Maternity

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.

Safer Care

Maternity capacity and capability across Thames Valley

capacity report - Maternity

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 actual maternity capacity across Thames Valley
  • choice of place of birth
  • workforce
  • the projected growth as a result of the new housing developments in each local authority

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;

Capacity infographic

 

Net increase in births

 

 

 

 

 

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.

Safer Care in the context of commissioning of pathways – Recommendation

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:

  • Trusts and Commissioners work together to agree and fund the additional capacity required to care for women throughout the maternity pathway
  • preconception counselling must be provided so women are risk assessed appropriately and cared for by the appropriate teams
  • a review of home birth provision and the introduction of labour assessments at home
  • development of community hubs and provision of care across a local maternity system
  • the care of high risk women is correctly funded – commissioners and providers from across the region should agree funding streams and commission the correct number of obstetric and high dependency beds in the relevant units

 


Saving Babies Lives Care Bundlematernity-mortality

All Trusts in TV are working with the SCN to complete a regular survey on progress against the 4 elements of the care bundle

  • Reducing smoking in pregnancy
  • Risk assessment and surveillance for fetal growth restriction
  • Raising awareness of reduced fetal movement
  • Effective fetal monitoring during labour

which is then reported to NHS England. The next phase is for Trusts to produce action plans by 16th  September 2016.

Saving babies lives care bundle


Preconception

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.

Mbrace full report

MBRAce exec summaryMBRAce infographic

 

 

 

 

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.

TVSCN Offer

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

Preconception Commissioner Recommendations

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;

  • robust antenatal booking assessments as piloted in OUHFT
  • preconception clinics for women with long term conditions and;
  • integrated perinatal mental health services.

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)


Oxford AHSN logoWork undertaken in collaboration with Oxford Academic Health Science Network

AHSN 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

  • Thames Valley CCGs to be aware of the pilot, outcomes and commission canges to services as indicated (timings TBC)

Further opportunities to connect with the Academic Health Science Network

AHSN activities - maternity2CCGs are advised to work with the AHSN to ensure the guidelines are being supported and implemented in their local area.


Maternity Capacity & Capability – Thames Valley

A similar dashboard for the Thames Valley has been agreed by the Maternity Steering Group for development in 2016

 

Dashboard Development

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.

Metrics

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;

Dashboard metrics - maternity

Further developments and reviews will be taken in the following areas;

  • Antenatal
  • Postnatal
  • Public health/social care
  • Mental Health

Commissioner recommendation

Maternity Capacity Dashboard – Recommendation

  • That once fully implemented, there is a Thames Valley CCG mandated move to ensure this is the single maternity dashboard commissioners  use across the region for data collection, analysis, performance and designing future services.

Perinatal Mental Health

Perinatal MH report

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.Perinatal MH diagram

The region demonstrates key strengths, which provide a basis and opportunities for future service development:

  • Dedicated clinical leadership in perinatal mental health
  • Commitment from providers and commissioners across the region to improve services for women with perinatal mental illnesses
  • Maternal mental health is everyone’s business – not just mental health services
  • Examples of rapid developments and innovation in maternity, health visiting, secondary care mental health and IAPT services across the region

Commissioner recommendation

Perinatal Mental Health – Recommendation

  • CCGs should include Perinatal Mental Health  in all plans relating to Long Term Conditions, Maternity and Mental Health
  • CCGs should mandate  and embed in contracts the need to collate regional data and performance evaluation through a regionally agreed platform
  • CCGs and the STPs should consult with the TVSCN Perinatal Mental Health Network when designing future services.

Postnatal Care

“Better Births” (2016) highlights better postnatal and perinatal mental health care to address maternity viewsthe 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

Postnatal care - offer maternity

 

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