Our plans for maternity services
Find out about our plans for maternity services and how well we are performing against them.
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.
Our aim is to encourage pregnant women to stop smoking during pregnancy, ideally altogether.
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;
Therefore, making sure babies are protected from tobacco smoke means that children have a healthy start in life.
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%
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.
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.
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.
Bradford Teaching Hospitals NHS Foundation Trust provides maternity services for our CCG.
Maternity services provided in the home or community:
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.
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.
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.
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.
Our aim is for all women to have one to one care from a qualified midwife during delivery
Our aim is for all women to receive 1:1 care during delivery from a qualified midwife.
A caesarean section is an operation to deliver a baby, it can be a planned or an unplanned operation:
To December 2015:
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:
In Bradford, breast feeding rates are assessed at delivery and at the postnatal checkup which happens in the 6-8 weeks after birth.
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:
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 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).
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 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:
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:
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;
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:
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/
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 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: