Maternity capacity and capability across Thames Valley
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
- 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;
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 Bundle
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.
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
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)
Work 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
- 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
CCGs 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
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;
- Public health/social care
- Mental Health
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.