Agenda item

June Lovett, Associate Chief Nurse and Head of Nursing, Midwifery and Professions at The Rotherham NHS Foundation Trust (TRFT) gave the following presentation to provide an overview of current activity and the course of direction for  maternity services.

 

Work to improve the strategy for maternity services was particularly focused on the seven key lines of enquiry within the national “Better Births” strategy.  These encompassed stillbirth and neonatal deaths; intrapartum brain injuries; personalised care plans; choice agenda; continuity of care; midwifery settings; and smoking.

 

What’s working well

*        Partnership working across the place e.g. one Personalised Care Plan

*        Local Maternity System Board (LMS) and Hosted Network (HN) Collaborative approach, jointly chaired by Louise Barnett and Chris Edwards

*        TRFT representation and attendance at the SY&B ICS Local Maternity System

*        Local Maternity System  Board and place working

*        Rotherham Maternity Transformation Plan including new tracker development and Funding Plan – sets agenda for next 12 months

*        Robust governance arrangements and reporting structures set up:

- Better Births Group (in Rotherham) – Key external stakeholders including Maternity Voices  Partnership (MVP), service user representation

- Sub Groups in place for progression of the 7 Key Lines of Enquiry - Action and Monitoring Logs created and maintained and reported to Better Births Group

*        Reporting into the Maternity Governance Group

*        Maternity Voices Partnership enhancing women and families engagement – robust and active group

*        Leadership, dedicated, energised and enthusiastic Team to drive forward transformation – staff engagement, ownership and vision

*        Place Partnership working to improve the health and wellbeing of mum and baby such as smoking cessation, and sub groups  with appropriate representation

*        LMS Achievement of Continuity of Carer LMS trajectory 20% and Use of a Personalised Care Plan 40%

*        Commitment and support from CCG Communication Lead regarding a communication Strategy to help the service raise its profile and encourage women to use the service

*        Involvement in the development of the Rotherham Health App – early stages

 

Smoking cessation was viewed as a golden thread across all the workstreams, ensuring the best health of the mother to then give the best chance in terms of health outcomes for the baby.  A strong smoking reduction focus for women would make a huge difference in relation to the Public Health agenda, on which TRFT worked collaboratively and in parallel with Public Health colleagues.

 

What are we worried about?

*        Achievement of all future key trajectories and sustainable support

*        The Rotherham NHS Foundation Trust  Estates provision that is required to progress the Place Plan – such as a Alongside Midwifery Led Unit, Hubs in communities Delivery Suite alterations including Bereavement Suite and Greenoaks relocation

*        Achievement of 35% Continuity of Carer by  31 March 2020 and embedding a new service model

*        Sustained funding and commitment in relation to workforce staffing for achievement of continuity of carer

*        On call processes and business continuity at times of increased capacity on the delivery suite, especially as simultaneously changing the service model

*        Improvement in relation to Maternity Data set information and Performance Dashboard information regarding Smoking Cessation Service – demonstrate outputs and difference made

*        Marketing of Rotherham Maternity Services

 

Hubs at Aston, Maltby and Rawmarsh would not only be for maternity services but around the children's agenda as well to offer a one-stop service for some of these community services rather than coming into the hospital. 

 

What needs to happen, by when?

*        Continued strong and focused leadership and committed Team – clarity and driving forward

*        Refresh Maternity Transformation Plan by 30 August 2019 and including the plans regarding the prevention, Public Health and digital agenda

*        Continue with TRFT robust governance, monitoring and  reporting arrangements

*        Plans in place for estates requirements  and Hub set up support – Greenoaks relocation imminent, look at triage area

*        Continuity of Carer Sub Group actively progressing plans to achieve the trajectory – increase in staffing  for the new model

*        Maternity Escalation Plan in place since May and Maternity On call Rota for acute services - commenced on 19 August 2019 to ensure a safe service

*        Set up of the new Maternity Hosted Network and Local Maternity System (LMS) Collaborative Group – 10 September 2019 and appointment of Maternity Clinical Lead

*        New Smoking Cessation Service Performance Dashboard from August 2019

*        New Maternity Digital Group established - commenced 14 August 2019

*        Raise the profile of Rotherham Maternity Services – Communication Strategy and marketing - Maternity and Family Showcase commencing 4 September 2019 to learn about services

 

The first Maternity and Family Showcase, featured a number of market-type stalls from both maternity and children’s services as well as external bodies such as Healthwatch and the Fire service.  Intentions were to hold an event on the first Wednesday of every month and to keep building on it to raise the profile of maternity services.

 

Discussion ensued on the following points:-

 

·         Details about the current breastfeeding service.

-  Breastfeeding was not a workstream within “Better Births” but the Trust was proactively looking at increasing breastfeeding, both at birth and sustained further down the line.  The service was accredited for its birth and breastfeeding and would be seeking re-accreditation in December. The hospital was committed to ensuring women had the right support for breastfeeding, which also fitted in with the Public Health agenda. Workstreams were ongoing around the breastfeeding aspects and from a monitoring point of view breastfeeding statistics were overseen by Performance Data Boards and the local authority.  At the showcase event a specific stand around breastfeeding had generated plenty of interest.

 

·         Support for patients to access the complaints procedure.

- If anybody had concerns the service tried to address those immediately but if not there were a number of aspects.  The birth afterthoughts service was initiated in 1998, not so much for complaints but rather because sometimes there were felt to be unanswered questions, as the service could seem a bit like a jigsaw where people could not always quite put all the pieces together. For example, in the delivery room if it had been necessary to get the baby out quickly without an opportunity to ask questions about what had happened.  The service could meet the family, talk to them about their whole birth experience, use their records and hopefully answer any questions, although that was not really a complaint. The birth afterthought service was embedded and if unanswered questions were not addressed they could become a complaint if people felt they had not had that opportunity.

 

Families would be supported to contact the complaints service and there was also Healthwatch but the service was very open in trying to go and speak with families to try to address issues.  Although women might be in hospital for a period of time when they returned home they also still had continuing care. 

 

It was confirmed that information about the afterthoughts service and the complaints service were provided in the information given to women accessing the service.

 

·         Statistics and information to come back on how successful the achievement of the future key trajectories, sustainable support and the 35% continuity of carer by 31st March 2020 had been.

 - Plans were in place to achieve these and a future update could be provided.  It was clarified that the percentage target was a collective one across the sub-region, not an individual target for Rotherham. Services wanted to achieve a high percentage, making sure that when women were booked on a pathway they had a small team of midwives providing that continuity of care as it was about building trust and that relationship. It was a question of getting the model right and keeping a safe model and the future plans would increase the models of care for the different groups of patients. 

 

·         Use of the Mjog service as well as developments with the  Rotherham Health App.

- Although unfamiliar with Mjog, maternity services had been keen to get involved with the Rotherham Health App at an early stage to give women a choice about access to information.  At the moment the personalised care plan was a paper version because it belonged to the woman but the service was looking to an electronic version as well and the app would be a great way to do that. The service also wanted to look at the App for self-referral processes.

 

·         For marketing the service to be first choice and letting people know how good it was, would the service have a presence at Rotherham Show?

- Yes this was planned.

 

·         Cllr Roche confirmed that smoking cessation in pregnancy was funded by the Council.  It was closely monitored as one of the performance indicators and had met the target last year. Rotherham was strict in how smoking cessation was measured as when pregnant women presented they had a CO2 test every time unlike other places which simply asked if they smoked.  This whole area was also taken to the Place Board which in turn reported to the Health and Wellbeing Board.

 

·         Statistics for smoking cessation were requested together with statistics on breastfeeding.

 

Members were invited to attend one of the open events.

 

June was thanked for her comprehensive presentation and would be invited back to report on progress.

 

Resolved:-

 

1)    To note the information provided on plans for maternity services and meeting the requirements of the “Better Births” guidance.

 

2)    That statistics on smoking cessation and breastfeeding be provided for the Health Select Commission.