From pre-conception the SCN are working strategically and regionally to align to the national priorities as set out in “Better Births“. This is done through creating a strong network of professionals committed to making maternity services and the user experience across Thames Valley as effective as possible.
Click here to access the TVSCN Maternity capacity report
The aim of the TVSCN Maternity capacity and future planning report , commissioned by the Thames Valley Clinical Senate was to determine if the Trusts in Thames Valley have sufficient maternity capacity and capability to respond to any increase in demand over the next 10 years. A number of issues were considered as part of the review and these include:
The report was produced and endorsed by the TVSCN Heads of Midwifery and Lead Obstetrician strategic group alongside the TVSCN Maternity Steering group and concluded;
The report was presented at the Thames Valley Senate where it was formally agreed that there is not sufficient capacity in maternity services for the next 10 years. Consequently the TV Senate will be leading a piece of work to identify how to address the capacity issue across the region.
TVSCN concludes its report with 19 recommendations for Thames Valley SCN, Health Education England ,commissioners and trusts in order to begin to support the system to meet the future needs and requirements of Maternity services whilst ensuring it is aligned to the recommendations in the National Maternity Review; Better Births 2016.
Commissioners are expected to ensure women and their families are included in maternity planning so they are truly engaged and understand the complexities of service planning and delivery.
Commissioners need to consider the totality of the pathway (preconception to the end of postnatal period) to include:
All Trusts in TV are working with the SCN to complete a regular survey on progress against the 4 elements of the care bundle
which is then reported to NHS England. The next phase is for Trusts to produce action plans by 16th September 2016.
The MBRRACE Report into Perinatal Mortality Surveillance for 2014 Births highlights the main causes of maternal death in 66% of cases were due to medical and mental health problems in pregnancy with 33% from direct complications of pregnancy such as haemorrhage. Three quarters of women who died had medical or mental health problems before they became pregnant.
A key recommendation from the report includes the need for women with pre-existing medical and mental health problems to have pre-pregnancy advice and joint specialist and maternity care.
The TV Maternity Network is in the process of establishing a task and finish group to implement the management of diabetes in pregnancy NICE guideline as this provides an excellent example of a pathway from preconception to the postnatal period
CCGs will be required to commission services that provide a pathway of care from preconception to the end of the postnatal period. This could include;
There is evidence that these will services will provide positive clinical and wellbeing outcomes. See ‘Saving Lives, Improving Mothers Care’ (Confidential Enquiry into Maternal Morbidity and Mortality (MBRRACE-UK Dec 2014)
Work undertaken in collaboration with Oxford Academic Health Science NetworkAHSN Maternity Network focus on the identification of Small for Gestational Age (SGA) babies.
Nationally only around 30%-40% of SGA babies are identified during pregnancy; the data for Thames Valley is similar. Schemes to improve the identification of SGA will have a positive impact on the rate of stillbirth in the local population.
In May 2016 OUHFT launched a pilot designed to significantly increase the identification of SGA babies
Commissioner Recommendtaion
CCGs are advised to work with the AHSN to ensure the guidelines are being supported and implemented in their local area.
A similar dashboard for the Thames Valley has been agreed by the Maternity Steering Group for development in 2016
Following the successful implementation from our colleagues in the South East Region, the introduction of a robust and valid maternity dashboard will allow maternity units within the Thames Valley to obtain a meaningful view of the quality and safety of their own service. In addition, a regional view will highlight areas of variation in practice and provide valuable benchmarking to facilitate improvement and spread of best practice, as well as suppoting conversations between commissioners and providers.
The anticipated metrics to support quality outcomes will be linked, where possible to those that can be processed from HES and linked to national clinical indicators (RCOG) including;
Further developments and reviews will be taken in the following areas;
Maternity Capacity Dashboard – Recommendation
Click to access Thames Valley Perinatal Mental Health Report (2016)
The Thames Valley Perinatal Mental Health Network is a multi-partner collaboration led by TVSCN and Oxford AHSN. Membership comprises provider and commissioner stakeholders from each locality, along with patient, family and third sector representation.
Engagement with local services and clinicians enabled the network to generate a map of current levels and models of service provision for women with mental illnesses during pregnancy and after delivery.
The region demonstrates key strengths, which provide a basis and opportunities for future service development:
Perinatal Mental Health – Recommendation
“Better Births” (2016) highlights better postnatal and perinatal mental health care to address 
the historic underfunding. This is vital as these areas of care provision have a significant impact on the life chances and wellbeing of the woman, baby and family.
Evidence is available about how postnatal care can be improved and should be used to review the provision of this service from Better Births, NICE guidance https://www.nice.org.uk/guidance/CG37 and the national survey of women’s views of maternity services attached
