Agenda item

To receive an update in respect of provision of maternity services in Rotherham.

Consideration was given to an update report in respect of maternity services presented by the Head of Nursing and Midwifery of TRFT. The presentation highlighted the workforce including specialist midwife roles; clinical areas of focus for the Service, including how the Service plays a part in addressing health inequalities based on the CORE20PLUS 5 agreed by NHS England in 2021. The presentation highlighted how the Service was working to mitigate the effects of deprivation which can affect how people interact with and experience maternity services in Rotherham. It was noted that the CQC rating was Good.

The presentation covered:

·       Continuity of Carer, focusing on deprived areas and BAME communities

·       Mental Health

·       Obesity / Diabetes

·       Hypertension

·       Smoking Cessation

·       Family Hubs

·       Maternity Voices Partnership

·       Current Drivers

·       Personalised Care

·       Improving Infant Feeding

·       Challenges

·       Proud Moments

In discussion, Members requested additional information around coordination of team working and training. The response from the Head of Midwifery and Nursing noted the Multi-Disciplinary Team (MDT) training that took place monthly, which included obstetrics and maternity. Culture training had also been sourced to enhanced the training offer already in place. This complemented the quadumvirate working of neonates, obstetricians, operational staff and midwifery as a cohesive team that trust each other and work well together at the senior leadership level, affording psychological safety. There was work planned with other trusts in the region which would also generate further learning. This was considered critical to everything that the Service does.

More details were requested around how learning has informed response to CTG emergencies, taking account of cultural and technical knowledge. The response described the prompt training in place on these scenarios. A dedicated fetal wellbeing day is a training led by the fetal wellbeing lead. It was felt that the level of detail and challenge was high with a test at the end. This came about after reports and trends nationally. The Service also considers its team makeup, behaviours and values to ensure people feel safe to escalate.

How do monitoring and assurance processes recognise that outcome data is not by itself a reliable indicator of safe, high quality care. The response from the Head of Midwifery and Nursing noted the importance of triangulation because data can look good. Healthwatch data, CQC, maternity feedback, MVP, Staff surveys were all taken together to create a picture. The perinatal quality surveillance tool is looked at locally and regionally. This is something that is being considered nationally to give a view of trends. The feedback from women and from junior staff who want to work in the unit was very important. As a team, there was continuous learning and striving for improvement, and the Service received challenge from the Board. No one measure was considered in isolation.

Further clarification was requested around the antenatal offer. The response confirmed that during COVID, there were not as many antenatal classes, although some virtual classes were offered but not as sustained as usual. The team was working on publicising and marketing the offer of antenatal classes which is already in place and ensuring that every women gets that offer. The hub model was important for achieving this.

Members sought further clarification around how continuity of care was being measured. The response noted that this was currently being audited every month. The standard was that a woman receive care provided by their own midwife. The aim was that a woman would not see any more than two midwives during a pregnancy. Because of the nature of the model, a midwife could be called out in the middle of the night to attend a woman in labour, this resulted in midwives seeing more women. This was what the Service was seeking to improve.

Members also sought further details around how cultural differences were accommodated and incorporated into training. The Service was learning all the time and taking feedback on board. The baby friendly training was not just about breastfeeding but about infant feeding and good practice and the relationship between the baby and the mother. Learning from communities relies on engagement with least heard communities, although there was a diverse workforce to help us understand what is important. Working with the Maternity Voice Partnership and other agencies was valuable to help the Service in this area.

Members requested further information around how the feeding assessments pick up on difficulties such as tongue tie quickly. The response noted that the baby has an examination within the first 72 hours of birth as part of post-birth examinations. This assesses how well the baby is feeding. There was more work to do on the tongue tie pathway, with engagement with service users and raising awareness. The Service was currently implementing actions from that engagement work worked with the infant health advisor and health distance services who handle EMT referrals. This was important for women to have the information because when health professionals visit, the visit is for a short period of time, so it is important to be able to recognise signs and signals when there could be a problem.

Members sought additional information around agency staff use and training rates. The response noted that agency midwives were not being used. There were some shortfalls during maternity leave, but it is often staff who choose to pick up the extra shifts. The training encompassed not just midwife training but the multiple disciplines related to the service delivery, and the rate was around 90%.

Members requested additional information regarding how women considering breastfeeding were given opportunities to engage with other breastfeeding mums groups. The response noted the importance of asking what women want. Currently, there was a peer support offer on the ward and within the community as well. The family hub work would expand on these opportunities for peer engagement and classes.

The Chair clarified the timeframe for an update in respect of continuity of care targets. The response noted that in a few months there would be sufficient data to show trends.

Resolved:-

1.    That the report be noted.

2.    That the next update be submitted in respect of continuity of care at an appropriate time.