Wednesday, January 17, 2018

The argument for bringing back maternity to King George Hospital

I attended the North East London Save Our NHS (NELSON)  meeting last night to be given a great piece of work by a campaigner to set out the argument for maternity to return to King George Hospital. NELSON is a cross party group who have been great friends to the save King George A&E campaign supplying speakers at meetings and turning up at photo shoots too. Article follows:

The argument for re-opening comprehensive maternity services at King George Hospital.

Better Births
The National Maternity Review ‘Better Births’ (Feb 2016)i set out the FYFV for maternity services in England. It aimed to make maternity care safer, in line with the Health Secretary’s ambition to halve the number of stillbirths, neonatal deaths and serious brain injuries occurring during birth, but also to ensure care that was kinder, more personalised, and “wrapped care around each woman”.

Better Births’ recommendations included:
  1. Genuine choice, with the ‘choice journey” beginning with services recognising women’s needs;
  2. Choice discussions with midwife about options for care beginning at booking;
  3. Organising services around women and their families (through, for example community hubs with a range of relevant services);
  4. Continuity of carer, close to home where possible;
  5. Choice of place of birth offered to all with unbiased information;
  6. Transfer to post-natal care that is seamless and well supported;
  7. Co-designing of services with local women.

New structures
In response to the Review, NHSE established a national Maternity Transformation Programme to be implemented by
  • a National Maternity Transformation Board (NMTB)
  • a London Maternity Transformation Board (LMTB), reporting to the NMTB, and
  • Local Maternity Systems (LMSs), bringing together commissioners, providers and service users and reporting, in London, to the LMTB.

North East London
NE London is covered by the East London Local Maternity System (ELLMS), reporting to the LMTB but also to the East London Health and Care Partnership (ELHCP) - or STP.

ELLMS has now developed a plan for the next 5 years to look at how their system will deliver NHSE’s ‘Better Birth’ recommendations. This plan involves significant ‘transformation’ from providers of maternity services.

Neither ELHCP nor ELLMS is a statutory body: they are not accountable for the delivery of maternity services. Instead accountability for commissioning remains with CCGs, and accountability for service provision remains with Trust Boards.

NHSE has produced a set of Key Lines of Enquiries for all LMSs to bear in mind while developing plans ahead of an assurance submission to NHSE in October 2017.

Better Care and Wellbeing in East London
The East London Health and Care Partnership’s document Better Care and Wellbeing in East London states that
With a shared goal to help people live healthy and independent lives, the Partnership’s mission is to protect vital services and provide better treatment and care built around the needs of local people, safely and conveniently, closer to home. (http://eastlondonhcp.nhs.uk/wp-content/uploads/2017/06/Better-Care-and-Wellbeing-in-East-London.pdf)
Plans of East London Local Maternity System (ELLMS)
Plans by the ELHCP and ELLMS for transforming the maternity services of East London were set out in a report to the Inner North East London Joint Health Overview and Scrutiny Committee in November 2017. This report confirmed that the aims of this transformation include:
  • To ensure more women have a personalised care plan
  • To expand choice, including choice in “the three places of birth” (hospital, midwifery led centre and home)
  • To ensure that women receive continuity of the person caring for them during pregnancy, birth and post-natally.
  • To ensure that more women will be enabled to give birth in midwifery led settings.

Current maternity services in East London
i) Provision
Maternity services are currently provided by the Royal London, Whipps Cross, Newham, BHRUT (Queens), and Homerton hospitals. Each has an obstetric labour ward and an alongside midwifery led unit. (King George’s provides clinics and antenatal care only.) In addition, the Barkentine Centre is a midwife-led birthing centre provided by BartsHealth NHS Trust.
A pilot is currently underway in Waltham Forest with a midwifery-led provider, Neighbourhood Midwives, in which low-risk women are offered continuity of care from the same midwife throughout pregnancy, labour and the post natal period. (Neighbourhood Midwives does not provide a birthing centre: birth takes place either at home or in one of the hospitals or midwife-led units described above.)ii

ii) Challenges
According to the ELHCP and the ELLMS, challenges facing maternity services in East London include:
  • A projected increase by 4.41% (about 1500 births) within the next 5 years, with greater pressure anticipated in the BHR footprint. iii
  • High turnover of midwifery staff and workforce gaps in acute providers means challenges with clinical capacity or transformation.
  • Variations exist in patient ratio to GP with Redbridge and Waltham Forest falling in the lowest 20%
  • The age of women giving birth is higher than national average (NEL 32.16 years compared to national average of 30.4 years).
  • 19.9% (2712) of women are presenting with multiple co-morbidities (which may rise as high as 23% by 2018)
  • A more than 2% rise in the last 2 years in the number of women reported as unable to speak or understand English (from 6.9% to 9.3%).
  • An expected increase in the prevalence of diabetes by 1.5% (1051 women) per year.
  • A further 1% (254 women) of women are expected to develop gestational diabetes during pregnancy.
  • Mental health conditions are rising by 1% (254 women) per year.
  • Achieving continuity of carer is highly dependent on funding



Argument
This assessment of the challenges facing providers of maternity services in East London corresponds with BartsHealth’s assessment, set out in Transforming Services Together. This states that maternity services are struggling with rising birth rates and a population whose health complexity is increasing, while staffing levels are below recognised standards.

Pressure on services in East London is indicated by the fact that between April to June 2017, the obstetric unit at Newham was closed on three occasions, and the obstetric unit at Whipps Cross was closed once during the same period.

We support the intention to increase midwifery-led units for straightforward pregnancies as evidence suggests that these units, if well-resourced, can provide more continuity of care, fewer unnecessary interventions and better experience of care. However, to ensure the safety of maternity care, these units must be backed up by fully reliable emergency contingency provision.

At the moment, with the loss of obstetric or midwifery-led provision at King George’s Hospital (other than clinics and antenatal care), there is a significant gap - a substantial area of East London that is not covered by local maternity services or emergency provision. Currently, women going into labour in the (Redbridge/Ilford??) area who are not having a home birth have to travel to Queen’s, Newham or Whipps Cross. Any community hub or midwife-led unit set up in (Redbridge/Ilford) would have no local facilities for emergency contingencies.

Moreover, Better Births promotes choice for women in terms of place of birth as well as recognition of their needs. Yet lack of provision in the (Redbridge/Ilford) area ignores local womens’ needs and denies them any real choice. Local services have not been co-designed with local women. Without urgently meeting current and future demand for local maternity services, there is a risk that women will experience unsafe, poor quality services that do not meet their needs or choices.

We therefore urge ….. to re-open comprehensive maternity services at King George’s.





APPENDIX

Total births in NEL Jan-June 2017

Provider
Jan
Feb
Mar
April
May
June
RLH
436
358
430
420
434
414
WX
428
334
371
388
443
387
Newham
537
479
507
524
533
517
BHRUT
666
611
679
657
701
718
Homerton
496
406
469
419
502
521
Neighbourhood
midwives

4

7

8

7

7

8


Out of Obstetric Unit Births

  • Data suggests that low risk women are safer giving birth in midwife led settings and have a better experience of care
  • In 2016-17 approx 18% of births in NEL were in midwifery led settings with wide variation across providers from 13-25%
  • There is capacity to increase these figures even in the face of rising acuity


BHRUT
HUH
NEWHAM
RLH
WX
Out of Obstetric Unit birth rate 2016/17

18.34%

17.45%

25.3%

13.1%

15.6%
Aspirations for Out of Obstetric Unit Births 2021

22%

25%

40%

30%

35%



NEL Obstetric Unit births


April
May
June
RLH
79.5%
84.3%
80.7%
WX
84.5%
84.2%
86.8%
Newham
75.8%
74.3%
76.8%
BHRUT
79.9%
82.0%
79.1%
Homerton
80.7%
80.3%
81.8%




Neighbourhood midwives
29%
29%
38%

NEL Homebirths


April
May
June
RLH
0.95%
1.15%
1.45%
WX
0.52%
0.45%
0.78%
Newham
0.38%
0.75%
0.97%
BHRUT
0.20%
0.70%
1.80%
Homerton
1.60%
2.60%
1.80%




Neighbourhood midwives
43%
71%
63%


ii Neighbourhood Midwives is a private, employee-owned company, selling itself on the basis that the NHS is overstretched and often cannot provide continuity of care. Its website provides a link to its NHS funded services pate, where it says it is working with the NHS to offer women in Newham the chance to take part in a pilot of midwifery continuity of care. (Privately provided care cost - depending on the package - between £592 - £742 per month. The Programme Director of Neighbourhood Midwives was on the Review team for Better Births, along with Sam Everington among others). Neighbourhood Midwives is piloting ways of cross-boundary working and developing a new model of transitional care, including care in the community that would currently be hospital based.

iii Transforming Services Together (http://www.transformingservices.org.uk), the BartsHealth NHS Trust’s initiative to improve the local health and social care economy in Newham, Tower Hamlets and Waltham Forest states that maternity services in these areas are struggling to a population with increasingly complex health needs, staffing levels below recognised standards, and an estate that does not meet the needs of users. Over the next ten years, it is predicted that there will be an extra 5,000 births per year across north-east London, in particular in Tower Hamlets and Newham.

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