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; Rosemary Course; Bob Dawson; Helen Fairchild; Katy Fox (deputising for Jo Sharman); Cheryl France; Victoria Frost; Birte Harlev-Lam; Sarah Lumley; Rachel O'Leary; Anna Richardson; Sharon Shipp; Jo Watt
Apologies were received from Geraldine Bradford; Penny Brett; Jo Brown; Angela D’Amore; Nisrin Marcus; Maddie McMahon; Sarah Ockwell-Smith; Jenny Schiller; Jo Sharman; Shahida Trayling
Introductions were made and welcomes extended to new attendees (Helen and Katy)
Item 1: Cheryl France requested that her name be corrected from French to France.
Item 2.2: RO’L asked if any steps had been taken to give information to breastfeeding mothers about taking codeine
ACTION: BH-L to chase Nigel Gooding
Item 3 -re composition of committee’s membership: Louise Mitton is no longer able to continue as a member of the committee. Community midwife Geraldine Bradford has replaced her.
Item 3 - re publicity and communication: SA-M has spoken to the website host about the site being updated to include a members-only area, and this is in the process of being set up
ACTION: SA-M
Item 5 - re one-to-one care in labour: SA-M has asked the NCT if they knew of any guidelines on how to define one-to-one care for the purposes of collecting data on the provision of this, but they didn’t. BH-L reported that a recent meeting of Heads of Midwifery had agreed a working definition of one-to-one-care as a woman having a midwife available to her 100% of the time during established labour. This means that the midwife is not responsible for any other woman during that time, but she may not necessarily be in the room with her patient 100% of the time. NICE guidelines are that established labour is defined as the woman being 4cm dilated, with regular, painful contractions.
The terms of reference have been modified as discussed at the last meeting. The revised version was brought to the meeting and approved unanimously.
Jo gave a very informative and positive presentation entitled ‘Taking the Rosie forward to achieving UNICEF Baby Friendly status’. There are seven stages of the procedure, from registering intent to full accreditation (which lasts for two years, after which time a re-assessment is carried out over a 3-day period - this re-assessment is carried out every two years to maintain accreditation, or the hospital would need to work back up again). The total length of time to complete the procedure is approximately five years. All staff who come into contact with mothers and babies (approximately 450 members) will require training. This training takes 18 hours, including three hours clinical for all staff. New staff should be trained within six months of starting. Training all the current staff is what will be most time-consuming initially. If desired, neonatal units can apply for the status independently.
Jo is still working on issues that she would like to improve.
Further information about the Baby Friendly programme can be found at www.babyfriendly.org.uk.
BH-L reported that complaints are collated every quarter, the latest available being the period July - September 2008. In this period there were ten formal written complaints. Complaints are graded from green (unfounded, which are rare) through yellow, orange to red (which is a very severe incident). In this latest period, there were six yellow and four orange complaints. The complaints are logged when they are received. They can be made up to a year after the occurrence of the incident that triggered them, although at the Rosie, complaints will be dealt with beyond this period.
Four complaints were received relating to antenatal clinics. These concerned advice given by staff, staff attitude, and patients feeling rushed. Complaints were also made about clinical care seemingly having been inappropriate, although on investigation this was not deemed to have been the case. It was acknowledged that perhaps communication could have been better. Approximately 1300 babies were born during this period, so BH-L felt that volume of complaints was small.
With regard to PALS, people drop into the service and make verbal complaints. There were nine complaints, which is an improvement on the previous quarter. These complaints are often from family members. Issues raised have been regarding inadequate pain relief, e.g. allergy to particular analgesia (in the postnatal period). Staff are now making more use of pain scores to assess pain relief needs, which is useful. Other issues raised have been difficulties getting scan appointments and antenatal clinic waiting times. It is important to balance out these complaints by acknowledging the many compliments that have also been received.
Previous complaints have included issues with women getting access to their babies, especially following caesareans. There are now some electric beds that allow easier movement. The Friends of the Rosie are to donate six height adjustable cots, which the Trust will match with another six. Priority for use of these will be given to c.section patients.
CF referred to a particular complaint about the neonatal unit. She expressed concerns with the unit’s review. For confidentiality reasons, CF will discuss the matter personally with BH-L.
The c.section rate is currently at 28% for the third month out of four. Most of these are emergencies. This is an increase from 25% previously. BH-L said that there was to be a weekly review, to examine emergency c.section occurrences.
Staffing – recruitment continues. MLBU is not always open due to staffing levels. There will be two intakes of student midwives per year starting in March.
Staff levels in December 2007 were at 139.51; in December 2008 they were at 165.97 wholetime equivalent staff.
ACTION: BH-L to circulate figures
- Staff have been looking at the incidence of third degree tears, and running roadshows targeting midwives to identify these.
- There has been some money donated by a recently bereaved staff member, and this has been used for a study day on supporting parents who experience the loss of a baby.
- A new project has begun, under the name of the Lavender Project, which takes a new approach to the management of care in the latent stage of labour. Some TENS machines have been purchased, and women are encouraged to borrow one and return home with them, thus enabling them to stay at home for longer. This started two weeks ago. The aim is to keep things natural and low key for the women. The project will hopefully be cost-effective as it should result in fewer women staying overnight in hospital. It is hoped that the machines will eventually be available through community midwives, so that women don’t have to go into the Rosie to obtain them.
- The DU has just received new, long-awaited infant resuscitaires.
When the audit tool was applied in September, the MSLC was assessed as being at Level 2 (‘In addition to travel expenses and admin support, childcare expenses for user representatives are provided’) on this element, but there are resources available for Level 3 (‘Staff resources for focus groups or sub-groups available on an ad hoc basis’), so this is achievable. If we are looking at achieving Level 4 (‘In addition to ad hoc resources, the MSLC has authority to offer training courses to members’), there is an issue of numbers and costs. There is currently a budget of approximately £2500 for the Rosie and Hinchingbrooke combined. Further funding could possibly be sought elsewhere. If there were a reasonable training plan in existence, Level 4 could be achieved. SA-M is currently investigating details of training.
ACTION: SA-M
CF suggested collaborating with Hinchingbrooke to share costs. New user member HF expressed her feeling that immediate training on joining MSLC could be somewhat overwhelming, due to lack of knowledge of the committee.
BD felt that Level 5 criteria (‘A de facto budget is available to support user involvement and the work of the MSLC’) seemed similar to Levels 3 and 4. VF felt that more awareness is necessary, needing feedback from the service, but at this time new user reps are not really necessary.
BH-L reported that archaeologists are currently checking the ground. This should take approximately two weeks. The project team are communicating with surveyors, and mapping out the needs of low risk/high risk women. There is currently little knowledge of the actual layout of the building, or rooms that will be available.
Three suggestions for a new MSLC logo were circulated for comment. It is planned to produce posters and leaflets to publicise the committee, and direct people to the website. It is also planned to update the welcome pack, bringing existing information up to date, to be given to new committee members. The PCT should be able to organise this. The pack should not be too bulky but contain enough material to be informative. VF queried about getting an MSLC page on the Addenbrooke’s website, to which SA-M replied that there is (or was) a link to the MSLC website on the Addenbrooke’s site, and the Rosie one. The hospital sites are under reconstruction, so the links may have got lost. VF suggested having a dedicated MSLC e-mail address. Messages that are left on the website cannot be replied to.
ACTION: VF and SA-M
Due to lack of time, this was deferred to the next meeting.
- RO’L announced she would be unable to attend further committee meetings due to new commitments, but will remain in e-mail contact. She expressed her delight at the developments of the MSLC over the years.
- SA-M has been contacted by a woman who has recently had a home breech birth, and who has set up a group offering support and information to women whose babies are breech. She has offered to collect women’s experiences of breech presentation, and is willing to attend a committee meeting later in the year to discuss the management of breech birth.
March 10 2009, 12.00 p.m. - 2.00 p.m., Rosie Seminar Room 5
