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; Callie Copeman-Bryant; Angela D’Amore; Kate Evans; Maddie McMahon; Anna Shasha; Heather Sturman; Jo Watt; Annie West; Kate Wilson; Sam Wood
Guests: Charlotte Ella (Team Manager Health Visitors – Huntingdon); Julia McLean (Team Manager Health Visitors – Cambridge City); Emma Morley (Health Visiting Project Manager)
Apologies were received from: Nicola Clapperton; Julie Gardiner; Sue Prytherch; Claire Thompson
Approved.
3.3.10.4 - AS has arranged for a scoping exercise to be carried out to establish whether there are any midwives who have training in complemetary therapies. The results of this are awaited.
3.4 - As there has been a change of Chief Executive at the PCT, AS and SA-M have deferred arranging a meeting with them, but have instead arranged a meeting with Helen Geall, the new Head of Children, Young People, Maternity & CAMH Commissioning on February 3rd. AS has had a productive meeting with Mandy Renton (Chief Nurse at the PCT).
3.9 - Emma Te Braake has told SA-M that she has not been authorised to include statistics on normal birth (as defined by the national Maternity Care Working Party) in the monthly unit statistics, but she provided the figures for November to the MSLC. The rate was 39%. The intention is to collect these figures for six months, then review the definition. JB questioned what criteria Emma was using. SA-M to forward details of these to JB.
ACTION: SA-M
6.2 - MMcM has not yet spoken to the GP whom she thought might be interested in joining the committee. SA-M has been in touch with Nisrin Marcus who has said that it is difficult for her to get to meetings, but she will confirm whether there any she would be able to make this year. SA-M has sent her a list of the meeting dates. SA-M has also contacted other members who have not attended a meeting for some time, but has not yet heard back from most of them.
It was suggested at the last meeting that a couple of meetings this year be held in the evening on a trial basis, to see what effect this has on attendance. It was agreed to see if the April 12th meeting can be switched to the evening. SA-M to ask Kitty to try and arrange this.
ACTION: SA-M
7 - SA-M has received a request from the NHS East of England Specialised Comissioning Group to present proposals for neonatal services for Norfolk, Suffolk and Cambridgeshire to the committee, at either the March or April meetings. SA-M to arrange this.
ACTION: SA-M
10 - SA-M contacted the GP liaison manager about GP’s receptionists notifying women about their positive GBS status. She has said that this should be raised with Helen Geall, who has confirmed that she would be pleased to discuss this with the committee to establish what action or communication to the GP practices might be necessary. MMcM to produce a brief on this.
ACTION: MMcM
AS has still not heard from the chair of the MSLC at her previous Trust, whom she contacted to request a copy of the questionnaire used there, but regardless of this, she feels that action should now be taken to move ahead on the proposal, and a working group, consisting of provider and user members, set up to prepare a questionnaire for use in the Rosie. Several of the user members present volunteered to be part of the group. AS will ask her PA to arrange an initial discussion meeting.
ACTION: AS
SA-M has established from Helen Geall that the MSLC budget for this year was £2500, of which £1470 had been spent up to the beginning of January. She is having a meeting on February 3rd to discuss the MSLC taking over control of the budget from the beginning of the next financial year. Implications of this include how the money will be held and how budgetary decisions will be made. It was agreed that if the MSLC is controlling the money directly, a Treasurer would be needed. KW said that she would in principle be willing to act as Treasurer if it was decided to have one.
The meeting was attended by Charlotte Eila, Julia McLean and Emma Morley from the Cambridgeshire health visiting service, who presented changes that are being planned for the service. The main drivers for these changes are a 20% vacancy rate that has existed for at least a year, the Healthy Child Programme 0-5 (which describes the role of a health visitor) and performance targets set by the commissioners. A caseload weighting tool was applied to the service. This is a tool which, in addition to utilising public health data, specifically levels of deprivation in Cambridgeshire, determines how many qualified health visitors are required for each area. It showed that if all the vacancies were filled, there would be the right number of health visitors, but working in the wrong areas and potentially not meeting local needs. In terms of provision of service, it became apparent that there were huge inconsistencies across the county. The service is now actively recruiting more staff, including staff nurses and nursery nurses. A health visitor advice line is also being piloted which will provide instant access to the service. In addition, three new care pathways have been designed, each supported by standard packages of care. These are a Universal Pathway, Universal Plus and Progressive Pathway and a Safeguarding Pathway. A draft version of the Universal care packages was shown to the meeting (a copy of this is being circulated with these minute, together with a copy of the Universal Plus and Progressive packages and the Safeguarding packages – please note these are in draft). The aim of the pathways is to provide consistent care, to avoid service duplication and to save money. Services will not always be provided by health visitors if they can be provided equally well by staff nurses or nursery nurses. There was discussion around continuity of care, and liaison with the community midwifery teams.
In general, the committee welcomed the changes, which are due to come into effect in April
Jo Watt gave an update on progress towards Baby Friendly accreditation. A certificate of commitment has been obtained, with the intention of applying for Stage 1 in the summer. This application can be made once there are breastfeeding policies, guidelines and a curriculum in place. The focus currently is on staff training. A group of people have received BFI training to train others, and courses are about to start being rolled out across the region. All staff who have contact with mothers and babies need to be trained (midwives, MCAs, neonatal nurses, SCBU nurses, community staff, health visitors, children’s centre staff). The training programme will run for two years.
It was agreed to leave the terms of reference unchanged. However, it was pointed out that in many respects, they are not being adhered to. This is something that AS and SA-M intend to discuss at their meeting with Helen Geall.
AS presented the figures for November.
• There were 493 births. The rate for December was not as high as predicted (nearly 600 births), but was still the highest ever.
• There were 18 homebirths, with a transfer rate of 5.
• The caesarean rate was 24%. SA-M asked if there was anything that could be identified that contributed to rates of c. 24% in April, July and November, while in May, June, August and October, the rates were 27% - 28.6%. There is no clear reason for this. CP has recently held a meeting of obstetricians to discuss the decision-making process with regard to caesareans, as well as the appropriate use of induction, the rate of which is also high, with the aim of reducing the incidence of both procedures.
• There were 61 births on the Birth Centre, which had a low closure rate of 7%. SA-M asked how many births it would be reasonable to expect to take place on the Birth Centre each month if it operated to capacity. The estimate is around 80.
• There are currently 8-10 midwife vacancies, for which recruitment is underway, and AS is confident that the posts will be filled.
• JB flagged up that the community service is under strain, and work is ongoing to make changes in this. A consultation on reorganising the service was completed last month, and it is hoped changes will be introduced shortly.
• It has proved difficult to collect data on one-to-one care in labour accurately. An electronic system is being set up to facilitate this
AS showed plans for the new birth centre, with fittings for the rooms marked on them. Construction is due to start w/b January 17th, with a ‘sod-cutting’ ceremony taking place on the 17th.
It is planned to have a set of care pathways in place by the time the new unit opens (summer 2012, it is hoped). There is a lot of work to do to formulate these, and JB requested user representation on the planning groups.
KE reported that the DU Forum discusses cases that are ‘near misses’ or of concern, as well as enhancements to the DU. Currently under consideration are the adoption of the national maternity dashboard for record-keeping, and changing the way in which information about what is going on with patients on the unit is communicated and stored.
SA-M reminded the meeting that the reason DU Forum reports are on the agenda is that the Terms of Reference include the clause: “The MSLC will receive reports from and advise the local provider units on…[the] work of the Delivery Unit Forum”. It was agreed that rather than this being a routine agenda item, DU Forum minutes should be provided to the MSLC, and any specific items from them that were of interest or concern to the committee should be brought to a meeting. KE will arrange for minutes to be circulated to SA-M.
ACTION: KE
SA-M reported two pieces of feedback from the MSLC website/e-mail. One was a complaint from a woman who had seen a different midwife at all of her antenatal appointments and was unhappy about the lack of continuity of care. The other was from a mother who wanted to express her appreciation for the care she had received from Ruth Norfolk, Hilda Beauchamp, Lisa Borthwick and the staff on C3. This will be passed on to the people concerned.
AS asked the committee to pass on to all the pregnant women they are in contact with the fact that the Trust is strongly encouraging women to have a flu vaccination.
MMcM expressed concern that a client of hers, who was going home directly from the DU, had been visited on the DU by a Bounty representative within 20 minutes of giving birth. This to be passed on to KE.
AW reported that the information leaflet for women staying on Lady Mary Ward postnatally was now finished, and awaiting final checks. MSLC members have contributed to the writing of this.
AW said that two discussion forums are being held on Lady Mary Ward later in January for midwives/MCAs to talk about problems and complaints.
AW mentioned that a fundraising drive is taking place to raise extra money for the new build.
March 1, 12.00 pm – 2.00 pm
Addenbrooke's Treatment Centre, Seminar Room 4
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