North London NHS Trust

Here is a brief introduction and service profile of maternity services at our Client Hospital in North London NHS Trust. (Public Hospital).

Maternity Service Structure

Maternity Services are part of the Women and Children's & Head and Neck Division at the Trust. The Women's Directorate is managed by the Senior Management team which includes the Clinical Director, Head of Midwifery & Gynaecology, Divisional General Manager and General Manager.

Service Profile

Maternity Services are provided at the Maiin Hosptial site including an Antenatal Clinic at another hospital and within the Boroughs of Brent and Harrow. Antenatal services are provided at both sites and in the community. Gynaecology Direct Referral Services are provided at the main site ensuring a streamlined early pregnancy service. Women who require admission prior to 20 weeks gestation are cared for on a dedicated female surgical ward at the main site. The Trust has two fully functioning A&E Departments where women are assessed and referred appropriately out of hours.

Birthing Centre

The Birth Centre relocated to the main hospital site in July 2008 and provides birthing facilities for women who are expected to have a normal, low risk pregnancy. It is a midwife led unit, which has 6 delivery rooms. It is projected that approximately 700 births will occur at the unit per annum, this is a 50 % increase in activity on the stand alone facility.

Main Hospital Site

Hospital maternity services have recently been upgraded and refurbished as part of a £19m development programme. Facilities include the following:

• Modern Delivery Suite with 11 delivery rooms, 4 high dependency beds, 4 recovery beds, 4 triage trolleys and two dedicated obstetric theatres
• 29 bedded post natal ward with a mixture of single bed rooms and 4 bedded bays
• 12 bedded antenatal ward
• Day Assessment Unit (DAU) - attended by c.400 women per month
• Fetal Medicine Unit facilities are in development
• Dedicated antenatal clinics including conjoint clinics (Diabetes, endocrine, HIV, VBAC, Haemoglobinopathy)

Community Midwifery Services

Community midwives run antenatal clinics at general practices across Brent and Harrow and provide parent education classes and postnatal care. The team of midwives makes in the region of 60,000 contacts per annum, of which about 3,000 are post natal visits for women who have delivered elsewhere but who return home into the community of Brent & Harrow with their new born baby. A new integrated model of care has been consulted on and agreed and fits strategically with national policy (Maternity Matters 2007). This will meet women's needs for choice, continuity and individualised care packages which will be provided by teams of midwives working across hospital and community, based in Children's Centres.

Birth Profile

There were 5240 deliveries in 2007/08, 4864 in 2008/09 and a similar outturn is expected in 2009/10.

In 2008/9 the unit achieved an overall caesarean section rate of 25 % against a target of 27 % and normal birth rate of 65 %. The Birth to midwife ratio average was 1:27 which compares favourably to pan-London.

The Directorate has received a total of 36 complaints during 2008/09.

Maternity Dashboard

The Hospital's maternity unit has piloted a maternity scorecard following implementation of special measures this provides a scorecard with key performance indicators identified (capacity, workforce clinical outcome measures user representation and supervision of midwives) with triggers built in to alert the maternity management team where action is required in response to the results outside of acceptable levels. This dashboard has been adopted nationally and is a RCOG Green Top guideline.

Independent Review of Maternity Services

Following three maternal deaths in 2007/8 and two other serious untoward incidents the Trust initiated an independent review and the report was published on 16 September 2008 and found that:

• Maternal deaths not the result of deficiencies of care
• Standards of care on delivery suite are well above average
• Staff are to be congratulated on raising standards and morale during a very challenging period of change
• The local population includes a high proportion of vulnerable and high risk women
• The high standards achieved need to be recognised and publicised
• An action plan encompassing the recommendations of the report and comments received from HCC on the report was published with the report. A monitoring group chaired by the CEO has been established to ensure all recommendations are met

Statutory Supervision of Midwives

This is a statutory function of the Nursing and Midwifery Council and the primary aim is to protect the public through professional regulation and accountability. There are ten Supervisors of Midwives who provide 24/7 on call provision to support midwives practice. The NMC recommends a supervisor to midwife ratio of 1:15 and the team are proactive in succession planning and role modelling to encourage midwives to undertake the role. They collaborated with the maternity management team to successfully achieve compliance with CNST level two maternity standards achieving 100% in all 8 standards in December 2007.

In 2009/10 they were influential in achieving a favourable report from the NMC in regard to increasing the numbers of student midwives commissioned each year. The supervisors of midwives had an LSA audit in June 2009 and successfully achieved compliance with all five standards an action plan has been developed. They continue to be advocates for public protection and women's choice and have been involved in partnership working with women.

CNST (Clinical Negligence Scheme for Trusts)

The maternity services were assessed as compliant with CNST Level 2 standards in December 2007, achieving 100 % compliance with all eight standards. This is an objective assessment of patient safety processes and culture within maternity services.

HCC Review of Maternity Services - 2007

The maternity services was one of eight London units to be rated as 'fair' in the HCC national survey of maternity services. An action plan was developed to address weaknesses in the provision of services, mainly around issues of access to antenatal care, postnatal care and information about antenatal screening. In November an update was provided to London NHS assuring them that all areas of the action plan are at level 3 score, i.e. 'good' score.

Maternity Matters

Maternity Matters (DoH 2007) which outlines a national framework for local improvements to choice, access and continuity of care in maternity services. Successful provision and delivery of the best possible maternity services, including choice, requires full engagement of all service providers, commissioners and organisations that facilitate regulation, systems management and support. Implementation of this policy is monitored by London NHS. An action plan has been developed following benchmarking against the standards and recruitment of midwives is a key factor in achieving early access and providing 1:1 care in labour.

The agreed trajectory for Early Access for Women to Maternity Services defined as the number of women in contact with the service who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 completed weeks of pregnancy is as follows:

2008/9
50 % of all bookings

2009/10
70 % of all bookings

2010/11
90 % of all bookings

Currently the Trust achieves 90 % compliance with booking all women by 12+6 whose letters are received by 10+6 weeks.