Issue - meetings

A review of maternity services has taken place over the last two years, and the views of over 2000 women, families and staff who work in these and related services have been listened to across Bath and North East Somerset, Swindon and Wiltshire. The formal consultation was launched on the 12th November 2018 and will run until 24th February 2019.

The Senior Commissioning Manager for Preventative Services was joined by Rhiannon Hills, Women & Children’s Divisional Manager, RUH to give a presentation to the Select Committee. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

Our Journey so Far

•  We began talking to women and families in 2017 about their experiences of pregnancy, labour and birth across the counties of B&NES, Swindon and Wiltshire

•  Their feedback, together with national guidance such as ‘Better Births’, has led to development of a proposal for future maternity services across the BSW region

Choice of place of birth

•  11,200 births annually in B&NES, Swindon and Wiltshire

•  85% Obstetric Unit (65% were high risk, 20% were low risk), 6% Freestanding Midwifery Units (RUH), 7% Alongside Midwifery Unit (Great Western Hospital), 2% Home Births.

•  Increasing pressure on services in our obstetric units at Royal United Hospital and Salisbury District Hospital

•  Lack of parity across the Local Maternity System

Changing clinical needs

•  Average age of a woman giving birth is now 35

•  More and more high risk pregnancies (eg high blood pressure, diabetes, obesity) which  need medical support in a hospital setting

•  50% - First time mothers who need to transfer from midwife led community hospital unit to obstetric unit in hospital for extra medical support with their birth

•  9 Post-natal beds available in the community: 5 in Paulton, 4 in Chippenham: Empty 95% of the year

Right staff, right place, right time

•  We don’t always have right staff in the right place at the right time to offer the services women want to receive and we want to provide.  This is a particular challenge for Royal United Hospital

•  We have the right number and mix of staff, but they’re not based in the right locations

•  RUH staff currently support births across four community midwifery units, the hospital obstetric unit and home births, 24 hours a day, 7 days a week - often staffing empty buildings and empty beds

Issues

•  Staff too busy looking after empty beds and buildings or travelling from community hospitals with very low births to extremely busy obstetric units, often at short notice, which they dislike. Frustrating for staff – effect on morale, retention and skills

•  We want to increase opportunity for home births but staff are not able to promote and support due to existing working patterns

•  We’re not giving women the service they want

Our proposal

Element 1

•  Continue supporting births in 2, rather than 4 Community hospital units. Women will be able to deliver their baby at Chippenham or Frome

•  Trowbridge and Paulton proposed as pilot sites for our new community hub model of care

•  Antenatal and postnatal clinics will continue at Chippenham, Trowbridge, Frome and Paulton

Elements 2 / 3

•  To create two new Alongside Midwifery Units,  ...  view the full minutes text for item 54