Agenda item

To consider a report produced by Healthwatch West Berkshire on local maternity services.

Michelle Paice, Alice Kunjappy-Clifton and Andrew Sharp introduced the Healthwatch report about Maternity Services in West Berkshire

They explained that their work followed on from the BOB STP maternity survey undertaken by the five local Healthwatch services, which highlighted the need for improvement in a number of key areas.

Healthwatch wanted to find out more about what women thought about their whole maternity experience. Their survey attracted around 200 responses.

Their report highlighted that West Berkshire mothers used three hospitals:

·         Royal Berkshire Hospital in Reading (40%)

·         Basingstoke Hospital (24%)

·         Great Western Hospital in Swindon (28%)

Healthwatch recommended that future data on maternity services should come from all three hospitals.

They highlighted that only 35% of ante-natal care was provided by GP practices and that data from the three hospitals must be included to get a more representative picture.

They suggested that more work was required to explore if women wanted an alternative to giving birth in a hospital delivery suite.

They highlighted issues and variances between hospitals and across various aspects of maternity services. Particular issues were identified with women being able to make their own decision, and the quality of post-natal care.

Between 12 and 15% described their birth experience as ‘poor’ or ‘traumatic’. Also, 34% of mothers said that they did not get the opportunity to speak to a health professional about their experience.

They explained that a West Berkshire Maternity Forum had been set up to enable women to share their childbirth experiences. The forum highlighted issues during Covid lockdown when many new mothers lost support from their families and friends, and lacked information about where to get help.

They highlighted inconsistencies between the hospital trusts around partners being allowed to visit and attend scans and births.

They also expressed concerns about the impact of Covid on health visitors, who were unable to perform their role normally and highlighted the mental and physical impacts of the pandemic on new mothers.

They summarised maternity care for West Berkshire women as being disjointed and inconsistent and stressed the need for continuity of care from ante-natal to post-natal care, and the need to work across NHS and local authority boundaries. They noted that women wanting home births could only book with Royal Berkshire Hospital.

They suggested that more work was needed to understand the birth experiences of minority groups, since they experienced additional risks and had been disproportionately affected by Covid.

They also suggested that maternity provision should be given greater priority in the District Needs Assessment, and pointed out that it was a priority of the NHS Long-Term Plan.

Healthwatch encouraged the Board to engage more with new mothers, learn from the report findings, and improve monitoring processes for all of the maternity hospitals.

Councillor Woollaston asked about the John Radcliffe Hospital. Michelle Paice indicated that only a very small number of respondents had used this hospital.

Action: Healthwatch to confirm John Radcliffe Hospital maternity figures for Councillor Woollaston.

Councillor Woollaston also asked about the number of survey responses.

Michelle Paice stated that there had been around 200 responses. Andrew Sharp stated this represented just over 10% of the births in West Berkshire.

Councillor Doherty agreed with the recommendation to look at all hospitals used by West Berkshire women. She stated that comments about emotional and physical support after birth focused solely on health professionals and did not take account of support in the wider community. She questioned a couple of the report findings. For example, during Covid-19 lockdown, she had been informed that every new mother was still getting new birth visits, which was in contrast to the report’s findings. Also she had talked to one new mother whose partner had been permitted to attend the birth and they had felt ‘safe and cocooned’ in the hospital, which again was at odds with the report’s findings.

Alice Kunjappy-Clifton stated that the information she had received was from the new mums’ Facebook group, and this had highlighted variations in the approaches adopted by individual hospitals. She also stated that changes had been made since the start of the pandemic, but there was a clear pattern both locally and nationally of more women birthing alone.

Councillor Masters thanked Healthwatch for the report and hoped that the Board would act on the recommendations. In relation to the inconsistencies raised, he suggested that this was inevitable. He noted that whilst there were a number of areas that were working well, some issues needed looking at.

Councillor Vickers also expressed her thanks for the report. She highlighted the addendum on health visiting. She noted that one new birth visit was provided, but suggested that this was not enough, and the traumatic post-natal period was when additional support was needed. She also noted that while peer support was good, a professional viewpoint was of paramount importance. She pointed to the priority of the first 1001 days as a key driver in this and noted that post-natal depression could have long-term impacts.

Councillor Doherty agreed and stated that the first visit was a screening visit to assess needs and determine if additional help was needed. She had been informed that additional visits were being made as necessary.

Michelle Paice commented that if could take up to 6 weeks for post-natal depression to appear.

Alice Kunjappy-Clifton indicated that there was still a communication gap and mums needed to be told how and where to access information.

Sam Burrows commended the report. He stated that he had experienced excellent post-natal care with all three of his children. He explained that his second child had been stillborn and they had experienced outstanding bereavement care, but he recognised that this was not always the case. He noted that the CCG too often looked solely within its boundaries and acknowledged that it should look beyond these for residents who use other hospitals. He indicated that there were some recommendations in the report that could be tackled quickly and stated that he had been working with Hampshire Hospital to improve continuity of care for West Berkshire residents. He concluded by highlighting the need to focus on fathers as well as mothers in post-natal care.

Dr Bal Bahia agreed with Sam Burrows on the need for a cross-boundary approach, given West Berkshire’s proximity to a number of hospitals. He noted that some patients chose to switch hospitals if a previous birth experience was poor. He noted that his practice had always worked closely with midwives and health visitors and recognised the need for continuity of care that was flagged in the report. He welcomed the feedback provided by the report, but suggested that it was important to note that the report only reflected a small proportion of the overall number of births in West Berkshire. He also noted that at the start of the pandemic, hospitals were instructed to minimise visitors and partners being present, but this quickly changed to allow more flexibility. He also noted changes in primary care – midwives visited within 10 days, followed by a health visitor check, and an 8 week check to coincide with immunisations. However, he recognised that there may be cases where this did not happen as planned and welcomed the feedback highlighted in the report. In terms of cross-boundary working, he confirmed that a midwife from Basingstoke Hospital now held regular clinics at his surgery in Thatcham. He stated that previously it had been agreed that the Board should discuss exceptions (issues that were not being resolved), but this approach could change.

Matt Pearce thanked Healthwatch for the report and agreed the need to focus on the first 1000 days. He stated that 97% of mums had a new birth visit in Q1 and during Covid a feeding call was introduced. He also stated that Berkshire West were looking to recommission the 0-19 service and he undertook to incorporate the report’s recommendations in the new contract.

Action: Public Health to consider the Healthwatch Maternity Report findings when recommissioning 0-19 services.

Councillor Bridgman asked for clarification on the time period of the births in the report. He asked if the 75 births at the Royal Berkshire Hospital took place over the 3 year period of the BOB survey. He also noted differences between the Healthwatch survey results and hospitals’ own surveys and asked how these could be reconciled.

Andrew Sharp stated that 3 out of 10 mothers were not asked about their experiences, which was a problem, and he suggested that some of these would have responded to the Healthwatch survey, so there was not necessarily parity between the surveys.

Michelle Paice stated that the Healthwatch surveys covered births between January 2016 and December 2019.

Alice Kunjappy-Clifton noted that the Reading Maternity Voices survey results focused on patients in Reading and Wokingham with limited feedback from West Berkshire women.

Councillor Bridgman suggested that the survey responses did not account for 10% of births if taken over a three year period.

Andrew Sharp stressed that the important thing was to note the 500 women on the Facebook group who had provided feedback. He suggested that too much focus was placed on Royal Berkshire Hospital, with Reading Maternity Voices failing to talk to Basingstoke, Great Western or John Radcliffe Hospitals. He stated that the qualitative feedback in the report raised issues that needed urgent attention.

RESOLVED that:

·         All future reports and data on maternity services presented to the West Berkshire Health and Wellbeing Board to include data on West Berkshire births at the Great Western Hospital and Basingstoke and North Hampshire Hospital in addition to Royal Berkshire Hospital.

·         Any tracking data sets and data dashboards developed and used to evaluate quality of maternity services by West Berkshire Health and Wellbeing Board should include data on West Berkshire births at the Great Western Hospital and Basingstoke and North Hampshire Hospital, in addition to Royal Berkshire Hospital

·         Data on all maternity services including during pregnancy, during birth and 10 days following birth are presented to the West Berkshire Health and Wellbeing Board on an annual basis including national and comparative area benchmarking.

·         Postnatal care in particular is scrutinised and improved in whatever way possible, including setting up of postnatal classes to help women learn from each other and the involvement of voluntary and community groups, supported by health professionals, and that all discussions include Health Visitors, Midwives and Family Hubs.