Issue - meetings

This update provides a summary of the Maternity Service Reconfiguration programme, which has been running for the past three years across BaNES, Swindon and Wiltshire (BSW). It includes an update on the decision made by BSW Governing Body on January 16th 2020 and next steps.

Lucy Baker, Director of Service Delivery, BSW CCGs introduced this item to the Panel, a summary of her presentation is set out below.

Future Vision

Our LMS vision is for all women to have a safe and positive birth and maternity experience and to be prepared to approach parenting with confidence.

Journey so far

·  We began talking to women about their maternity experiences in 2017

·  We have now worked with over 4,000 women and families, plus our staff and partner organisations

·  Their feedback, together with national guidance such as ‘Better Births’, has led to these recommendations for future maternity services across the BSW region

·  Partner organisations include Great Western Hospital Trust, Salisbury District Hospital, Royal United Hospital Bath, and B&NES, Swindon and Wiltshire CCGs

Assurance process

·  NHSE - 7 stages of assurance & 5 Key Tests for consultation

·  Clinical Senate Review

·  Independent Travel Impact Analysis by NHS South Central & West CSU

·  Independent analysis of public consultation responses by Bath Centre for Healthcare Innovation and Improvement (CHI2) School of Management, University of Bath

·  Independent Expert Panel Review

Case for change

Current activity in relation to births across BSW were split between:

85% Obstetric Unit Births

6% Freestanding Midwifery Unit Births (provided by the RUH)

7% Alongside Midwifery Unit Births (GWH)

2% Home births

Complexity in obstetric care:

·  Increase in complexity

·  Impact of safety improvements

·  Patient choice and expectation

·  AMU provide opportunities for more women to access midwife led care

·  Enables obstetric focus

·  Decrease in transfer times

Benefits of midwifery led birth:

·  Safe for mothers and babies

·  Significantly fewer interventions No difference in caesarean birth rates between AMU and FMU

·  Clinical evidence shows that a low risk woman birthing in an obstetric unit has a higher probability of an assisted birth

Staff experience and satisfaction

·  Low number of births in FMUs impacting on maintenance of clinical skills and confidence

·  Reduced need for short notice redeployment of staff - Improved staff satisfaction

·  Flexible workforce will help to support improvements in continuity of carer models

·  Right staff, right place, right time

·  Improved utilisations of staff resource

·  Opportunity for enhanced multi-disciplinary working

Our consultation in numbers

·  1,855 consultation responses over 15 weeks

·  662 face to face conversations

·  1,193 completed surveys were returned

Public Consultation - independent analysis

·  66% strongly agreed/agreed with creation of AMU

·  70% strongly disagreed/ disagreed with closure of postnatal beds

·  59% strongly disagreed/ disagreed with reduction in FMU. 40% Strongly agreed or agreed

The team listened to feedback and as a result 4 post-natal beds will remain open for a further 12 months in Chippenham to allow further time to co-create new pathways with mums and families.

Consultation feedback themes

·  Improved infant feeding support. Particular focus on night time breast feeding support. More early identification of infant feeding issues and support

·  Better screening and continuity of care for mental health both in pregnancy and postnatally

·  People and staff to continue to be involved in co-design of community hubs and AMUs including parking provision at RUH

·  More antenatal education for mums and families  ...  view the full minutes text for item 37