Agenda item

Purpose: To provide an update on the response to the recent CQC report.

The Chairman welcomed Alex Whitfield (Chief Executive) Julie Dawes (Chief Nurse) Elliot Nichols (Associate Director Comms and Engagement), Fay Corder (Associate Director Midwifery) and Wendy Landreth (Communications Team Coordinator) to the meeting. The Chairman invited them to present their report on the Maternity Services provision.

The Committee considered a report on Maternity Services at Basingstoke and North Hampshire Hospital (Agenda Item 6).

Alex Whitfield (Chief Executive) introduced the team. She gave apologies for Julie Dawes (Chief Nurse) and introduced Sarah Musset who was coordinating the Care Quality Commission) CQC response on behalf of the Trust. It was noted that the presentation had been requested off the back of the Healthwatch report from a couple of years ago and also on the recent CQC visit where they had made an unannounced visit as a result of which the rating for maternity service had been downgraded from ‘good’ to ‘requires improvement’.

Fay Corder (Associate Director Midwifery) gave the presentation. She advised the Committee of the current maternity service provision from Hampshire Hospitals to West Berkshire women. She then introduced the Healthwatch report, which had highlighted communication as a key concern. The Trust had put a number of measures in place to address this, including improvements to the website and social media, electronic patient information leaflets on Badgernet, and printed complex care plans for women giving birth at other NHS Trusts. She then highlighted the positive feedback from the CQC before covering the should-do’s and must-do’s from the inspection. She went through a series of slides on the progress made in responding to the key concerns raised in the CQC report, which related to: sepsis; security; emergency equipment; domestic abuse; red flag reporting and risk; learning from incidents, staffing levels; and leadership and culture. She noted that 51 out of 64 actions had been completed. Finally she advised the committee of the main challenges facing the service, progress in terms of Ockenden compliance, and the aspiration to build on changes introduced since the CQC inspection, with the development of QI Plans.

Councillor Alan Macro highlighted the theme of staffing in the CQC report in terms of number of staff, staffing at the appropriate levels and staff working above competency levels and asked for further information on whether the recruitment campaign would be sufficient. Alex Whitfield responded to advise that more midwives were needed for the same number of babies and so they had been chasing a moving target in terms of recruitment. The actual number of midwives had increased, but so had the number of vacancies. However in recent months they were closing the gap through recruitment and retention. The numbers coming in over the next few months would mean that by the autumn they should be where they needed to be.

Councillor Tony Linden noted the Ockenden report and the seriousness of it. He welcomed the progress that had been outlined and the importance of giving assurance to mothers and families associated with the birth experience. He highlighted the higher rates of stillbirth babies for black, Asian and older mothers and mothers from deprived backgrounds and asked how this was being addressed. Secondly he asked if homebirths had been suspended in Basingstoke. Alex Whitfield advised that they did occasionally have to suspend homebirths services because it was safer to bring midwives in. Fay Corder advised homebirths had been suspended for the last two weeks because South Central Ambulance Service (SCAS) had been on Level 4 and so they could not guarantee an ambulance would be available. Fay Corder advised that patients had been ok with that, as they understood the reasons why. Fay Corder then responded to Councillor Linden’s first question. She advised that numbers were low in the area and so when they had a sad case of a stillbirth it made the figures look worse than they were. They were working towards the Saving Babies Lives Version 2 Care Bundle and so they put a lot of antenatal surveillance in place – additional scans for growth, public health, quit smoking advice and wrap around health and wellbeing messages. There was also the continuity of care team to help these women throughout the maternity services.

Councillor Moore asked for clarity around the inspection / rating level. Sarah Mussett confirmed that while the Maternity service required improvement, the overall rating for the Trust had not changed. Councillor Moore then asked about how immediate feedback from the CQC happened, as the date of the inspection was 16 November 2021, but it was not published until 28 January 2022. Sarah Mussett confirmed the Trust had initial feedback from the CQC in November and so a significant amount of work had been done before it was published. 54 of the 64 actions had been completed. They had moved quickly with all the improvements, and there had been a huge amount of staff engagement with the improvements at all levels. Some mock CQC inspections had also been carried out.

Councillor Moore highlighted that residents in West Berkshire may go to one of a few hospitals and noted that in the presentation it said that complex care plans were printed for those having babies at Royal Berkshire Hospital. He highlighted anecdotal information, not in relation to Maternity Services, about patients having difficulties with electronic data transfer between hospitals and asked about the difficulties in moving data electronically. Fay Corder said that Basingstoke and Reading did not have the same systems and that they didn’t connect. Care plans were printed out and women were able to give it to the hospital. Alex Whitfield confirmed that their systems covered all of Hampshire, but they were clunky across ICS boundaries. Andy Moore asked if there was any medium term solution to this and if there was any directive from NHS England? Alex Whitfield confirmed that there was a desire to share information in a more straightforward way across all services. GP Information was shared more widely. NHS England was setting expectations around ability to share information between systems with standard protocols but not necessarily on the same systems.

The Chairman asked about the main barriers to recruitment and how the mental health needs of midwives were being addressed in order to retain them. Fay Corder advised the Trust was fishing in a really small pond. All maternity units were looking for the next midwife to qualify. The Trust was talking with Winchester University about providing midwife training so that they would have more locally developed midwives. They were also: looking at Maternity Support Worker’s going on apprenticeship courses; advertising for return to practice midwives; supporting international nurses doing the midwifery shortened course as a pilot; and meeting with colleges and schools to engage students at an early stage. To answer the second question about midwife mental health they had practice midwifery advocates. They had increased their workforce so that that had training and support for their midwives. They also had a health and wellbeing hub, and a good chaplaincy service. Staff coudl speak to line managers. There was TRIM training avaialble. Also after traumatic experiences staff had external psychologists do debriefing sessions. Sarah Mussett highlighted the specialist midwife roles which provided opportunities for career development and helped with retention. Fay Corder advised of promotion opportunities also.

The Chairman thanked the team for their attendance and presentation.