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Over the last few years, Bradford Districts Clinical Commissioning Group (CCG) have been working with our partners to improve maternal and child health.

We welcome the increased focus on maternity services following the publication of the National Maternity Review. The National Maternity Review led to the Five Year Forward View for maternity care - Better births: Improving outcomes of maternity services in England (2016).

The report highlights that staff should be supported to deliver care that is centred around the woman. It also outlines a vision for maternity services to become; safer, more personalised, kinder, professional, and more family friendly. 

Bradford Districts CCG is currently working with our maternity service providers and the Maternity Partnership to assess the current maternity services we commission.

Information about the work and vision of the West Yorkshire and Harrogate local maternity system can be found here

Better birth report summary

How are we doing? 

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Smoking cessation

Our aim is to encourage pregnant women to stop smoking during pregnancy, ideally altogether.

Why measuring smoking cessation is important

Each year, in the UK, smoking during pregnancy is associated with up to 2,200 premature births, 5,000 miscarriages and 300 perinatal deaths. Smoking during pregnancy also increases the risk of babies developing a number of other conditions, including;

  • respiratory conditions,
  • attention and hyperactivity difficulties;
  • learning difficulties, and;
  • problems of the ear, nose and throat.

Therefore, making sure babies are protected from tobacco smoke means that children have a healthy start in life.

What is the smoking cessation rates in our CCG?

Smoking cessation is measured by the number of women smoking when first pregnant in comparison to the number of women smoking at time of delivery. 

We are working with partners across health and social care to help women who are planning to have a baby or are already pregnant to quit smoking as we recognise that there is a need for improvement. 

National average - 11.4%

In our CCG - 18.6%

Neonatal mortality and stillbirths

Why measuring neonatal mortality and still births is important

Stillbirths are 15 times more common than cot death. In the UK, each year, there are more than 3,600 stillbirths - one in every 200 births ends in a stillbirth - 11 babies every day.   

Around half of all stillbirths are linked to placental complications – where the placenta (the organ that links the baby's blood supply to the mother's and nourishes the baby in the womb) isn't functioning properly.

About 10% of stillborn babies have a birth defect which contributed to their death.  

A small percentage of stillbirths are caused by problems with the mother's health, for example pre-eclampsia (problems with blood pressure during pregnancy), or other problems, including cord accidents and infections.

  • still birth is calculated as – a baby born after 24 completed weeks of pregnancy with no signs of life. The rate is the number of still births per 1,000 births. This figure is not included in the infant mortality statistics.
  • neonatal mortality is calculated as – a baby who dies within 28 days of life. The rate is the number of neonatal deaths per 1,000 births. This figure is included in the infant mortality statistics.

What are the neonatal mortality and stillbirth rates in our CCG? 

  • 11.80 neonatal mortality and stillbirths per 1,000 births,
  • this figure has been calculated from 59 stillbirths / 4,971 births,
  • this shows a great level of need for improvement. 

Low birth weight babies

Why measuring low birth weight is important

Preterm birth and being small for gestational age are the reasons for low birth weight. Preterm birth is also the most common direct cause of newborn mortality. Both are important indirect causes of neonatal deaths.

Low birth weight is considered to be a factor in 60-80% of neonatal deaths. Therefore, by improving the care for mothers during pregnancy, childbirth for babies of low birth weight, we can help reduce neonatal and infant mortality rates.

What are the low birth weight rates in our CCG?

Experience of maternity services

Why measuring experience is important - the friends and family test (FFT)

Patient experience is measured through the friends and family test (FFT). The FFT is a survey given to all patients about the quality of the care received – asking if they would recommend the service to family and friends. The results of the FFT give services a better understanding of patient needs and enables services to make improvements.

What are the friends and family test results in our CCG?

Bradford Teaching Hospitals NHS Foundation Trust provides maternity services for our CCG.

For 2015/16:

  • response rate - 28.1% (more than 1 in 4 mothers responding),
  • 97.8% of women said they would recommend the maternity services provided by Bradford Teaching Hospitals NHS Foundation Trust to friends and family;
    • 99.2% would recommend the labour ward/birthing unit,
    • 95.1% would recommend the postnatal ward.

Maternity services provided in the home or community:

  • 95.2% would recommend the antenatal service,
  • 98.9% would recommend the postnatal community service.

Find out more about the friends and family test in the video below from NHS England.

 

Care Quality Commission (CQC)

The 2015 Care Quality Commission (CQC) National Maternity Services Survey assessed patient experience across the entire maternity pathway. This includes antenatal, intrapartum and post natal.

In 2015, women in our CCG, reported a score of 78.7. We recognise that this needs to be improved as it falls within the 2nd to lowest quartile in England.

Antenatal assessments

Why measuring antenatal assessments is important

To assess needs, risk and to promote choice, all women are asked to see a midwife or a maternity healthcare professional within 13 weeks of getting pregnant. To allow a woman to plan, they should receive appropriate information about the likely number, timing and content of antenatal appointments. These may vary depending on the option that has been chosen for care.

What are the antenatal assessment rates in Bradford?

  • Bradford Teaching Hospitals NHS Foundation Trust see 94.1% of pregnant women within 13 weeks of conception

Choice over maternity services

Why choice over maternity services is important

Giving women personalised care where they are free to choose the maternity service to meet their needs is a key part of the Five Year Forward View for maternity. Choice is about giving women the option of where they would like to deliver (such as at home, midwife-led unit, hospital) and what type of birth they want (such as water birth, with epidural). 

By giving women choice, which is informed, they are more likely to have a better experience and better outcomes.

Choice over maternity services in Bradford

Data on choice over maternity services is not yet available. We will be publishing this data when it becomes available, we expect this to be released in the next few months.

Care during delivery

Our aim is for all women to have one to one care from a qualified midwife during delivery  

Care during delivery in Bradford

Our aim is for all women to receive 1:1 care during delivery from a qualified midwife. 

  • during delivery we promote the provision of 1:1 care for women,
  • nearly 3 in every 4 women (72.8%), received 1:1 care from a qualified midwife during delivery.

Cesarean section

Why measuring caesarean sections is important

A caesarean section is an operation to deliver a baby, it can be a planned or an unplanned operation:

  • planned (elective) – where a medical need for an operation become apparent during pregnancy or it is requested by the mother in advance.
  • unplanned (emergency) – when circumstances before or during labour mean that a ceasaran section must be performed.

Rates of cesarean section in our CCG

To December 2015:

  • 3,060 births in total,
  • 248 (8.1%) were by planned caesarean,
  • 329 (10.8%) were by emergency caesarean section,
  • 577 (18.9%) total number of caesarean (planned and emergency).

Breast feeding

Why measuring levels of breast feeding is important

Levels of breast feeding are measured at delivery and in the 6-8 weeks following birth. In the UK, 73% of mothers start breastfeeding. Breast feeding provides health benefits for both mother and baby and helps build a strong emotional bond. It also reduces the risk of: 

  • infections, with fewer visits to hospital
  • diarrhoea and vomiting, with fewer visits to hospital
  • sudden infant death syndrome (SIDS)
  • childhood leukemia
  • type 2 diabetes
  • obesity
  • cardiovascular disease in adulthood

What are the levels of breast feeding in Bradford?

In Bradford, breast feeding rates are assessed at delivery and at the postnatal checkup which happens in the 6-8 weeks after birth.

  • breast feeding at delivery is 3 in every 5 (60.4%) of mothers,
  • by the 6-8 week check up by a health visitor, breast feeding drops to 1 in 4 (26.2%) of mothers.

What you tell us about maternity services

We make sure that we are listening, engaging and involving patients in the planning and design of their local NHS. To do this, each programme of work has the infrastructure to engage and collect information from people through:

Maternity Service Scorecard

The insight and feedback you give us makes sure that we don't just collect information, but that we have the means and ability to use it to inform our commissioning activity and improve quality. All the insight and feedback is pulled together in a system we call grass roots.

Grass Roots

Grass Roots pulls together information reported through NHS Choices, Patient Opinion, Healthwatch, complaints, local groups and direct patient, family and community feedback so that we can understand experiences of local NHS services. This information helps us inform our CCG planning and decision making. 

The following represents feedback received in to grass roots regarding maternal and women’s health from September 2014 – end October 2015. The number of responses received relating specifically to maternity services was 26 (this related to patient feedback from 253 patients / carers and 39 staff).

What you report through grassroots

In addition, for each programme of work, we tailor engagement to ensure we are reaching people who use local services. Specifically for maternity services, the Maternity Partnership and the Women’s Health Network dive in deeper to understand experiences. 

The Maternity Partnership

The Maternity Partnership covers Bradford District and Craven. It works with providers and commissioners of maternity services to make sure that services meet the needs of local women, parents and families.

Each year the Maternity Partnership conducts a series of focus discussion groups throughout the district to listen to the views and experiences of new mums and mums-to-be on topics chosen by people who use the service. The aim of the focus groups is to gain insight into the views of women who are seldom heard and less likely to use other feedback mechanisms such as grass roots and the friends and family test amongst others.

Each focus group has a different theme, 2015/16 focused on personalised choice and 2014/15 focused on community midwifery, you can see the key themes the emerged from each of these groups below: 

2015/16 focus groups, personalised choice:

2014/15 focus groups, community midwifery:

Women's Health Network 

Bradford Districts CCG has supported the development of the Women's Health Network to enable key messages to be shared with women and develop a better understanding of health matters. Specifically, the network is helping us share messages relating to the importance of pre-conception care, diet and nutrition, accessing health services for children and preventative care (such as immunisations and screening) appropriately and in a timely manner.

The Women's Health Network have hosted a series of focus groups, workshops and events to build better understanding. Key themes include:

Patient stories 

2015/16 - what have we done?

During 2015/16 we have worked with providers of maternity services and our partners to improve maternal and child health outcomes. 

This work is split into three main areas;

  • developing maternity services
  • improving outcomes - through Better Start Bradford
  • research - through Born in Bradford.

Developing maternity services:

Improving outcomes - Better Start Bradford

We have continued to support the Better Start Bradford programme. The programme received £49 million in funding from the Big Lottery to improve maternal and child health outcomes. This programme is based in the Bowling and Barkerend, Bradford Moor and Little Horton areas of the city and will benefit 20,000 young children, aged betwen zero and three years old over a 10 year period.

In the past year, through Better Start Bradford, a number of projects have commenced including:

Research - Born in Bradford


Born in Bradford (BiB) is a long term study of a cohort of 13,500 children who were born at Bradford Royal Infirmary between March 2007 and December 2010. The health of the 13,500 children are being tracked from pregnancy through childhood and into adult life.

Born in Bradford researches the many influences that shape our lives, including; parents and wider family, genes, the way we choose to live, the local environment, and the services we access. It then looks at how these all come together to impact health and wellbeing.  

The information collected from the Born in Bradford study is being used to find the causes of common childhood illnesses as well as explore the mental and social development of the next generation. Findings from the study will be used to inform our future commissioning decisions.

Images courtesy of http://www.bradfordtrident.co.uk/ and http://www.borninbradford.nhs.uk/ 

Our plans for the next five years

Through the establishment of a programme to improve outcomes in maternity services we will build on the learning from our two maternity pilots which are currently in Airedale and in the Better Start Bradford locality.

Developing and building on our learning will help create personalised maternity care. We plan to meet the needs of all our communities, as set out in Better Births: improving outcomes for maternity services in England (the five year forward view for maternity care).

We will be working with the Maternity Partnership, the Women’s Health Network and other community based forums to ensure that services are developed which are accessible  to women from all communities and meet their needs and expectations of personalised care.

We will also develop our relationship with the Born In Bradford research project and Better Start Bradford, their findings help inform the evidence based for ongoing service development. 

We will continue to be active participants in the Yorkshire and Humber Maternity Clinical Network and use this forum as a vehicle for sharing good practice around key themes and developing toolkits to address shared priorities for action.

We see a bright future for maternity services in Bradford, which will include:

The future of maternity services