Agenda item

Midwifery Services at RWT

[To receive a report on Midwifery Services at the Royal Wolverhampton NHS Trust]. 

Minutes:

The Matron (neonatal) from, The Royal Wolverhampton NHS Trust (RWT) introduced a report on Midwifery Services at the Trust.  The present birth to Midwife ratio was 1:27/28.  This was a positive ratio and met the recommendations of the birth rate and Midwifery acuity review of the Trust in 2017.  They did not have an issue in Wolverhampton recruiting Midwives, unlike some other areas in the country.  They had introduced the Midwifery Delivery Suite Coordinator, who had no caseload of their own during the shift, which allowed oversight of all birth activity in the area. 

 

The Matron remarked that they had took a decision to cap births after reviewing the birth rate in Wolverhampton.  Capping arrangements had been successful in maintaining birth rates within manageable levels over the last year with birth rates just under agreed commissioned activity.  Capping restrictions had since been lifted in October 2019.  Since the capping had been lifted, the bookings had started to rise but at a manageable level. 

 

The Matron commented that there were some significant changes happening in Maternity Services across England.  The Better Births Maternity Review and the NHS Long Term Plan (2019) had some ambitious objectives, which included a 50% reduction in still births, maternal mortality, neonatal mortality and serious brain injury by 2025.  The Trust were working hard to achieve the target across the region.  The key priorities to achieve the objectives were to ensure that the Saving Babies Live Care Bundle was implemented across every maternity unit in 2019. 

 

The Matron stated that there were 5 key elements to this Care Bundle which were outlined in the report.  The Trust reported quarterly progress to NHS England against the five key elements of the Care Bundle.  Recommendations from the national maternity review – Better Births were being implemented through the Local Maternity System (LMS).  The name was changing to Local Maternity and Neonatal System.  These systems brought together Local Authorities, CCGs, maternity providers and user groups.  They were aiming for women and their families to achieve seamless care across the maternity pathway, including between maternity and neonatal  service providers. 

 

The Matron remarked that one of the key recommendations from the Better Births Review was regarding continuity of care.  This required providing consistency in the midwife and clinical team that cared for her and her baby throughout pregnancy, labour and the postnatal period.  This was a key challenge for every maternity unit in the country.  In Wolverhampton they were anxious that continuity of care was not at the cost of safety.   They were therefore looking at the best model to support continuity of care but not at the expense of safety and quality.  They needed to achieve 51% of women receiving continuity of care by March 2021. 

 

The Matron commented that the Trust in 2019, fully achieved all of the 10 safety actions recommended within the Maternity Incentive Scheme.  The Trust therefore recovered the full element of their contribution related to the CNST (Criminal Negligence Scheme for Trusts) incentive fund and also an additional share of unallocated funds.  The money would be reinvested into the service to continue to improve standards. 

 

The Midwife, stated that she was proud of the service.  There was a Maternity Voices Partnership which allowed them to receive feedback and feedback was also received from the Baby Friendly audits. 

 

The Chief Executive of the Royal Wolverhampton Trust commented that he had hoped the CQC (Care Quality Commission) would have inspected Maternity Services during their recent inspection because he believed it would have been rated as outstanding on all levels.  He hoped they would return later in the year.

 

Following a question from a Panel Member, it was confirmed that the perinatal (pertaining to the period immediately before and after birth) mortality rate was higher in Wolverhampton than the national average.  The Chief Executive of the Royal Wolverhampton Trust commented that this was due to the characteristics of population that the Trust served, which had higher levels of deprivation than many places.  People presenting later and smoking and alcohol intake during pregnancy were other factors.  The Trust did however take perinatal mortality very seriously and were working hard to improve the mortality rate. 

 

The Matron remarked that they had secured some funding to work on a smoking cessation programme for pregnant women.  This has been extremely successful and figures for reducing smoking in pregnancy had improved.  They had also worked hard to ensure that a woman delivered their baby in the correct hospital with the right facilities available to avoid them having to be transferred between hospitals.  This ensured better outcomes.  It was however undeniable that there were high levels of women in Wolverhampton classed as high risk.  The Midwife commented that at the beginning of 2019, smoking at time of birth was at 17-19%.  The latest figures for February 2020 were 13.6%.  So, it was clear the support service was effective. The Trust site would be smoke free before the end of 2020.  A poster campaign was ongoing, “Think of Me.”

 

Panel Members complimented the RWT Staff on the Maternity Service and the success they had achieved with the smoking cessation project.

 

A Panel Member commented that it was important to also consider life changing circumstances in addition to perinatal mortality.  The Matron responded that there were changes happening currently that would impact on this area.  Currently and over the last few years babies were resuscitated at 24 weeks gestation, but this was going to change to 22 weeks.  Extreme prematurity did have associated risks with areas such as learning disabilities in the future.  The Chief Executive of the Royal Wolverhampton NHS Trust commented it was very much a political question and one for politicians to consider.  Holland had a completely different view on when babies were offered neo-natal intensive care. 

 

The Healthwatch Manager stated that they had completed a report on pregnancy.  Overall the report was positive, there were a few areas for suggested improvement.  Support for partners was one of these and information on baby care such as feeding support.  The report also referred to the length of time health visitors continued to visit new mothers after birth.  The report had not yet been published and she would send it to the Trust for their comments before publication.  

 

The Matron commented that they had recently reintroduced bath demos on the ward.  There weren’t facilities for partners to stay on post-natal wards, but they did in some cases use a side room in specific cases.  There was also a Transitional Care Ward, for babies that needed additional care, partners were able to stay on this ward.  Midwife visits in the community would normally take place up to ten days, but could be extended up to 28 days.  They were working on a video on baby care for Mothers and were working with the LMS on a video for Fathers. 

 

The Chair commented that he thought Maternity Services at the RWT were excellent.  He asked if any learning had been taken on board by the Trust following the problems with the Maternity Services in Shropshire and other areas.  The Chief Executive of the Trust responded that when there was a public inquiry it would be revealed one of the biggest problems was people making the wrong decisions about when to transfer women to specialist centres for delivery.  There were only four Level 3 neo-natal units in the West Midlands, Stoke-on-Trent, Coventry, Birmingham and Wolverhampton.  He didn’t know the reasons why decisions had not been taken to transfer certain women. 

 

Resolved: That the Midwifery Services report be noted. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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