Agenda item

Olivia Clymer (Director of Strategy and Partnerships, Oxford University Hospitals NHS Foundation Trust), has been invited to present a report containing an update on Maternity Services.

 

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Yvonne Christley (Chief Nurse, Oxford University Hospitals NHS Foundation Trust [OUH]) and Professor Dr. Andrew Brent (Chief Medical Officer, OUH), were invited to present the report containing an update on Maternity Services.

 

The Chair welcomed the Chief Nurse and Chief Medical Officer and invited the Committee to proceed directly to substantive discussion. Members sought clarity on whether the Trust had met families affected by maternity concerns and whether longstanding campaign groups had been meaningfully engaged, particularly in light of previous tensions. The officers reported that groups such as Keep the Horton General had engaged with the Trust at various times, including at listening events, although concerns had persisted about transparency and the handling of information shared by those groups.

 

The Committee reflected on the private meeting with OUH on 22 December 2025, which had enabled sensitive matters to be raised directly and had provided an opportunity to secure clearer commitments regarding transparency, responsiveness and future engagement. Members underlined the need for renewed dialogue among the Trust, campaigners and affected families, recognising the depth of feeling and the imperative to rebuild confidence.

 

Attention then turned to the potential for a fresh approach to engagement with campaign groups and the part that Healthwatch could have played as an independent bridge. The officers acknowledged the longstanding nature of concerns within local groups and recognised that earlier engagement had not always built confidence, partly due to misunderstandings and worries about the treatment of information. They supported a renewed, structured model of engagement that brought campaign groups and the Trust together more effectively. They agreed that Healthwatch’s independence made it a valuable, community‑facing partner, capable of both facilitating dialogue and offering challenge, particularly while national arrangements for patient‑voice functions remained uncertain.

 

The financial environment formed a further line of inquiry. Members explored the implications of NHS tariff changes for maternity services, especially in the context of increasingly complex clinical presentations. The officers noted that national tariff adjustments had been affecting multiple clinical areas. As an illustration, ophthalmology had experienced reduced tariffs for routine activity contrasted with increases for complex procedures, a pattern they considered relevant to maternity. With workloads growing more complex and requiring greater staff time and specialist intervention, the officers questioned whether current tariffs adequately recognised rising acuity. The Trust had already raised these pressures and advocated for sustainable funding models that reflected the real cost of safe, high‑quality maternity care. Members warned that tariff misalignment risked worsening workforce and capacity pressures, and the officers confirmed that the matter would remain a focus for continuing scrutiny.

 

The discussion moved to maternity safety outcomes, with reference to the historic spike in postpartum haemorrhage (PPH) and the measures that had subsequently driven improvement. The officers explained that the increase in PPH had been linked to several factors, including a more complex maternity population and service pressures that had undermined consistency of care. The Trust had conducted a detailed review to understand contributory causes and had implemented a targeted improvement plan. The most effective actions had included strengthening clinical guidelines, improving escalation pathways, enhancing staff training and focusing on the early identification and management of risk during labour and birth. These combined measures had produced a clear improvement in PPH rates and greater consistency in practice across teams, with continued monitoring to sustain progress and embed learning.

 

In parallel, members examined the newly launched Induction of Labour Improvement Initiative, introduced to address persistent delays. The officers stated that the initiative had been designed to streamline the induction pathway, reduce waiting times and improve outcomes for women needing medical initiation of labour. Although specific process changes were not detailed in the transcript, the officers advised that early signs already indicated reduced delays and better flow through the pathway. Monitoring had continued, with the Trust focused on embedding improvements to deliver safer and more timely inductions over the longer term.

 

Questions about minimising harm, maintaining safety and responding to shortfalls in outcomes led to further detail on governance. The officers reported that the Trust had strengthened clinical governance procedures through clearer guidelines, rapid escalation routes and closer outcome monitoring. They added that incident reviews had been completed more quickly, making it possible to apply learning sooner. Complaints and concerns had been tracked for themes and fed into service‑improvement discussions. The private OUH meeting in December had provided a forum to raise sensitive points directly and to reinforce expectations around transparency and responsiveness. Members stressed the need for consistent application of improvements and for a demonstrably responsive approach when things went wrong.

 

The Committee then considered the increase in concerns reported in September 2025, where communication, consent and postnatal care had emerged as dominant themes. The officers confirmed that the spike reflected a cluster of cases in which women and families felt communication had been unclear, consent processes had fallen short of expectations and postnatal support had been inconsistent. Each case had been reviewed, and the resulting learning had been routed through governance to identify and address weaknesses. Targeted work had subsequently reinforced staff training on communication, good practice in shared decision‑making and appropriate postnatal follow‑up. The officers stated that these themes continued to be monitored closely and that improvements were already being embedded through ongoing quality and safety work in maternity.

 

Members asked whether longstanding dissatisfaction might have contributed to the heightened reporting observed in September. The officers acknowledged that unresolved distress and breakdowns in communication could have influenced the pattern of concerns and emphasised that complaints were being reviewed individually, with attention to their emotional impact. Regarding the national requirement for independent review of 50% of baby deaths, the officers confirmed that the Trust was working towards compliance and that independent scrutiny formed part of established governance processes. The Committee reiterated the need for sensitive communication, clear support for complainants and sustained transparency in oversight.

 

Discussion of the complaints process continued. The officers accepted that earlier failings in communication had undermined trust and reported that work was underway to strengthen practice. They explained that each complaint was reviewed on its merits, that themes were captured and fed into governance and that learning informed improvements in communication, consent and postnatal care. The Committee underlined that confidence would only be rebuilt through consistent, timely responses, improved escalation and clearer explanations when outcomes fell short, and that visible follow‑through would be essential.

 

A focus on inequalities prompted questions about how the Trust monitored experience across different groups and reached communities at greater risk. The officers stated that patient‑experience feedback, complaint themes and incident reviews informed the understanding of variation in care and allowed earlier, more targeted responses. Strengthening the interface between hospital and community services had been prioritised as neighbourhood health models developed. Better communication, more consistent postnatal support and earlier identification of need were presented as critical to reducing inequalities and improving safety, and the Committee stressed the importance of tracking lived experience alongside clinical outcomes.

 

Cllr Garnett left the meeting at this stage.

 

Historic learning was then revisited, with members requesting details from the 2023 maternity case reviews in Oxford. The officers reported that the dominant themes aligned with those already discussed: the quality of communication with families, the robustness of consent processes and the consistency of postnatal care. These same issues had been visible in the September 2025 increase in concerns, suggesting persistent underlying challenges. The officers confirmed that each 2023 case had been reviewed through governance processes and that learning had been fed back to clinical teams. Improvement efforts therefore continued to prioritise communication standards, shared decision‑making and reliable follow‑up after birth, with monitoring in place to ensure that learning translated into sustained change.

 

The Committee asked whether a specific risk cited in discussion was included in the NHS England Maternity Bundle and how national focus translated locally. The officers confirmed that the bundle did contain a section relating to this risk and stated that the Trust’s governance incorporated these expectations into day‑to‑day practice. The bundle was used to guide monitoring, escalation and improvement, ensuring alignment between national standards and local delivery. Members also sought an update regarding women with epilepsy becoming pregnant. The officers noted the importance of this issue, particularly in the learning‑disability population, undertook to obtain a clearer system‑level update and confirmed that recent LEADER findings had highlighted epilepsy‑related inequalities which would be fed back through the Health and Wellbeing subgroup.

 

Recent media reporting in the New Statesman and on Channel 4 News was acknowledged. The officers observed that the concerns described in those reports overlapped with issues already discussed: communication, consent and postnatal care. They reiterated that steps had been taken to strengthen governance, escalation and learning processes, and that improvement work was ongoing to address the highlighted areas. The private meeting with OUH on 22 December 2025 had enabled direct examination of sensitive matters and had provided reassurances about transparency and responsiveness. The Committee welcomed these clarifications as useful context for anyone who had viewed the coverage.

 

The conversation then turned to postpartum injuries and whether the BOB ICB was working toward a standardised approach. The officers recognised the significance of postpartum harm within maternity safety and explained that, while the transcript did not set out a single ICB‑wide programme, approaches to perinatal risk and harm, such as postpartum haemorrhage and postnatal care, had been under active review through strengthened governance and shared learning. They added that clinical guidelines, escalation pathways and monitoring mechanisms were being improved locally and that collaboration across the BOB system formed part of the wider improvement agenda. Members reiterated the value of system‑wide consistency, and the officers confirmed that cross‑ICB alignment would remain a priority.

 

Workforce planning was examined in light of service pressures and the specific context of Oxfordshire. The officers acknowledged the scale of the challenge, citing rising clinical complexity and sustained demand. They described how workforce planning had been strengthened using national guidance, local activity data and learning from incident reviews, ensuring that staffing models reflected both acuity and capacity. The Trust was refining skill‑mix, improving recruitment to specialist roles and focusing on the retention of experienced staff through support and training. The overarching aim was to deliver a flexible, evidence‑based workforce aligned with neighbourhood‑based care and ongoing maternity improvement work.

 

The future configuration of maternity services, particularly the longstanding debate about the Horton and the concentration of obstetric services at the John Radcliffe, was then revisited. The officers stated that current review work was aimed at ensuring services remained resilient, safe and capable of meeting future demand, but they did not indicate any imminent change to the configuration. When asked whether anything other than resources stood in the way of reopening obstetric services at the Horton, the officers explained that decisions of that scale depended on system‑wide and national factors, including regulatory requirements, workforce sustainability and formal service‑change processes. Previous evaluations had identified significant challenges, notably around staffing sustainability and clinical safety standards, which continued to act as major constraints. The Committee stressed the importance of transparent, ongoing review.

 

Technology’s role in improving safety, communication and clinical effectiveness also formed part of the discussion. The officers stated that digital tools already supported monitoring, decision‑making and information‑sharing. They indicated that technological improvements were complementing broader maternity‑improvement work, particularly in strengthening governance, escalation and learning, and were helping staff to respond more consistently when outcomes fell short. Digital solutions were also being used to streamline pathways such as induction of labour and to improve communication between hospital and community‑based teams as neighbourhood health models developed. These tools supported more reliable follow‑up and earlier identification of risk, contributing to safer postnatal care, even if no single initiative was presented as transformative.

 

To close, members asked about experiences at Chipping Norton, Wantage and in home‑birth settings, noting that previous discussions had centred on the Horton and the John Radcliffe. The officers confirmed that women had given birth at those locations, as well as at home, although the report they submitted to the Committee did not provide detailed comparative data or outcomes. They emphasised that the broader improvement work, encompassing communication, consent, postnatal care and pathway development, applied across all birth settings, not only acute sites. Strengthening the interface from hospital to community, particularly through neighbourhood health models, had been intended to improve follow‑up and ensure consistent support regardless of place of birth. Members welcomed the reassurance that community‑based and home‑birth services were included in ongoing work and reiterated the importance of monitoring experiences across all birth settings, not just obstetric units

 

The Committee AGREED to issue the following recommendations subject to minor amendments offline:

 

1. To implement a Trust wide maternity communication standard covering: timing, clarity and translation of information, as well as expectations during induction, labour and postnatal care.

 

2. For the Trust to produce a quarterly, public-facing learning report showing: complaint themes, patients’ experience of the complaints process, actions taken, percentage achieved of involvement of independent reviewer in any baby death, and evidence of impact. This is to ensure transparency and restore confidence in maternity services.

 

3. For the Trust to produce an evaluation framework for: Equal Start Oxford’s expansion to Didcot and Banbury, general support for asylum seekers and underserved groups, and translation and outreach programmes. It is recommended that such an evaluation framework should include uptake, impact on outcomes, and service user satisfaction.

 

4. For the Trust to plan and explain how the current national maternity tariff, demand modelling, and BirthRate Plus projections align with staffing expansion and staff burnout.

 

5. For the Trust to provide a written update on progress on the accepted JHOSC recommendation on epilepsy, and how it plans to align with the NHS England maternity bundle section on epilepsy.