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The Maternity and Neonatal Service Review
What you said overview!
Surinder Hunjan
ICS CSS Programme Lead
December 2019
Work-stream Maternity and Neonatal ICS Clinical & Community
Services Strategy Date of group Parent/ carer focus groups:
1. 02/08/2019
2. 20/08/2019
3. 25/09/2019
Workshops: 1. 24/06/2019
2. 06/08/2019
3. 06/09/2019
Name of
organisation/ group
holding/ supporting
the event
1. Summerhouse Children’s Centre
2. Small Steps Big Changes – Patient Champions/
Ambassadors
3. Zephyr’s Charity (Held with Maternity Voices Partnership)
How many people
took part in total
(excluding
facilitators)?
Focus group 1: 6 mothers
Focus group 2:
Focus group 3:
Workshop 1: 42
Workshop 2: 24
Workshop 3: 25
Maternity and Neonatal CCSS Work stream
Workshop 1
24th June 2019
Stakeholder/Patient & Carer Feedback
Prevention
Smoking
Obesity
Diabetes
Antenatal Care/Postnatal
Care
Partnership working
Location
Workforce
Birth Care
Safety - Workforce
Location
Reduction in Variation
Care of the Newborn
Admission Avoidance
Demand for Neonatal Care
Workforce
Transition
Maternity and Neonatal Services Key Themes
Physical and Mental Health Support
Key Themes Are they covered?
97% of attendees that responded, thought that the themes discussed were the right ones
3% (1)thought that the themes did not cover the service issues.
When this 1 was asked what was more important, the response was:
• “Separate out neonates from postnatal – combine postnatal with antenatal”
General Feedback?
How would you rate the event: 4.2 / 5
How would you rate the venue: 3.3 / 5
How would you rate the exercises: 4.2 / 5
Really good to meet new people all working towards the same agenda albeit looking at
the issues and solutions through a slightly different lens - be good to continue to
capitalise on the knowledge and opportunities for learning in the room thank you
Very good Second
half I felt I had less
to offer from my
knowledge and
experiences.
Great parking (what a
relief) but hall noisy
and distracting
Great parking (what a relief) but
hall noisy and distracting
Microphones
It was thought provoking and
increases awareness of need
to change whilst allowing
identification of challenges..
Big question is will
anything actually change?
Important to have a venue easily
accessed by public transport
Very good discussions from a
broad range of people and
experience
Good opportunity for discussion.
Might have been useful to have
copies of slides on tables.
The exercises generated very
useful discussion - great to have
such a varied cross representation
on our table Enjoyed it
Needed longer to discuss each area
Prevention – Facilitator Feedback Key Changes / Challenges
Much earlier education and understanding of risk factors and input on
pregnancy/ babies - System approach to smoking cessation e.g. ice bucket
challenge
To take ownership of
own health and
encourage shared
decision making
Passivity
To take ownership of own health
and encourage shared decision
making
Lack of resource, including staff, and no set number of contact
points with women to communicate - pre-conceptual care
Health care professionals have
different priorities to their service users Maternal mental health should be added as a key challenge
Standardisation of pathways and offer
Access to a single record that any
provider can access with the ability to
talk to other systems
Whole system approach to prevention i.e. from
schooling, early life and through to adulthood -
changing peoples “normal” to an informed healthier one
Need to offer multiple routes to obtaining information and advice on
preparing for pregnancy hopefully digital as access points. Needs a
whole system approach, everyone saying the same things Consistent and universal
pre-conceptual care at
every stage of life
Ensuring the ICS partners and platform support and deliver this
collaboratively
Resources and “artificial” boundaries
between services and staff
Early intervention with evidence-based, accessible,
and understandable information
Prevention – Attendee Responses
Prevention
I agree with the priorities set by the ICS for obesity, smoking cessation and mental health. These are wide
reaching and aligned with population health
Partnership working more effectively - too many services offering slightly different things
Focus on having a great pregnancy and building support networks rather than the risks to engage people and
then look at support with risk areas
Much earlier education and understanding of risk factors and input on pregnancy/ babies - System approach to
smoking cessation e.g. ice bucket challenge
Adopt a whole system approach - start in the pre- conception period
Early education engaging with schools and social media
Much earlier education and understanding of risk factors and input on pregnancy/ babies - System approach to
smoking cessation e.g. ice bucket challenge.
Promoting healthy lifestyles, physical activity, obesity
Messages that allow woman to recognise how their behaviours impact on their baby
I agree with the priorities set by the ICS for obesity, smoking cessation and mental health. These are wide
reaching and aligned with population health
Working on areas of deprivation in a focused way
Prevention Theme: • 49% of delegates felt preconception care and education was vital, but
also to improve education and available information, earlier (schools)
Prevention – Focus Group Feedback Prevention
Little support or signposting for specific physical health issues – more support from GP needed
Generally very little intervention from GP including preconception advise
Continuity of carer (GP and midwife) would help build trust, prevents repeated your story each time
Having recently lost 7 stone and fortunate enough to
conceive, I found I developed pelvic girdle pain. I
was advised to do light exercise and decided to
swim, however, breast stroke exacerbated the pain,
which meant I was on crutches for several months
after delivering. I felt guilty about complaining as I
was at least blessed with having a baby.
Being a smoker
and drinking
alcohol, I managed
to quit easily for my
fist two children. It
was a struggle for
no. 3 but I had
access to new leaf
through midwife
referral. Having had IVF a couple of
times and miscarrying I
became severely
depressed and this was not
picked up or supported
Antenatal Care – Facilitator Feedback Key Changes / Challenges
Co-ordinated pathway of multi-agenda care but will have huge workforce.
Impacts. new pathways will require a single site solution to meet maternal
medicine review
Partnership working
and sharing of
information and data
To improve
access
The transformation and change
required is not cost neutral
Finding and backing across the system rather than through
individual organisations - need true joint up approach and support
No
apolitical
answer
Cross charging of the public estate creates barriers and huge
infrastructure costs across GP surgeries/ children s centres/ health
centres etc
Antenatal peer support for
women, not necessarily led by
midwives, utilising community
resources including VCS
Better communication for all involved in patients
circle of care e.g. GP/HV/community
midwife/midwife and obstetricians/other hospital staff
Need to revisit education to offer more info on prep for parenthood
as well as birth. Make these easier to access, different locations
and more focused on what women want to know
Decide whether we
wish to invest in a
quality service
Who will provide this. How do we link into other professions and to ensure a cyclical approach to maternity
health education
Knowledge of what’s available and appropriate individuals to
lead. Professionals need to know what services are available
to who
IT
Antenatal Care – Attendee Responses
Antenatal Care
Investment in people( clinical staff and support workers) and space to accommodate the increasing need for
patient appointments both in community and hospital.
Better information for women. Access to better networks through improved technology.
Ensure better access to parent information for all users ensuring better communication between services
Better access to central antenatal hubs by free and better parking and better transport to hospitals.
Train other groups of staff other than midwives to undertake some specialist roles
Improved knowledge of what will actually happen after baby is born - many risk factors for the normal
population for admission to neonatal unit can be mitigated - start parent-craft earlier in pregnancy to enable
better thermal care and feeding as soon as the baby is born
Joined up approach between health and public health in pertinent areas e.g antenatal education, mental health
support
Better communication between hospitals and care in the community. This should be achieved by working as
teams which incorporate both hospital and community staff.
Multi-disciplinary input into antenatal care which will have workforce implications. A single-site maternity
service in Nottingham will be needed to ensure continuation of highly specialised maternal medicine services.
Ensuring the ICS partners and platform support and deliver this collaboratively.
Sharing of information in a more timely manner between providers of services
Antenatal Theme: • 33% of comments are themed around staff and support
• 30% link to access
Antenatal/ Postnatal – Focus Group Feedback Antenatal/ Postnatal Care
Continuity of carer and seeing the same GP/midwife strongly felt to be important, particularly for picking up
post-natal depression
Lack of contact with professionals during pregnancy and after birth and in community
Wider community and VCS support seen as vital but difficult for some to be aware of and access
End of midwife support 2 weeks after birth was felt to be too soon – need to adapt to mothers’ needs
Mixed experiences of consistency in midwifes – some had 1 and others 6 or 7 – all felt continuity of carer was
very important – when you see a new midwife ‘they didn’t know what was normal for me’
Most of the postnatal support mothers required appears to be received from Voluntary and Community Sector
– breast feeding support, general support signposting signposting
Mothers felt they had to ask for help when discharged, it was not always forthcoming.
Sporadic support for post natal depression (PND) as may be visited on a ‘good day’ and then not on the bad
days – continuity of carer would help here as the same midwife would recognise when things weren’t right
Poor breastfeeding support in the community and low awareness of community and voluntary and community
services (VCS) support
Antenatal/ Postnatal – Focus Group Feedback cont.
Being epileptic I was surprised there
was no follow up to warn me of the
dangers – by chance I remained fit free,
but only saw my epilepsy consultant two
week prior to giving birth
A/P - There was little or no input
from the GP – I even by-passed the
GP and went straight to midwife to
confirm my pregnancy. Preference is
to see the same midwife or GP so
would rather avoid busy GP
surgeries with many doctors.
I got no support with PND
– sometimes I had to lie to
the midwife and say I was
okay just so that I could be
left alone as she was not
able to provide the mental
health support I needed.
When I did conceive and
deliver the staff were then
really helpful with my post
natal depression (PND).
I would rather see the same midwife,
then having to repeat myself every
time about my background.
Postnatal weighing – this is self-service, no support,
you have to weigh and plot your own baby’s growth
on chart. Health visitor support or visit had to be
justified before they would come out to see me.
With risk of Edward’s and Patau’s Syndrome, monitoring
at KMH was very good as was the care due to high risk.
I had PND and would tell the
midwife I was okay to get rid of her
as she couldn’t help me with it.
Birth Care – Facilitator Feedback Key Changes / Challenges
Ensure adequate workforce who are trained and knowledgeable
to provide care. Looking at roles and skill divisions to expand
coverage between these might help.
Workforce model is not sustainable
across the region, recruitment band
retention is poor.
Staff the units appropriately
Taking the public and
professionals on this journey.
Need to make working at any
site more attractive with career
development carefully planned.
Resource allocation including
physical, staffing and patients
1. Workforce - shortages and the impact this has on current staff and
women (midwives and medical staff shortages)2. Increased clinical
availability of midwives on labour ward with e.g. shared managerial and
clinical roles rather than losing skilled workforce to management
Offering a sustainable, equitable
choice through a population model
which facilitates individual realistic
choice
1. Recruit and train a 50% male midwifery workforce 2. Ensure
the right baby is born in the right place - transfer mother pre-
labour 3. Co-producing care to manage mother's expectations -
personalised care
Engage with service users and staff to create a service that meets the needs of the local
population whilst maintaining a focus on safety and choice. Focus on this rather than
location whilst recognising that the decision can’t be made in isolation.
Single consultant led unit
Funding and location
Workforce spread too thinly not enough in training, poor
retention, impact of Brexit and immigration controls
Training,
retention and cost
Birth Care – Attendee Responses
Birth Care
Estates to reconfigure to maximise staffing capacity as lack of staff is a significant issue
The right baby born in the right place. IUT pathways for extreme preterm babies to avoid the harm of post-natal
transfer. This also needs to include adequate capacity within Nottingham to ensure there is space for all the
babies that require care. This feeds into a single site for women’s and children’s in Nottingham, maintaining
Kings Mill as a local service.
More focus on wider health needs not just delivering babies
Workforce capacity
We need single unit at QMC and we need to increase and improve services at KMH. 3 needs to change to 2.
Support staff and look after staff to avoid burn out
Joined up approach between health and public health in pertinent areas e.g. antenatal education, mental
health support
Continuity of service for mums. Facilitating 4% home births staffing wise.
Single site Consultant led service for obstetrics and maternity
Workforce capacity challenges.
A single site service in Nottingham
Real choice so if you plan to give birth in a particular setting it does not get taken away because of staffing
issues
Workforce is a huge challenge which impacts on every other aspect of the pathway
Birth Care Theme: • 35% of comments link to workforce capacity
• 40% Talk about estate - largely linked to single site in Nottingham
Birth Care – Focus Group Feedback Birth care
Generally care was good during labour and birth
Breastfeeding volunteers want to do more on wards but there are too many restrictions
Overall sense of being rushed and pushed to leave hospital before you are ready
Lots of good feedback for discharge from KMH
Some good experiences of detailed discharge with lots of discussion but felt that this was only for complex
cases – this level of care needs to be the same for all mothers
Giving birth was so exhausting and traumatic so it was
shocking when they wanted to discharge me from the
hospital, until I reminded them I had haemorrhaged, felt
extremely weak and still not started breast feeding.
In hospital doctors were always
busy – not enough of them.
One doctor asked what I
had against caesarean
section, when I was told
my baby was breach.
Discharge seemed too fast and early. I
didn’t feel ready but told I had to go home.
Red, amber and green
hat system used in SFH
is good.
Post Natal Care/ Care of the Newborn – Facilitator Feedback Key Changes/ Challenges
Single site neonates unit would transform both neonatal and maternity
services All women’s should have at least one home visit mandated to
ensure social and mental health requirements are understood
A single neonatal
intensive care unit and
a co-located obstetric
unit in Nottingham Postnatal -
continuation of a
personalised care
plan. Newborn -
single NICU
An engaged, equipped and
resourced workforce with effective IT
Giving the service that is needed to
a population that is spread over
many sites is inefficient, but keeping
these women on a single site (ie
hospital) is and occupies resources
Wider impact on families (who
may have less choice of where
to deliver) and safe, qualified
staffing
1. Improved communications across pathways and the system -
keeping mother and baby at the centre of the care. 2. workforce
across all disciplines in the hospital and the community
Continuity and consistency of care in
the postnatal period. Development of
single NNU and community hubs. Single unit service for Nottingham
on QMC site for women's, neonatal
and associated paediatric services
Start thinking about home care of the newborn, rather
than postnatal care. Identify what women need and
put the correct people in place to meet this need
Creative use of staffing and
increased capacity so staffing levels
and facilities are fit for purpose
Estates and role
boundaries
Funding and assurance commissioning would be
supportive. Funding mental health services as
mostly funded through charities at the moment.
Postnatal- workforce to
meet the holistic care and
social needs. Neonatal-
funding and location
Post Natal Care/ Care of the New Born – Attendee Responses
Postnatal Care/ Care of the Newborn
We need a single neonatal intensive care unit in Nottingham with a co-located obstetric unit
For babies requiring neonatal care, they deserve a big, well-staffed, modern environment. The neonatal
environment within Nottingham is old and dated and does not have the required capacity. Currently neither unit
fulfils the criteria for NICU, but combined they do. Communication across secondary care and community
services also needs improving,
A large single unit for maternity services and neonatal including mental health support more capacity and
parent accommodation
Change in role perception
prove pathways across the whole system with mother and baby at the centre. Focus on improved outcomes
Multiagency working in community settings building strength from public and voluntary sectors as well.
Thinking creatively to address health issues in a way that families feel able to access and participate in.
Improved communication / shared care across clinicians and services incl. pathways of care for support for
vulnerable women / families. Focus on giving every baby / new family the best start in life.
To ensure we provide the optimum support on one site as in a new women’s and children’s hospital
More timely discharges with a smoother system to do so, allowing women to access post natal services in the
community.
Single neonatal intensive care unit in Nottingham with co located obstetric
Postnatal/ Neonatal Theme: • 50% of responses believe a single site neonatal/ children’s and
women’s unit is required in Nottingham
Maternity and Neonatal CCSS Work stream
Workshop 2
6th August 2019
Stakeholder/Patient & Carer Feedback
General Feedback? How would you rate the event: 4.0 / 5
How would you rate the venue: 4.4 / 5
How would you rate the activities: 4.0 / 5
How would you rate the supporting material: 4.0/5
Feel that the meeting was very medicalised when
so many influences are social and the LA and
voluntary sector, who can have a big influence
Well-presented
and structured
event
It would have been helpful to have had an
example for the group activity
Useful discussion. It is nice to have everyone on the same page
Keen to engage. Hard to know ‘who is who’
and how this fits in “ aspiration” or “real” Needed Facilitation
on the tables Well
structured
Some challenges in reducing a
complex system into a single model Facilitator would help. Not sure we had a clear
focus. Lot of “at a tangent” conversation –
enjoyable but not productive a it could have been
Little confusing in parts. Took a while to understand what
was needed and how to put into boxes
Good brainstorming Good opportunity to meet other colleagues
and hear differing ideas and views
To implement usefully will cost money? All
resources currently very stretched in
Maternity & Neonates.
Useful, thank you.
Really good cross
organisational
thinking
Good event first time all Nottinghamshire
brought together to solve our problems
Very useful open discussion
Promoted discussion and allowed
people to gain clarity regarding plans
Helpful example from Frailty Unfortunately I was
unable to read it
beforehand
Good evidence review
Good to have the summary of
workshop 1 Presentations demonstrated the amount of work
already done and what is still to do
WORKSHOP - OUTPUTS ACTIVITY 2
What questions arise form the System that you have developed that will shape
what needs to be included in the Transformational Proposal?
TABLE 1
How do we get to a single site Maternity and Neonatal service (in Nottingham) with sufficient capacity to deliver safe effective tertiary
services for the network, which meet national recommendations? (Includes all levels of service.) |How does this/ would this affect
activity/ demand Kingsmill Hospital (Neonatal and Maternity)? |Do we need midwife led + consultant care when the transformation
proposed cuts across this and is focussed on time/ urgency of what is needed regardless of ‘risk’ assessment. Low and high risk
women need all options. |Can we really afford more obstetric care + scanning in to the community when already so stretched in
resources?
TABLE 2
Single acute neonatal and obstetric unit in Nottingham. Maximising potential for KMH high dependency neonatal care, antenatal +
fetal medicine care. Community hubs. Integrated pathways and impact on EMAS, e.g. of home births. |What is effect on acute
capacity? |What is effect on community care? |What is impact on transport? |What is the effect on babies and families?|
TABLE 3
|Hub system – Access – who dictates this? |Workforce – capacity? Across whole system/ skill mix standardising and maximising.
|Finance – how do we move money with limited resources? |Available technology – how do we maximise this – considering
governance around this? |Different commissioning models giving rise to variation in the core offers within services – confusing for
families.|
TABLE 4
Aligning Better Births ambitions with Clinical Services strategy ambitions. |ACE awareness – how do we make service/ system ACE
aware? 30 min ACE aware training via PH – PH pays for this. |Preconception services – who will provide these not currently
commissioned e.g. pregnancy prevention, fitness for pregnancy. |Family approaches to holistic care – who will provide this, does not
sit solely with maternity services. Keeping staff safe – moving more care into homes, how do we make sure all staff have all the
information they need to know what they are walking into? |’One-Team’ approach – midwifery and health visiting being perceived by a
family as a continuation – will result in improved communication, consistency, enable mothers to understand health visitor role – and
feed ‘drip feed’ information, e.g. breastfeeding from the start of pregnancy + throughout. Better emotional, mental + physical
preparation for birth, for babyhood and for life.
WORKSHOP - OUTPUTS ACTIVITY 2
How does the model proposed support the sustainability of the health and care
system in Nottingham and Nottinghamshire?
TABLE 1
|Safe NUH site gives more efficient + higher quality care and use of resources workforce. |Single NUH site will improve outcomes.
Will prevent transfers long distances for care in other networks. |Will attract staff and more recruitment and retention. |Option for
flexibility of workforce moving around network. |Telemedicine – how to use effectively. |The model needs bespoke commissioning
for services e.g. homebirths, PTSD/ trauma clinics, pre-pregnancy counselling, etc.|
TABLE 2
|Neonatal Transformation Plan: A neonatal intensive care unit site should have >2000 IC days – combining City and QMC on one
site does this. Advantage of larger centre, greater expertise and better outcomes.| A local neonatal unit should have >1000
respiratory care days – this can be facilitated by a single intensive care unit at Nottingham (2 locations – KMH and single NUH,
rather than KMH, QMC and City). |EMAS: Above allows easier decision making for urgent (emergency care e.g. possible delivery of
single neonatal/ maternity door if stand-alone site. |Community Hubs: Keep well pregnancy care and well babies in the community.
Facilitates better use of acute hospital beds and reduces length of stay. |Centre neonatal transport –we would not transfer babies or
pregnant women and postnatal women between QMC and City if one site in Nottingham, reducing unnecessary work for an under-
commissioned service, reduce transport better outcomes, psychological effects on parents and families.|
TABLE 3
It supports sustainability because its moving resources upstream. |We would need to plan services together to understand the
impact on other services – system mapping/ to eradicate e.g. unintended outcomes, County stopping baby clinics based on moving
resources/ patient feedback – impact on CityCare HV service
TABLE 4
|Focus on care provision outside of o hospital reduces cost and drain on resources. |Early intervention and prevention key to
sustainability, services focused on providing access to information for families to manage own needs with support. |Centralised
information hub (?on ICS Website) for women and families + all professionals to access and update. |Baby friendly model of
sustainability consistently adopted – lower cost, embeds standards into services, prioritise culture, leadership, progressing service,
small annual MDT. Achieving strong bonds. |Continuity of carer across all professions to promote personalised care which will
assist in appropriate resource use.|
WORKSHOP - OUTPUTS ACTIVITY 2
What is the impact of the care model on the requirements of Workforce,
Technology, Estate, Culture?
TABLE 1
|If the care model is moving into the community then this will have huge impact on workforce and overall costs. |Workforce more
efficient but adequate numbers to meet national standards are required. |Change of activity (increase capacity) will require more
recruitment/ funding. |Need single IT system across maternity and neonatology which is compatible with national data collection
systems (NMPA/ NNAP/ NDAV etc.) + allows communication and information sharing across all sites.
TABLE 2
|A single NICU and obstetric/ midwifery unit in Nottingham, will increase efficiencies in workforce, opportunity for Estate to be fit for
purpose, increased staff psychological safety giving better patient outcomes. | Community Hubs – Rightsizing, efficiencies of staff,
travel times, reduce LOS in acute care, Continuity of carer and Maternity Transformation. |Technology – Single IT System..
|Families - Right care, in right place. Need adequate parental accommodation. Improved delivery of stated expectations.
Need ICS to support decision on single site.
TABLE 3
|Primary investment |IT infrastructure – Wi-Fi |Joint use of all estates – cross charging |Culture – change away from protecting
own business model. Workforce transformation – really understand why we are doing something; building a resilient workforce;
time engagement and participation of workforce and pubic.
TABLE 4
|Much more alignment between professionals. Need to socialise professionals as a team not separate professional bodies with
distinct roles. |Massive impact on technology as need robust IT methods for full sharing of information. |New roles and ways of
working, focus on skill mix and care functions rather than professional roles. |Care pathways will be reflective of family view not
just women, women + baby, baby as isolated factors. |How do we negotiate a workforce which is enabled to focus on continuity
personalised approaches rather than ‘task’ orientated.
Maternity Focus Group Small Steps Big Changes – Patient Champions/Ambassadors 20 August 2019
Focus Group Feedback
Different services are available in different areas – This needs to equitable
Timings of appointments offered – Need to be conscious of people’s circumstances and should be offered
different alternatives
Continuity of carer (GP and midwife) would help build trust, prevents repeating your story and history which
can be upsetting from past experiences. Notes are not always up to date for clinicians and health care
professionals.
Sourcing information – some people are confident to do this but there needs to be key consistent information
and communications about what is available.
Seeing different people
whilst in labour is hard –
Repeating stories and also
there are different genders
in the room which women
from different cultures will
find difficult
Patients are aware of staff
workloads and time
constraints and the
pressure that staff are
under.
Hospital car parking charges are extortionate – To get public transport to appointments can be expense and
tedious especially if you have more than one child to look after.
Key messages to patients need to be consistent – Parking charges can be reimbursed for patients who are on
specific benefits – Not everyone knows this but people should be aware
The attitude of staff in clinical settings can be harsh and upsetting.
The mental health support service within the community for antenatal and postnatal care is excellent. There is
always the same person and they understand your circumstances.
There needs to be some sort of reassurance to women when they return home with their children to provide a
little reassurance.
Breastfeeding Support – This isn't always encouraged by health care professionals although this is the wish for
ladies – There needs to be additional support for women who may appear to be struggling and need
assistance. .
Mothers felt they had to ask for help when discharged, it was not always forthcoming.
Women felt criticised by health care professionals on how mothers had handled situations – Their instincts
proved right – women know when something is wrong with their children.
Resources need to be available in hospitals for women – Women feel guilty around breastfeeding and if the
child is then given a bottle.
Pain relief – health care professionals need to understand personal and specific situations and also patients
emotions.
Focus Group Feedback
Teams need to work together to ensure
consistency for mum and baby. Being prescribed anti depressants and
then being told conflicting information
from health care professionals was
confusing and upsetting – Teams need to
work together.
Allergies – Why do people not
listen to what women are
telling them around family
history and what the outcomes
could be for their family.
I would rather see the same midwife, then
having to repeat myself every time about
my background.
Each child is different and the same option as other
births and plans doesn’t always work!
Excellent care by the Community Mental Health Team –
Birth went to plan – conflicting messages around
medication that was taken prior to birth .
Women feel guilty when they cant
breastfeed and bottle feeding may be
the option – More support needed.
Focus Group Feedback
Focus Group Feedback
Personal approaches needed from staff and also to provide emotional support and to be supportive in difficult
situations.
Fathers should be able to attend 24/7 to provide support to their partners – More privacy for mums and families
needed
Overall sense of being rushed and pushed to leave hospital before you are ready
Traumatic births – Follow on experience and health care professionals dismissing comments from mums –
Took time to have a referral to a consultant to ascertain issues and resolve matters following birth. Surgery
and procedures were needed.
Some good experiences of detailed discharge with lots of discussion but felt that this was only for complex
cases – this level of care needs to be the same for all mothers
Key and consistent information needed for families
(including dads) – What to expect when you return
home
Compassion and emotional
support from staff needed. Lack of communications
available – There needs
to be clear messages
and the right messages Need to ensure that all information is birth
plan to include all wishes and feelings.
Maternity and Neonatal CCSS Work stream
Workshop 3
6th September 2019
Stakeholder/Patient & Carer Feedback
Responses to Slido Polls?
How was the event rated: 4/5 8% rated 3/5
88% rated 4/5
4% rated 5/5
How was Exercise 1 rated: 3.7/5 4% rated 2/5 (1 person)
28% rated 3/5
64% rated 4/5
4% rated 5/5
How was exercise 2 rated: 3.9/5 20% rated 3/5
72% rated 4/5
8% rated 5/5
How was the approach of holding 3 workshops rated: 3.8/5 4% rated 2/5 (1 person)
24% rated 3/5
60% rated 4/5
12% rated 5/5
How was the diversity of stakeholders rated: 3.5/5 4% rated 2/5
42% rated 3/5
54% rated 4/5
Some of the first hey questions were not clear. Better
second group. Good to contribute
Good venue, mix of people Found this session facilitated so
really good discussion about the complexity of issues and
the identification of golden threads e.g. workforce retention
and family approaches
Sometimes appears much
has already been decided
It was surprising to hear how maternity
services differ within areas of the county
More input from mental health services
It would be good to have
had more chance to
share our thoughts within
he room.
Better venue
Good to see the overview and
noted that previous comments
and issues have been included.
Good challenge and sense check of
information previously identified. Opportunity to
reflect and consider wider implications of the
work. Good participation.
Good across discipline discussions A good venue regards location,
parking, room acoustics etc.
Good venue. Useful
discussions
I found having a
facilitator in previous
session useful
Comments on the event
Very complicated but some good
discussion generated
More time given
Helpful exercises to explore
previous assumptions
Comments on Exercise 2
Some caution around mapping
a plan which then translates
into ‘must do’ for us as
operational managers in the
ICS
Interesting would be interesting to
hear more points from the floor
Difficult to do when no idea
of capacity and financial
support
This was more difficult to
think f the steps needed. So
much interconnection
between pieces of work
Good to grasp process for
implementation in practical
terms.
Good group discussions
and we recorded some
outside the box comments
Comments on Exercise 1
I worry that many staff affected by this haven’t been involved
The workshops have improved as they have gone along,
more clarity about the purpose of the workshops Attended 2 ( meeting
during August not ideal)
Any stakeholders missing?
Comments: Could have included services offering care up to age
one, eg Children's centres, nursery settings etc
AHP that work in
antenatal clinics
Someone to
represent
education it would be useful to
engage the community
and voluntary sector as
they have excellent links
with communities and are
critical to the system, and
supporting the work and
delivering messages,
especially to harder to
reach
Positives and negatives to differing attendance at
each workshop however offers wider opportunity for
greater participation and networking.
Could have included services offering care up to age
one, eg Children's centres, nursery settings etc
Obstetrics in workshop 3,
sonography not represented
Cross organisation/
regional representation??
No obstetricians
on Workshop 3
Not sure if local
authority presence
More parents
Comments on the approach to 3 workshops
Do you feel this transformation proposal will transform maternity and neonatal services for Nottinghamshire citizens?
83% said YES
0% said NO
17% were UNSURE
The Transformation Proposal
But only if a review of workforce included,
joint outcomes and user views are
collectively considered.
....but will it have an
impact on health of
individuals?
‘Transformation’ is an ambitious term
and poorly defined. The proposed
changes will certainly have a positive
impact in some areas if fully delivered
Neonatal capacity and single site
greatest priorities and will be
transformative
Not confident that the financial investment will
be there
Highest priority is one site at NUH
Depends on the implementation,
and inclusion of all relevant
services
Comments about the transformation proposal transforming Maternity and Neonatal Care
Maternity Focus Group Engagement with Zephyr’s Charity/ Maternity Voices Partnership (Healthwatch also present) 27 September 2019
Positives:
Some staff provide
reassurance and full
details and explanations
provided to parents
Kind and genuine staff –
going the extra mile
showing empathy in
difficult situations
Compassionate staff –
Clinical and after care
Parents blame
themselves and
question themselves
Staff can be confrontational Lack of
communication
Staff are not aware of situations
and don’t know what to do
Excellent community midwife care
Use of language by staff
No communication when child had to go to Sheffield
for a post mortem – Mother didn’t know where her
child was – Extremely upsetting for mum and family
Rude
staff
Negatives:
No emotional
support
No empathy from staff around situations
No emotions from clinicians – people
feel like they are just a clinical case After care support – More needed and
postnatal support for families
Staff didn’t want to talk to the dad even
though they are going through this too Continuity of care and staff is not consistent and
does not help when you have to repeat yourself on
several occasions
Workshop 3 Outputs Updated Transformation Proposal 27th September 2019
Prevention
Smoking
Obesity
Preventable Medical
Conditions
Antenatal Care/Postnatal
Care
Partnership working
Location
Workforce
Birth Care
Safety - Workforce
Location
Reduction in Variation
Care of the Newborn
Admission Avoidance
Demand for Neonatal Care
Workforce
Transition
Maternity and Neonatal Services Key Themes
Physical and Mental Health Support
Area for
focus/
Action
LMNS/ LTP
Area of
focus
Transformation Proposal
Workforce Technology Culture Estate/
Configuration
Priority
(High/ Med/
Low)
Whole Nottinghamshire approach to
deliver consistently available home birth
service
Development of Nottinghamshire Neonatal
capacity to ensure Nottinghamshire
neonates can be cared for within the ICS -
with single site neonatal unit and obstetric
led care in Nottingham and network
pathways, at the QMC
Development of antenatal community hubs
for the provision of obstetric and midwifery
antenatal services to increase proportion of
contacts close to home, improving
prevention agenda and access to social
care services, supporting a holistic MDT
approach (shared protocols and
guidelines)
Alignment
(ICS/ ICP/
PCN)
Continuity of carer (team) provision
through antenatal, intrapartum and
postnatal care
Development of breastfeeding support/
advice in all settings
Health improvement service development to
support healthy pregnancy and early childhood
years including preconception advice (e.g.
obesity, smoking) and post pregnancy
opportunities, (e.g. weight management)
Maternal wellbeing and mental health care
service provision development in all care
and urgency settings including preventative,
supportive and crisis
Personalised Care Plan development
High
High/ Med
High (Med timescale)
High
High
Med
High
High
PH Cons./ DVSA cross role training Specialist support/ Voluntary sector
Partnership workforce across system/ needs midwives 24/7 availability
Partnership workforce/ Paediatric radiologist cover, more AHP time Sustainable staffing rosters More staff for to meet national numbers
RCN/ Link workers Access for peer support BF volunteers – needs staff and volunteers across services Community champions
Competency based training and joint roles
Obstetric outreach requirement - Staff to cover running of hubs Technician can reduce impact on workforce across several services , e.g. for scanning,, with video links for support. Obstetric outreach GP re-engagement/ training Much closer working across organisational boundaries.
More MH staff and appropriate training of maternity staff including midwives
Would require extra planning time, therefore more staff Holistic working/ training
ICS/ICP
ICS Approach
at ICP/PCN
Level
ICS/ ICP
ICS Approach delivered
at ICP/ PCN Level
ICP/PCN
ICP – delivery at PCN level
ICS Approach delivered
at ICP/ PCN Level
ICS
App/ Web/ TV preconception e-platform advice/ information sharing
Shared Care record/ single ICS wide IT System including mobile tech.
Shared Care record/ single ICS wide IT System (Badger?) With AHP staffing at recommended levels according to professional bodies
App based or digital peer support Tech. enabled services e.g. Skype consultations with specialists High use of Apps
Shared Care record/ single ICS wide IT System
Shared Care record including social care – central repository High use of Apps and handheld devices More sonographers , (already stretched within acute setting)
Interconnected systems to prevent repeated questions/ information requests - Integration with NHS App
Shared Care record/ single ICS wide IT system Co-author capabilities linked to maternity records
Need to make use of current estate differently
Linked to working from hubs
Review capacity at QMC/ SFH Huge estates development at QMC
Makes good use of existing estates with community hub add-on
Access to community Hubs
Community Hub capacity US Scanning facilities in community setting Free up space in acute areas Equipment in suitable accommodation will be required
Access to community hubs
Minimal impact on estate, but more hub based working
Finance/
Commissioning
Note impact on stability of SFH activity/ service – need to support neonatal at SFH to prevent impact on maternity services across the system Impact of NICU on ODN
Breakdown professional barriers and budget to improve access for all Shared working with integration of organisations and workforce
Alignment of system processes and cross organisational contracts
Bringing together two ways of working Closer working between SFH and NUH Cuts out perverse incentives linked to transferred babies Public opinion – change may be challenging
Breakdown professional boundaries especially midwife and health visitor Increased partnership working with improved communication
Integrated working across roles and organisations
Stronger partnership working and trust. Need to unblock difficulties around cross charging Shared and integrated working towards successful MDTs
Demands a focus on shared decision making Mapping out PCPs can be used to offer holistic joined up care Women’s voices as important as professionals
LMNS Maternal Health & Better Postnatal Care Work streams Smoking Cessation Plans, SBLCBv2, Postnatal Improvement Plan in place Work underway in LMNS
LMNS Personalisation & Choice Work Stream Choice Offer in place, plans to increase home birth rate, workforce modelling.
Work underway in LMNS LMNS Better Postnatal & Neonatal Care Work Stream in place. ODN representation at LMNS Programme Board TBC Business Case LMNS Programme Board in place with the ability to support/ coordinate
LMNS Better Postnatal & Neonatal Care Work Stream BFI full accreditation Postnatal Care Improvement Plan Work underway in LMNS
LMNS CoC T&F Group. Delivery plans in place, pilots underway, evaluation commissioned. To upscale with future investment
LMNS Better Postnatal & Neonatal Care, Personalisation & Choice Hubs yet to be developed, aligned to Better Birth Recommendations and local PCN requirements – this will form part of the overall Clinical Services Strategy review across several services requiring community hub capacity
LMNS Perinatal MH Work stream, plans being developed to include LTP. ICS MH Strategy
Work underway in LMNS
LMNS Personalisation & Choice PCP Developed with digital solutions Work underway in LMNS
