Agenda item

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, one at Salisbury District Hospital and one at Royal United Hospital Bath 

•  Will provide more women with opportunity for midwife-led birth.  Two new units will be in addition to the White Horse Alongside Midwifery Unit at Great Western Hospital

Elements 4 / 5

•  We propose to improve our range of antenatal and postnatal services, eg more breastfeeding support, to women in their own homes, and to develop community hubs to enhance our antenatal and postnatal care

•  We want to support more women to give birth at home if that is their preferred choice

Element 6

•  We’re proposing to replace our community postnatal beds at Chippenham and Paulton with support closer to or in women’s homes.

•   Women who need to be admitted for medical treatment after giving birth would continue to be treated at their local obstetric unit at one of the acute hospitals at Bath, Salisbury or Swindon

Benefits

•  We can provide more choice for more women across our area about where and how they are supported before, during and after the birth of their child

•  We can make better use of our resources and workforce so we can further improve our antenatal and postnatal and birth services

•  We can improve continuity of care and carer for women

•  We can enhance and improve our home birth service

•  Free up our staff, so they are able to maintain their skills, improve their motivation and provide the services they want to women who need them

Future finances

•  We are NOT planning to reduce how much we spend on maternity services

•  We are NOT reducing the numbers of staff we have

•  We are NOT closing any buildings

If we don’t change …

•  There will continue to be a difference in choice, quality and access from across B&NES, Swindon and Wiltshire

•  The current model will continue to cost us £1million more a year

•  We won’t be providing the changes that women and families and our staff have told us they want us to make

We want to hear your views

•  Consultation runs from 12 November to 24 February 2019

•  Information on our website: www.transformingmaternity.org.uk 

•  Consultation documents, key facts documents, response forms

•  Public Consultation Events

–  Thursday 29th November 5.45pm – 7.45 pm, The Oasis Conference Centre, Building E6, RUH

–  Monday 10^th December 2-4pm Victoria Hall, Church Street, Radstock 

Councillor Robin Moss commented that the report highlighted a changing world and that the statistics included supported this. He added that on behalf of his fellow Labour Councillors that represent the ward of Paulton that there are concerns within the community as the hospital is seen as an important community resource. He said that he would encourage a public meeting to be held in Paulton during the consultation.

Councillor Tim Ball asked if within the proposals there had been some room for manoeuvre built in.

Rhiannon Hills replied that it was a five year forecast model and that the transition plan has suitable capacity.

Councillor Eleanor Jackson said that she welcomed the detail in the report and the acknowledgement of the need to use resources effectively. She added that safe outcomes are of course the primary concern and that is understandably why more women are choosing to be in hospital, at least for the birth.

She asked if the figure relating to numbers of child deaths due to transfer was available.

Rhiannon Hills replied that she did not have that information to hand. She added that she was sure that the local figure had been halved in recent years. She said that the RUH was involved in the ‘Saving Babies Lives’ work which focusses on reduction in smoking and tackling obesity in pregnancy. She stated that extra scans are provided when a baby is identified as being small during pregnancy.

Councillor Vic Pritchard commented that the proposals seemed very sensible. He added that he felt that the inclusion on one of the slides that the current model will continue to cost us £1million more a year weakens the overall proposals.

Dr Ian Orpen stated that he agreed with Councillor Pritchard and that it was the safety of births that was paramount and that the Plan is driven by providing a quality of service.

The Select Committee noted the report and its accompanying consultation document.