Safety in maternity_services gl

Improving Maternity Care

Giuseppe LabriolaDeputy Head of Midwifery

Our vision

A safe high quality services across 3 sites

One Maternity Service on Three Sites

• Cross site management team• Cross site specialist teams• Capacity managed across the 2 acute sites• Staffing managed across the 3 sites• One community service consisting of 13

community teams

Improving Safety in our serviceImproved Fetal Surveillance- GAP protocol- Fetal monitoring master classes- Fetal wellbeing and Surveillance Champions- Competency testing- Central monitoring- Ability for the on-call Consultant to view Fetal heart

traces from home to improve decision making

GovernanceOur aim is to reduce to zero the incidents where care/management issues are identified to have contributed to harm

• UHL reported 16 SI’s • QEH reported 22 SI’s • Weekly conference calls (cross site) where all SI’s/Red incidents

are discussed• Shared learning from incidents through cross site

meetings/guidelines• 56 Maternity guidelines reviewed to standardise safe evidence

based care cross site

Staffing• Recruitment continues to be a challenge• A review of skill mix• Establishment review carried out Dec-Feb (BR+)• Reduction in Agency usage over the past months

London Maternity Quality Standard24/7 consultant presenceLGT Consultant presence:81 hrs at UHL 68 hrs at QEH

Standard 3

• One consultant midwife for every 900 expected normal births.

LGT position:– 2 Consultant midwives– Need another 1.6 WTE consultant midwives

Normalising BirthReduction in overall caesarean section rate on both sites• QEH = 24.9%• UHL = 27.3%• LGT = 25.9%

Reduction in elective section rate at UHL 12.7% 10.8% 11.6% 11.7% 7.3% 5.5% 7.8% 6.9% 9.0% 6.5% 7.2% 7.52% 10.5% 8.1% 11.5% 8.7%

Increasing out of Labour Ward BirthsLewisham Birth Centre has just celebrated its 5th Birthday with 4065 births Increase percentage of out of labour ward births

• Increased homebirths at UHL (2%)• Opening of the Greenwich Birth Centre• Increase choice for women

– Telemetry– Pools for homebirths

Place of Birth Decision Tree

Access and Advice• Self referral via phone (call or text) or online form• Maternity helpline about to go live 15th June 2015• Edie (e-midwife for non urgent enquiries)

Listening to what women tell us

Service user involvement • Maternity Services Liaison Committee now up and

running in all 3 boroughs • Whose Shoes workshop • Reduction in formal complaints• DVD’s of women’s stories (good and not so good for

training)• Service user involvement in our transformation

programme

Early Pregnancy Evenings

Improved Friends and Family Test results

Return rate % that would not recommend our service

At Merger

QEW 2% N/A

UHL 3.3% 33.33%

April 15

QEW 38.90% 3.52%

UHL 37.98% 1.56%

Next Steps• To continue to build a culture within the workforce which

embraces our vision of one maternity service• Increase births – ambitious target but there will be lots of

opportunities• Clarify commissioning intentions regarding the London Quality

Standards• Continue the 2nd year of the maternity transformation

programme– Enhanced Recovery– Outpatient induction of labour– Reduction on length of stay