Agenda item

Present for this Item:

Worcestershire Acute Hospitals NHS Trust: Jackie Edwards, Interim Chief Nursing Officer and Justine Jeffery, Divisional Director of Midwifery

Worcestershire County Council: Lisa McNally, Director of Public Health

The Interim Chief Nursing Officer referred to the Agenda report which gave an update on how Worcestershire Acute Hospitals NHS Trust (the Trust) was improving Maternity Services. As a Worcestershire resident herself, she had family members who had used the service and recommended it, which was important. There were some aspects which could be better and listening to user feedback was important.

The Divisional Director of Midwifery reminded HOSC members of the context for the successive updates to the HOSC, following a negative Care Quality Commission inspection in 2020 which reduced the overall rating for Maternity Services from ‘Good’ to ‘Requires Improvement’.

Improvement against the resulting Improvement Plan had continued and since the last update good progress had been made in filling staff vacancies. Importantly, new roles had been added to the Team including advanced practitioners which was very exciting and an incentive to the existing workforce. 24 Midwives had just been appointed to start in September, which was very pleasing as they had undergone their training with the Trust. Feedback from a recent visit by the Local Maternity and Neonatal System (LMS) was very good and although this needed to be validated, the representatives were confident the Service was now in a very good place.

The Chairman invited discussion and the following main points were made:

·         HOSC members were very pleased to see improvements being made, which were particularly evident in the latest update.

·         A member sought assurances that the situation could not lapse, and the representatives acknowledged that a previous lack of leadership consistency at the Trust had likely had an impact but that the maternity leadership team was now much stronger. The role of the LMS provided further scrutiny - there was no way the Service could drift back.

·         Some of the new measures introduced had been enabled by additional NHSE funding arising from the national Ockenden Review.

·         The absence of current data for elective caesarean rates and emergency caesarean rates was because these indicators were no longer considered indicators of safety and were therefore no longer reporting measures, which was an outcome of the Ockenden Review.

·         In response to a query, it was explained that caesareans classed as emergency were monitored using the Robson classification to see trends of mothers having caesareans for the first time or repeated caesareans, to keep an eye on any changes, and this was monitored monthly by the LMS.

·         A member who had heard negative feedback from same sex couples about communication asked how this was dealt with and was advised that the Service had received considerable good feedback from same sex couples, although all feedback was actively invited as a listening approach was important. The Service had recently sought input from a Brighton hospital team and a number of changes around language were being introduced.

·         A HOSC member highlighted the great improvement in the Trust’s stillbirth rate, and asked how this had been achieved and it was explained that the neonatal death rate had reduced when the Service was centralised, and the stillbirth rate had reduced as a result of several initiatives including looking at smoking in pregnancy, monitoring smaller babies and pre-term initiatives; it was a slow shift and an area of focus was raising awareness of low foetal movement to encourage woman to come forward more promptly if any changes were noticed.

·         Regarding the Continuity of Carer teams who provided care to some of the most deprived families, these were in areas of deprivation, although the original team was based in Pershore.

·         The Director of Public Health highlighted the risks of smoking during pregnancy, in particular for premature births. She praised the work of public health colleagues with the Trust to fund specialist midwives which was now resulting in figures dropping from above average, to below.

·         It was explained that figures for completion of Personal Development Reviews and mandatory training rates were not at the required 90% due to workforce challenges and the balance required between releasing staff and maintaining safe staffing levels. However it was now easier to release staff due to improvements in the workforce.

·         The Trust held regular health and wellbeing initiatives and the Interim Chief Nursing Officer encouraged staff drop-ins.

·         When asked whether staff could complete reviews and training in their own time, it was clarified that these activities needed to be done during normal working hours, although some could be done online.

·         It was explained that high rates of induction of labour was the case nationally following a huge change in clinical practice around five years previously, which had changed the offer of choice when a risk factor was present. The Trust’s rate was similar to that of other Trusts in the region and the Trust had looked at how the guidance was applied and worked with staff to ensure advice was appropriate.

·         A member asked whether the reduction in vaginal births was likely to continue to the point of becoming abnormal, and the representatives advised that such trends were affected by choices being offered and would likely rebalance, and that choice and safety were the important factors.  The ‘Big Baby Trial’ was referred to, from which feedback was awaited.

The Chairman thanked the representatives for their encouraging update.