Making it BetterMaking it Better

Presentation to Salford OSC Presentation to Salford OSC 2525thth July 2012 July 2012

Making it Better

• Commitments made to improve the safety and quality of maternity, neonatal and paediatric services across Greater Manchester

• Maternity and paediatric changes now complete

• New maternity, neonatal and children’s unit to open at Royal Oldham Hospital – late 2012

• Promises made to Greater Manchester residents

• Establishment of 10 Children’s Community Nursing Teamsinvolving the recruitment & training of 90 children’s nurses

• Establishment of 11Paediatric Observation & Assessment Units to reduce number of children needing to be admitted to hospital

• Local routine antenatal & postnatal care continues in community and local hospitals in all areas

• New Antenatal Assessment Day Units established to provide enhanced local services and reduce admissions

• Development of Neonatal Outreach services to provide care and support at home

•

Care close to home

Safer overnight services

• Safely relocated inpatient maternity, neonatal & children’s services from 4 sites

-Trafford (February 2010)

- Rochdale (June 2011)

- Salford (Nov 2011)

- Bury (March 2012)

• Local services developed

• 8 inpatient maternity units (5 new maternity units)

• Establishment of 6 co-located Midwifery Led Units and standalone Birth Centre in Salford

• Improved access to tertiary maternity services

• Achievement of BirthRate Plus midwifery staffing levels at all 8 units, involving the recruitment of 81 midwives

• Additional consultant obstetricians recruited

• Improved Consultant Labour Ward Presence

Maternity Services

Salford

2006 Current

Saint Mary’s 53 99

Royal Bolton 40 98

North Manchester 22 102

Salford 40

TOTAL 155 299

Number of Hours Consultant Presence on the Labour Ward – NW Sector

• Reducing the rate of temporary closures was a key driver for change in reducing the number of overnight maternity units

• Work over the past three years has reduced incidents of maternity units closing temporarily for admissions

• Direct contribution in areas where Making it Better changes have already taken place

Maternity Diverts

Trends in Maternity Diverts across Greater Manchester

• 8 inpatient children’s units with critical mass to maintain & develop specialist expertise

• 4 new children’s units to improve care environment

• Additional consultant paediatricians recruited

Services for children

Newborn ServicesNewborn Services

• 8 inpatient neonatal units with critical mass to maintain & develop specialist expertise

• Achievement of required BAPM standards for neonatal nurses, involving the recruitment of 79 neonatal nurses

• Additional consultant neonatologists recruited

• 5 new neonatal units offering improved facilities for babies, parents and staff

• New neonatal intensive care unit at Royal Bolton Hospital, improving access for families in north west of Greater

Manchester

• Royal Oldham Neonatal Intensive Care Unit to open late 2012

Building capacity & improving facilitiesBuilding capacity & improving facilities

• 5 major capital builds to increase capacity and improve facilities for families and staff

• New & expanded facilities for women and children at St Mary’s, Royal Bolton, North Manchester, Wythenshawe and Royal Oldham (from late 2012) hospitals

• Offer choice of midwife led birth care

Services for Salford families

• Consultant-led Paediatric Assessment and Decision Area (PANDA) offering:

- Child friendly environment in which children and young people area treated by dedicated children’s doctors and nurses

- Improved likelihood of avoiding an overnight stay as short term care can be provided for longer than in an adult A&E department

- follow up at home or in community if necessary

Children’s Services in SalfordChildren’s Services in Salford

• Expansion of the Children’s Community Nursing Teams (CCNT) across Greater Manchester – 18 nurses in

Salford team

• Treatment in the home and at local nurse-led clinics

• Improved training opportunities means a wider range of treatments

• Attend afternoon and evening shifts on the PANDA to assist with discharge and provide continuity of care

Children’s Community Nursing Children’s Community Nursing TeamTeam

• Significant investments made in CAMHS via Salford City Council & NHS Salford

• Include:

- Development of community based services for older adolescents with complex mental health needs

- Appropriate community services for young people with mental health problems

- Investment in training primary care providers to recognise early symptoms in children and adolescents

Children and Adolescent Children and Adolescent Mental Health Service (CAMHSMental Health Service (CAMHS)

• All routine antenatal and postnatal care continues to be provided in Salford – at home, local clinics and at Salford Royal

• Routine scans, antenatal clinics and Antenatal Assessment Day Unit provided at Salford Royal

• Antenatal clinics provided by staff from the Royal Bolton and Saint Mary’s Hospitals

Maternity services in SalfordMaternity services in Salford

• Saint Mary’s Birth Centre in Salford

• Home births in Salford

• New and expanded maternity units at Saint Mary’s, the Royal Bolton and North Manchester General Hospitals

with capacity to accommodate Salford women

• Women in some areas may continue to choose Warrington Hospital

Birth ChoicesBirth Choices

Saint Mary’s HospitalSaint Mary’s Hospital

The new Saint Mary’s Hospital in central Manchester

• brand new hospital for women and babies opened in July 2009 where the very highest levels of specialist care are being provided

• includes a midwife-led birth centre

• new, state-of-the-art Newborn Intensive Care Unit (NICU)

Royal Bolton HospitalRoyal Bolton Hospital

£20 million worth of investment in new, improved and expanded facilities at the Royal Bolton Hospital

• expansion and improvement of the maternity unit, including additional, en-suite rooms and new obstetric theatres

• a midwife led unit

• new, purpose built Antenatal Day Unit

• a brand new Neonatal Intensive Care Unit and refurbished Special Care Baby Unit

(SCBU)

North Manchester General North Manchester General HospitalHospital

A £35 million new women and children’s unit opened at North Manchester General Hospital in June 2010

• includes a new, modern and spacious maternity unit including more single rooms with en-suite facilities

• new neonatal unit where higher levels of specialist care can be provided

• includes a midwife-led birth centre

•

Where are Salford women Where are Salford women choosing to have their baby?choosing to have their baby?

Gaining understanding of experience by:

• Maternity Services Liaison Committee

• Patient Diaries

• Maternity Services User Group organised via Maternity Services Liaison Committee

• Patient Complaints and PALS issues (very few)

What are families’ experience of What are families’ experience of the new services?the new services?

• High levels of satisfaction with services (particularly midwifery care)

• Issues related to:

- Ultrasound scanning

- Cost of parking

- Availability of breastfeeding information

- Approach to preparation for parenthood/birth

What are families’ experience of What are families’ experience of the new services?the new services?

The Saint Marys Birth Centre In Salford

Kathy MurphyHead of Nursing & Midwifery

Saint Marys Central Manchester

The Stand-Alone Service

Choosing the Birth Centre – how it works Booking – Community Midwife (Assess suitability) Give Information Leaflet During pregnancy – Community midwife, Ultrasound appt, ANC, AAU, Parent Education, Tours 36 week assessment by midwife – to assess suitability, offer Tour ‘Accidental’ – oops! – only 3 Impromptu Assessment!

Tours of the Birth CentreWork in Evolution – looking for women to shape the format

Either using a

Tues 7pm group session 3 or 4 in first weeks Numbers increased to 10 per weekOr

Individual – half-hour appt

Appointment FunctionTour of rooms – 6 – Lavender, Rose, Mint,

Chamomile, Sandalwood & Aqua Explanation re experience, training &

commitment of staff – core & community midwives

Give information regarding statistics & evidence re normal birth – “safe for the baby and offer benefits for the mother” (NPEU The Birthplace Cohort study, 2011)

Services not available – medical staff, epidural anaesthesia

Appointment FunctionServices available – 3 of 6 rooms en-suite, own choice of room

Equipment : pool, birth balls & mats, recliners, music, tea & coffee-making facilities, free visiting times , option for partner to stay, short or longer post natal stay,

ambulance transfer with midwife if necessary, resuscitaire & transport incubator, 1:1 care with 2nd midwife available

Appointment FunctionDiscussion re suitability, choice, option to

complete / update Birth Centre booking form, add any additional information e.g. recent blood results/blood group

Option to discuss Birth Plan

Ensure woman has contact number for labour or queries

Statistics (Dec – June)TOTAL PARA PG

Births 107 8680.3%

21 19.6%

Transfers 29 out of 136

21.3%

9 20

Length of Postnatal Stay

12 hours

Pool Use 6950.7%

19 9

Pool Birth 4542%

36 9

Drugs –IM 2820%

16 12

Perineal Trauma requiring repair

1614.9% 10 6

Breast Feeding 7368.2%

Transfers dataTransfers per month run from 1 in March the lowest

month to 8 in May the highest month

More primps than mulitps transfer

Reason for transfer include Requests for an Epidural = 2Delay in the first stage of labour =5Delay in the second stage of labour =3Meconium = 5 Maternal raised BP = 1 Fetal indication = 2 (one was postnatal ) Other retained placenta / suturing /pyrexia /IOL

Data at a Glance Births Total

TransfersLabour

TransfersPostNatal

Transfers

December 2011

11 2 2 0

January 2012

14 5 5 0

February 15 4 3 1

March 12 1 1 0

April 16 6 5 1

May 21 8 4 4

June 18 3 2 1

TOTAL 107 29 22 7

Evaluating the ServiceThe facilities are good, staff brilliant – a great experience & very relaxing. Vicky March

Staff very accommodating, could not do enough! I’ve already recommended it to friends – a lot less clinical & more relaxed.Estelle Jan 2012 Very comforting, soothing &

calming, it made me feel at ease compared with my other births. Very professional staff but at the same time friendly & reassuring.Donna Donna February

Staff were fantastic, can’t thank them enough. I was really anxious about birth but my care from start to finish was outstanding.Ashley 23/1/12

Couldn’t have wished for a more enjoyable & safe birthing experience.Jenna Feb ‘12

Homely & clean, staff amazing, would definitely come again. Angela Jan ‘12

“Providing midwife-led care on the birth centre has given me the opportunity to develop skills in autonomous practice, and increased my confidence in my own skills and the process of normal birth.”

“Providing midwife-led care on the birth centre has given me the opportunity to develop skills in autonomous practice, and increased my confidence in my own skills and the process of normal birth.”

“I have gained real job satisfaction by providing women centred care, and caring for women throughout labour up until discharge home.”

“I have gained real job satisfaction by providing women centred care, and caring for women throughout labour up until discharge home.”

“I feel extremely grateful to have had the privilege of practising true midwifery in a positive environment that is conducive to normal birth.”

“I feel extremely grateful to have had the privilege of practising true midwifery in a positive environment that is conducive to normal birth.”

“Practising in a stand-alone birth centre has allowed me to reclaim autonomy, promote normality and further empower women, and myself.”

“Practising in a stand-alone birth centre has allowed me to reclaim autonomy, promote normality and further empower women, and myself.”

Birth Centre Midwives March 2012

AQUA ROOM

LAVENDER ROOM

THE MINT ROOM

SANDALWOOD ROOM

THE ROSE ROOM

THE ROSE ROOM (2)

Any questions?Any questions?