide for women and
babies. However there are issues highlighted that can improve. The Midwifery, Neonatal and
Obstetric service will operationally address the actions in this report through the relevant clinical and
management working parties.
Monitoring of actions will be performed with Head of Midwifery and Matrons at monthly meetings.
Sarah Windfeld
Head of Midwifery/ Assistant Chief Nurse
14 November 2007
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