Cambridge Maternity Services Liaison Committee
We care about your care!
Cambridge Maternity Services Liaison Committee
We care about your care!
In Attendance:
Sue Allen-Mills (Chair); Jan Butler; Nicola Clapperton; Callie Copeman-Bryant; Angela D’Amore; Cheryl France; Ashley MacDonald; Maddie McMahon; Anna Shasha; Sharon Shipp; Jan Stokes (for Claire Thompson); Heather Sturman; Jo Watt
Guests: Charlotte Ella (Team Manager Health Visitors – Huntingdon); Julia McLean (Team Manager Health Visitors – Cambridge City); Lucy Dominy (NHS East of England Specialised Commissioning Group); Philippa Bennett, Chair, West Essex MSLC
Welcomes were extended to Ashley MacDonald as a new user rep and to the guests.
Apologies were received from: Kate Evans; Julie Gardiner; Sam Wood
Approved.
3.3.10.4 - A scoping exercise to establish whether there are any midwives who have training in complemetary therapies has been carried out, and three or more such midwives have been identified. Midwives have been offered the chance to attend a training day on complementary therapy to be run by Denise Tiran. JB is keen to focus initially on developing midwives’ massage skills. Philippa Bennett mentioned that Newham PCT have been developing this service. She will send Newham contact details to SA-M, for forwarding to JB.
3.3.9 - JB has not yet checked with Emma Te Braake on the criteria she is using to calculate the normal birth rate. She suspects that use of Entonox may be being wrongly taken as an exclusion criterion. The figures Emma has provided for December and January are 38.3% and 35% respectively.
3.6.2 - The GP whom MMCM asked about joining the committee did not express an interest in doing so. SA-M has been in touch with the GP Liaison Manager, who has approached two groups of GPs to see if any of their members would like to join the committee. There has been no response to this as yet.
The next meeting, April12th , has been switched to the evening (7.00 pm – 9.00 pm).
3.10 - SA-M has spoken to Helen Geall about GPs’ receptionists notifying women about their positive GBS status over the phone. Helen is looking into this. SA-M has emphasised that the issue of how women are informed about anomalous test results is a general one.
CF and Lucy Dominy gave a presentation on changes to neonatal services in Norfolk, Suffolk and Cambridgeshire. These have been developed by the NHS EoE Specialised Commissioning Group, which serves 13 PCTs in the east of England, and focuses on rarer and more costly services that are best commissioned across a wider area.
The changes are being made in order to meet the nationally mandated requirement that all neonatal units are designated (i.e. formally categorised in terms of the level of care they are able to provide, in line with agreed standards) to reflect their activity and staffing levels, within structured clinical networks. Once designation has been achieved, each unit can then be supported to meet British Association of Perinatal Medicine standards to ensure appropriate staffing levels for their designation. The aim of this is to improve outcomes for the sickest babies, and to ensure that appropriate care is provided for mothers and babies as close to home as possible.
The designation process does not involve the neonatal intensive care units at Addenbrooke’s and Norfolk and Norwich, as they were reviewed and designated separately in 2006. Nonetheless, they have been closely engaged with the wider project as part of the network philosophy. For the other units in the region, a process of appraisal and review in 2008-10 has resulted in plans for three hospitals, Peterborough, Ipswich and Queen Elizabeth Hospital in King’s Lynn, to have local neonatal units (providing less intensive care than NICUs); and three, Hinchingbrooke, West Suffolk and the James Paget in Great Yarmouth, to have special care baby units (providing less intensive care still). Units providing the most intensive care will also offer all other levels of care.
The review has been undertaken with parental involvement, and parental views have been at the heart of it. Because the changes proposed are nationally mandated, are not major, and affect only small numbers of people, formal public consultation has not been necessary, but the review group has been engaging with clinicians, commissioners and charity groups, and is beginning a process of engagement with parents.
In practice, for Addenbrooke’s, little will be changing. There was discussion about the impact on Addenbrooke’s neonatal services of out of area women birthing at the Rosie, and this sometimes having the consequence of unwell babies of local women needing to be transferred out because of the lack of availability of neonatal cots. JB said that she is shortly to have a meeting with heads of community midwifery services in neighbouring areas, and will bring Addenbrooke’s capacity issues up with them. The need for out of area women to be reassured about the provision of services in their local hospitals was stressed.
CF pointed out that the area of neonatal care was one where parental choice was generally limited, in that it was necessary for the baby to go to the nearest hospital where the care required could be provided.
CF and LD asked if the MSLC would pass on any feedback they have or receive on neonatal services, and help them to contact groups and people with an interest in this area.
Julia McLean and Charlotte Ella gave an update on the proposed changes to the health visiting services that they presented at the last meeting.
The care packages are being finalised in readiness for staff to start receiving training on them. The new service is to begin on April 1. Most staff have now been trained on the new electronic system, Systmone, and response to it has been positive. One area is still to go live on it. The new helpline has been put on hold until the system is live everywhere.
Ten new health visitors have been recruited. Further recruitment is ongoing.
The service is looking at ways of co-ordinating with Children’s Centres, to reduce duplication of services and to ensure equity. The service is keen to become more integrated with maternity services, as well as to see more communication between health visitors and breastfeeding drop-in sessions. JMcL will talk to Bridget Halnan and Helen Greathead about what information about these sessions is included in the red book. JMcL is interested in attending MSLC meetings while BH is not in a position to do so.
NC pointed out that the Healthy Child Programme is also looking at bringing together health visitors and Children’s Centres, and will report on this to the Children’s Trust Board.
SA-M, AS and NC had a meeting with Helen Geall, Head of Children, Young People, Maternity & CAMH Commissioning at the PCT, and two members of the PCT finance department on February 3rd. The issues discussed were admin support for the MSLC, involving the MSLC at the planning stage of maternity services commissioning, and the MSLC budget.
Because of lack of resources at the PCT, it is not possible for any admin support to be offered to the MSLC beyond what is currently provided. PCT staff themselves are without admin support. The implications of this are firstly that when the Terms of Reference are next reviewed, they will need to be modified realistically to reflect the position regarding PCT admin support, and that future Chairs will need to be aware of the amount of admin that needs to be undertaken by the committee itself. It was suggested that the issue of support should be discussed with GP commissioning groups. PB pointed out that ChiMat has some information about this.
With regard to commissioning intentions, Helen expressed a willingness to involve the MSLC in the Joint Strategic Needs Assessment, a process carried out in the autumn in which commissioning intentions for the following year are formulated. NC will be working on preparing service specifications, and will be consulting the committee about this later on in the year.
It was confirmed that the committee has an annual budget of £2500. This cannot be held in an MSLC bank account, but it was agreed that it can be held as a ‘pot’ of money within the PCT, the expenditure of which can be determined by the MSLC. Spending decisions can be made by the MSLC and MSLC requests for payment can be made by the PCT holder of the ‘pot’, without the need for further authorisation within the PCT. The holder of the ‘pot’ will provide the committee with a monthly account of spend and balance.
In terms of user expenses, it was agreed that SA-M will collect the cash for these from the PCT prior to each meeting, so that the payment of expenses does not depend on NC being at the meeting. NC will produce an electronic claim form, which will be circulated to all user reps, so that they can prepare their claims in advance of the meetings.
ACTION: NC
There is currently £1232 remaining in the 2010-11 budget. Funds that are left unspent at the end of the financial year will be lost. It was suggested that a good use of this outstanding money would be to arrange an MSLC training day, which can be done through the NCT. These cost £850 for a full day, for up to 15 participants. It was agreed that this would be a good idea. The committee would have to arrange a venue, and it was suggested that this should be away from the Rosie, possibly at a Children’s Centre. JB recommended Bassingbourn. It is too short notice to get a day arranged before the end of the financial year, but SA-M will ask the NCT if it is possible to make a provisional booking and to be invoiced before the end of the year.
ACTION: SA-M
There is a new Chief Executive at the PCT, Sushil Jathanna, whom SA-M and AS will arrange to meet in due course.
AS, SA-M and MMcM had a meeting to discuss developing a maternity services questionnaire. They agreed that there was little point in formulating content for such a questionnaire until it had been established how it would be administered and who would analyse the data. AS has arranged to meet someone from within the Trust to discuss the possibility of dovetailing a maternity services questionnaire with one that is already administered.
AS is concerned about the tendency for women on Lady Mary ward to keep their curtains closed all the time, as this makes it impossible for midwives to keep a check on the well-being of mothers and babies. She has asked the MSLC to visit the ward to talk to women about this issue. This is due to happen in the second week of March.
AS presented the figures for December & January.
• There were 532 births in December and 506 in January.
• There were 10 homebirths in December and 16 in January, with transfer rates of 5 and 4.
• The caesarean rate was high - 30.5% and 28.5% in January. JB reported on the work of the VBAC clinics, which have good take-up. The consultants have made the decision that requests for a caesarean from women under 25 should be denied. It seems that some women are choosing to birth at the Rosie because they believe they will be able to choose to have an elective section. JB offers consultation sessions with women who may wish to have a caesarean because of previous trauma.
PB said that Princess Alexandra Hospital (PAH), Harlow, has a comparable section rate (i.e. c. 30%) and has a project to try and reduce this. Women are now being denied caesareans on request. If they ask for a second opinion, they are referred to a committee of four consultants to make the decision. It is accepted that this removes the option of choice for women. PAH have also visited Peterborough Hospital, which has a comparable demographic, but lower section rate. Peterborough have taken steps to reduce their rate, including deferring induction for postdates.
MMcM raised the fact that she knows of some women being told after a caesarean that they will always need to have caesareans in the future. JB will take this up with the consultants.
• There were 68 births on the Birth Centre in December and 59 in January, which had a low closure rate of 5% in January.
• SA-M asked why the midwife to birth ratio of 1:34 was being used as a benchmark, when Safer Childbirth recommends 1:28 and the SHA recommends 1:30. AS said that this is likely to be on financial grounds.
Work on the new build is on schedule.
A workforce development review is currently underway to identify staffing needs for the new build.
There is going to be a screening of a documentary about doulas on Friday March 4 at St Paul’s Church, Hills Road at 8.00 pm. Tickets are £5, with proceeds going to the new build and the Doula hardship fund.
SA-M is going to get together with Victoria Frost to discuss MSLC publicity.
The next meeting, April 12th, will include a discussion of the homebirth service. If there are any issues with regard to this that you would like to raise, please let SA-M know as soon as possible.
One of the Bounty Bag ladies has won a baby photo award.
April 12, 7.00 pm – 9.00 pm
Rosie Maternity Hospital, Seminar Room 4
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