Agenda item

The Chairman agreed to take the Agenda out of order.

Attending for this Item from Worcestershire Acute Hospitals NHS Trust (WAHT) were:

Paula Gardner, Chief Nursing Officer

Justine Jeffery, Divisional Director of Midwifery

Since the last report to HOSC, in May 2022, a number of improvements had been made, most significantly in workforce.  Staff turnover had reduced, new recruits had been retained and there had been an increase in the number of student placements available.  It was hoped that by February 2023, when the next cohort of students would qualify, the Service would have no vacancies.

Progress had slowed on the agreed actions from the Maternity Service Improvement Plan, although several engagement events had taken place over the summer and a number of actions had been completed.  Following the publication of the Care Quality Commission (CQC) report in March 2021, of the 20 actions, 4 remained partially completed with work in progress.  This was an improvement since the last HOSC update.

The Final Ockenden Report (the independent review of maternity services at Shrewsbury and Telford Hospital Trust) was published 30 March 2022.  The Report highlighted 105 actions which Health Trusts were required to review and make improvements on, if actions were not already in place.  This was a similar amount to the actions in the first Ockenden Report.  WAHT had undertaken a risk assessment and gap analysis and was developing a single overarching service improvement plan to consolidate all actions in one document.  It was acknowledged that nationally the spotlight on maternity services remained.

Members were invited to ask questions, with the following key points raised:

·         When asked whether 1 Consultant Midwife was sufficient, it was clarified that at present it was a 0.5 full time equivalent post, which needed to be increased.  The Ockenden Report recommended that consideration be given to maternity leadership requirements and funding had been secured to recruit a Deputy Director of Midwifery and other specialised midwifes.  It was hoped that further funding would be secured for additional staff

·         Members were concerned about the threat of national strike action over a fair pay deal and the possible impact on services locally.  It was explained that WAHT would not know in advance how many employees may be involved in any strike, however, safety would be monitored around the clock.  If at any point, staff were required they could be called for duty through an official process

·         A successful international recruitment campaign for nursing staff had also introduced to midwifery and staff were being offered incentives to take additional ‘bank’ shifts, to reduce agency spend.  Furthermore, WAHT was working with Wye Valley NHS Trust to explore career development opportunities for Health Care Assistants, which could result in enhanced pay for additional responsibility after 2 years of experience

·         It was reported that 50% of midwifes leaving were completely retiring from the profession, which was a change from previous behaviour which saw midwifes return on an occasional basis.  Other staff were leaving to return to previous careers

·         When asked how students were encouraged to stay in Worcestershire, it was reported that new recruits had Mentor support for 6 months.  Funding had also been secured for a ‘retention midwife’ to work with staff considering leaving and offering targeted support and well being

·         When asked why staff considered leaving, it was suggested that although nursing and midwifery were rewarding careers, some patients presented with co-morbidities which could add to the pressure of work and on occasion it had to be acknowledged that situations could go wrong

·         Work towards a Continuity of Carer model had established 6 teams over the last 2 years.  As a result of actions arising from the Ockenden Report, 5 of the 6 teams had been retained 

·         WAHT needed 219 clinical midwifes and an additional 8 to fulfil training needs.  At present, there were 218 in total and although there continued to be a reliance on ‘bank’ staff, the Service was in a much better position since new recruits started in September.  Full Time Midwifes were employed for 37.5 hours each week and Managers were actively monitoring wellbeing by ensuring that breaks were taken and contracted hours were not overly exceeded.  It was acknowledged that paperwork was sometimes competed after a shift, however the numbers staying on were decreasing

·         The HOSC was assured that although WAHT Board considered the Maternity Service Improvement Plan in July 2021, it did receive monthly safety updates and progress updates.  Furthermore, nursing and midwifery staffing was discussed by the Board monthly and Trust Leaders were given a staffing situation report 3 times each day

·         A Member referred to a national newspaper headline in relation to the recording of stillbirths.  It was agreed a written answer would be sent in response, however, the Agenda Report, Appendix 1, recorded the stillbirth rate for WAHT

·         WAHT had no target for elective or emergency caesarean rate.  It was explained that the Ockenden Report had found that it was not a good mark for safety and should not be reported.  WAHT continued to monitor the rates on quality grounds and there had been an increase in the year to November 2021

·         Members were informed that the reasons behind the centralisation of acute maternity services at Worcestershire Royal Hospital had not changed and workforce pressures remained.  Continuity of community midwifery was secure and once a patient was discharged, appointments continued to be in the locality

·         As a direct result of the actions arising from the Ockenden Report, there was an expectation that all 200 Maternity Services nationally would be inspected by the CQC in the next 6 months.  In addition, several Health Trusts were reported to be struggling.

The Managing Director of Healthwatch Worcestershire was invited to comment on the discussion and reported that Women and Families appreciated the service they received.  He added that the Continuity of Carer approach would have implications on staff and their wellbeing.

The HOSC Chairman thanked everyone for their contribution and asked for a further update in 6 months.