Professor Cathy Warwick Clinical Director, Maternity project

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• Professor Cathy WarwickClinical Director,
  Maternity project
• Professor Andy ShennanClinical Director,
  Maternity project

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Why do anything?

• Increasing Demand
• In 2006/07 there were over 120,000 births in
  London, that figure is expected to rise between
  124,000 and 145,000 by 2015/16.
• The majority (97) of women in London deliver in
  obstetric units or co-located midwifery units
  found in around a third of hospitals. Around 2
  of births take place at home and half a per cent
  in Londons two stand-alone midwifery units.
• Variable Access
• Londons population is highly diverse with some
  boroughs having disproportionately high rates of
  perinatal and infant mortality rates.
• In 2006, approximately  58,000 (48) births were
  to women born in British Isles (including all of
  Ireland) and 62,000 to women born elsewhere.
  Women born outside the UK who give birth are more
  likely to access care later, have poorer
  pregnancy outcomes and to die more frequently in
  pregnancy and after delivery.
• Healthcare Commission review of maternity
  services found significant variations in the
  quality of care across the country.
• Performance Shortcomings
• Healthcare Commission review identified
  significant concerns with the provision of
  maternity services in London - 19 out of 27
  London trusts were 'least well performing' (70).

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JCPCT 12 June Recommendations

• Expectant mothers should be offered
• an early assessment by a midwife to ensure their
  care is right for them and further assessments
  during the course of the pregnancy
• information to enable them to make informed
  choices, for instance, about the relative
  benefits and risks of different locations to have
  their baby and about pain relief
• care before birth provided at local one-stop
  centres
• services that meet their choice of where they
  give birth for instance, at home, in a
  midwifery unit, or in an obstetric (doctor-led
  unit)
• care with the same team from early pregnancy
  until after the birth whenever possible
• one-to-one midwifery care during established
  labour
• care following birth in local, one-stop centres
  as well as at home.
• All professionals involved in birth should be
  competent in basic newborn (neonatal)
  life-support skills.

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Recommendations for Healthcare for London

• Further work should be undertaken by Healthcare
  for London on the following
• managed networks of care, their size and
  configuration, and their possible impact on
  safety and safe transfers
• the configuration and impact of services which
  support the midwife as the first point of access
  in the community for women
• the possible configuration of obstetric units
  given the potential changes in paediatric
  services and
• the development of the workforce to deliver
  services within the agreed model of care and the
  anticipated increase in predicted deliveries.

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Our goal

• To design high quality, sustainable, flexible
  maternity services to account of Londons needs
  and diversity, based on national and
  international best practice, providing choice,
  quality outcomes, and a high quality experience
  for women and their families

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Who are we doing this work for?

• Feedback from women on current services
• Offer a high quality safe service across London,
  wherever it is accessed
• Offer choice to women
• Ensure the service meets the needs of women using
  it

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Our vision for Joanne

• Joanne is pregnant, expecting her first baby and
  lives in London
• Joanne is excited but nervous of what lies ahead
  of her
• Joanne needs to meet a midwife early in pregnancy
• Joanne needs high quality information throughout
  her pregnancy so she can make informed choices
  about her antenatal care, giving birth and
  becoming a parent
• Joanne needs to be able to contact a midwife she
  knows if ever she is worried and does not know
  what to do
• Joanne is well and her pregnancy is uncomplicated
  but if this changes she needs to be referred to
  someone who can help with her particular problem
  whilst not loosing contact with her main
  midwife/s
• Joanne should be able to expect that her main
  midwife/s keep a close eye on her pregnancy, stay
  in touch with her even if she is referred to
  another caregiver and ensure that there is
  excellent communication about Joannes needs at
  all times
• Joannes main supporters e.g. her partner, her
  mother, her friends need to be involved at all
  times

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Project Scope

• All maternity services pan London from
  pre-conception to post-natal care

Preconception
Antenatal Care
Specialised Care
Labour Delivery
Post natal care
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Healthcare for London maternity project structure
London PCTs
NHS London
Healthcare for London Programme Board
Clinical Advisory Group
Maternity Project Board
Maternity Services Improvement Board (NHS London)
Clinical Expert Panel
User Forum
Maternity Project Team
Maternity Services Liaison Committees
Community User Groups
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Understanding our service users

• Objective
• Understand what women want from their services,
  the reason for their decisions, and identify
  appropriate methods for providing information and
  guidance on
• Informed choice
• Health promotion (including pre pregnancy)
• The pathway of care they can expect
• What are we aiming to achieve?
• An understanding of womens wants and needs in
  maternity services
• Development of information/tools providing
• Health promotion advice to women at all stages
  along their pathway
• Additional information to support choice
  decisions

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How will we capture this information?

• User forum
• Maternity Services Liaison Committees
• Patient surveys
• Existing groups

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Finding the evidence - needs assessment

• Why?
• lots of information available on needs but not
  developed in a way to ensure all the strands are
  pulled together
• Objective
• utilise evidence to inform maternity project and
  drive improvements to maternity services across
  London
• With the aim to develop a population needs
  assessment undertaken clarifying requirements of
  future service provision and current gaps and
  issues

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Maternity project
Needs Assessment
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Taking the work forward

• Small groups being established
• Needs assessment
• User involvement
• Care pathways
• Models of care
• Networks
• Workforce
• Interested? Please let us know

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Next sessions

• Purpose
• To influence the development of the project and
  inform the next steps
• Focused on four key workstreams
• Care pathways
• Models of care
• Workforce
• Networks
• Opportunity to attend two sessions in the time
  available