Maternity and Newborn
What did we say in Healthy Ambitions?*
1
The Maternity and Newborn Care Pathway recognised the inequalities faced by babies born in Y&H – with particular variation in rates of breastfeeding within and between our PCT areas. They also recognised that the experience of NHS care could vary for women during pregnancy, birth and post-natally.
They therefore recommended that:
- Latest national guidance e.g. Maternity Matters should be strongly backed
- Levels of consultant staffing should be in line with Royal College guidance
- Action should be taken to improve rates of breastfeeding
- Action should be taken to reduce smoking in pregnancy
- The quality and consistency of information for pregnant women should be improved
- Midwifery time should be prioritised for women who need it most.
Who is taking this work forward?
2
Levels of delivery
PCTs across Y&H have worked with the SHA to agree which of the recommendations of the Maternity and Newborn pathway should be taken forward locally and which might need action at regional level. This is summarised in fig.2 on the next page.
*Full details can be found at www.healthyambitions.co.uk/maternity_newborn.html.
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When is it happening?
3
The actions to be taken forward in the first year of implementation for the Maternity and Newborn pathway are shown in fig.3.
Local delivery
4
PCTs working with their local partners and provider organisations have prioritised the recommendations in Healthy Ambitions in light of the needs of their local community and the current position of their services.
They have all set out the action that they will take to start to turn the recommendations in Healthy Ambitions into reality in their five year strategic plans.
An example of the action being taken by Rotherham PCT is shown below
Local delivery in Rotherham
Rotherham's Health Equity Audit in January 2006 showed that 40% of babies are given some breast milk (combined breast and mixed feed data) by 10-14 days, which reduces to 23% by 6-8 weeks (2005/6 data).
- The PCT has set local trajectories to March 2011 looking to increase initiation rates to 60% and 6-8 weeks rates to 32% by 2011
- NHS Rotherham and Rotherham FT are implementing UNICEF Baby Friendly Standards and have action plans to support their delivery
- All appropriate health professionals will be trained to give breastfeeding support and information in line with UNICEF baby friendly accreditation standards.
To ensure that the right messages are going out to women the PCT is commissioning a social marketing campaign, which looks to local women to provide the answers on how to target messages to them, focussing on both breastfeeding and smoking. It is essential for the PCT to understand how messages are received by the population so that they can allocate resources to have the greatest impact.
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How can you help make it happen?
5
Everyone with an interest in improving maternity and newborn services can play a part in taking forward the recommendations in the maternity and newborn chapter of Healthy Ambitions. In fig.4 we have set out some of the suggestions from staff about how people could help implement the recommendations.
As an NHS publication – this section has just focussed on the roles that NHS Staff could play – but we very much recognise that our partners have a big contribution to make if we are to deliver the recommendations of the maternity and newborn chapter in Healthy Ambitions. We know that local authorities have a big part to play – e.g. in creating an environment and culture which could support more mothers to breastfeed their babies. We are committed to working with our partners to help make this happen.
Who will make sure that this work happens?
6
There are a number of key leadership roles in the delivery of this pathway:
Locally
Each PCT Chief Executive is responsible for delivering recommendations in line with local priorities and strategic plans.
Collaboratively and regionally
Delivery will be overseen by a Pathway Delivery Board – as described in the chapter on governance arrangements.
For Maternity and Newborn the chair is Andy Buck Chief Executive at NHS Rotherham who will act as a sponsor within the wider chief executives forum and assist the clinical lead and SHA Director lead to promote implementation of the pathway.
The regional clinical lead is Dotty Watkins, Head of Midwifery at Sheffield Teaching Hospitals NHS Foundation Trust, who will oversee progress against the Maternity and Newborn recommendations, act as a champion for the recommendations, advise on delivery processes and encourage colleagues to continue to focus and give priority to the Maternity and Newborn recommendations.
Sue Proctor, Regional Director of Patient Care and Partnerships will oversee progress on the maternity and newborn pathway working with the clinical lead and the CE.
How will we measure success?
7
We have developed a “Healthy Ambitions Dashboard” based on a small number of key indicators which taken together can be used to start to measure the success of the Healthy Ambitions programme as a whole (see performance and metrics chapter). This is underpinned by trajectories which each PCT will set to reflect their local priorities and circumstances. It will show the measurable improvements they are making in each pathway area. This will supplement the “vital signs” indicators and trajectories which support delivery of the targets set out in the NHS Operating Framework and the selection of outcome measures which PCTs have included in their strategic plans. In many cases these measures are one and the same. All of these measures will feature in PCTs annual operating plans to be agreed with the SHA and be the basis for the SHA’s performance management regime.
Recognising that the pathway recommendations are many and various we intend to start by tracking progress against the key pathway pledge, which for Maternity and Newborn is to support an increase in breastfeeding rates – with reduced variation across the region.
We know that this doesn’t tackle all the priorities in this chapter. Smoking during pregnancy, staffing ratios and patient satisfaction will be tracked through existing routes. The percentage of women receiving a risk assessment and information on choices from a healthcare professional is a Vital Sign, whilst obstetric cover and midwife to mother ratios are CQUIN measures.
The key indicators we will therefore track in the "Healthy Ambitions Dashboard" will be:
- Percentage of mothers breastfeeding on discharge home
- Percentage of mothers still breastfeeding at 6-8 weeks.
- Staffing ratios: Midwives per 1000 births and consultant cover
Work has been undertaken to establish baselines for the pledge and by the end of March '09 trajectories for improvement will have been agreed between the SHA and PCTs and will be reflected in annual operational plans.* We intend to publish progress against individual trajectories.
*More details can be found in the performance metrics chapter.