Agenda item

Oxford University Hospitals NHS Foundation Trust has been invited to present a report on the current state of Maternity Services in Oxfordshire.

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

Oxford University Hospitals NHS Foundation Trust were invited to present a report on the current state of Maternity Services in Oxfordshire. Yvonne Chrisley (OUH Chief Nurse), Rachel Corser (Chief Nursing Officer for BOB ICB), Dan Leveson (Place Director for Oxfordshire: BOB ICB), and Veronica Barry (Executive Director: Healthwatch Oxfordshire) attended to answer questions form the Committee on the report.

Members requested that Officers provide further details on the new training programmes and staff participation, as mentioned in section 1.1 of the report. It was responded that the Trust had implemented new training initiatives for obstetricians and midwives, including the Peaches programme and PROMPT training. The Peaches programme aimed to recognise and prevent third and fourth-degree tears, while PROMPT focused on enhancing teamwork and coordination between medical professionals and midwives. Staff participation in these training programmes was regularly monitored and reported to the Trust board, with approximately 90% of staff having completed the training at any given time. These programmes had proven effective, as evidenced by lower-than-national-average birth injury rates.

Oxfordshire's birth injuries were generally below national rates, which was positive. Efforts continued to minimise these injuries further. Notably, therapeutic cooling rates for infants over 37 weeks had reduced to 0.07, beating the national target of 0.1 to 0.3, thanks to significant interventions. OUH maternity services handled complex cases, and maintaining low injury rates demonstrated the high quality and safety of care.

The Committee questioned why the number of patients accessing the birth reflection service was projected to be significantly higher in 2025. The higher projection was attributed to increased awareness of birth trauma among women and the service itself. The growth was seen as a positive indicator of timely interventions and greater awareness among women and families. Although there was not a direct link to COVID, the pandemic created an environment of isolation for women and families, possibly raising awareness and intervention needs as restrictions eased. The pandemic was further noted to have had a wide-ranging impact on health services, including potential interruptions in training.

The process of identifying and addressing risk was questioned, with members curious as to whether there was a standardised and consistent approach. Officers highlighted that the Trust had implemented a digitalised system through an electronic patient record (EPR) called Badger Net. This system ensured that risk assessments were both available and accessible to staff and mothers. A monthly audit program monitored compliance, and gaps were addressed with timely interventions. The digital system enabled quick audits and interventions, ensuring a standardised and consistent approach to addressing identified risks.

Members inquired about the mental health support provided for both pregnant mothers and fathers affected by mental health challenges. Officers discussed several aspects of mental health support.

The Trust had bereavement suites and specially trained staff to assist families experiencing stillbirth. These suites provided a family environment where families could spend time with their baby and access counselling services. There was a dedicated trauma midwife and a service ensuring timely interventions for those who had experienced birth trauma.

Mental health was assessed throughout the entire maternity care pathway, from antenatal to postnatal stages. The Trust had invested in mental health services, with Oxford Health NHS Foundation Trust developing clinical teams to support these pathways. The support also extended to fathers, acknowledging their need for mental health assistance during and after traumatic birth experiences.

Members raised concerns about the higher likelihood of women of ethnic minorities dying in pregnancy and childbirth, than other demographics. Members wanted to know what was being done to address this discrepancy in differing ethnic groups.

The Trust monitored birth injuries and patient experiences by ethnicity monthly to identify disproportionate impacts. Equality, diversity, and inclusion midwives worked with specific groups to ensure effective access to services and address health concerns. Community outreach was conducted to address health issues and improve service access for ethnic minorities. These measures aimed to provide equitable care and address disparities in maternal mortality rates.

Members raised the potential to work with partners on maximising what could be achieved with health checks, for both physical and mental health purposes.

The significance of collaborating with public health was noted to monitor weight management and address equity and prevention of ill health within the community, especially focusing on areas with greater deprivation and higher numbers of ethnic minorities. Oxford Health NHS Foundation Trust provided health visiting and school nursing services, working with midwives to support those most at risk and ensure a smooth transition of care. The importance of postnatal care was highlighted for the well-being of both the infant and the mother, emphasising ongoing efforts to improve and strengthen postnatal care services.

The Chief Nursing Officer highlighted the focus on improving postnatal care. An analysis of the 50 birth experiences from the Keep the Horton campaign identified postnatal care as ‘needing improvement’. The Trust invested in the Neonatal Voices Partnership to gather feedback and guide improvements in postnatal care. Efforts aimed to enhance postnatal care for both infants and mothers, addressing isolation and separation issues. Improvements included emergency parking at John Radcliffe Hospital and reducing antenatal travel by strengthening services at the Horton. Adjustments were also made on the postnatal ward to accommodate birth partners and provide spaces for those preferring privacy.

Members questioned, in a time where nationally there was a high level of dissatisfaction within the midwifery industry, what had been done to support staff and keep them in work. It was explained to the Committee that Professional Midwife Advocates (PMAs) provided structured guidance, reflection, and support to individual staff members, assisting them in managing their roles and developing their careers. The Care Assure Program involved weekly visits by leaders to engage with both patients and staff about their experiences, addressing any issues and offering support.

Efforts had been made to address workplace bullying and ensure that all individuals understood their responsibilities in maintaining a positive work environment. Training was available to prevent bystander behaviour and promote conducive values. Experienced leaders were described as essential for supporting staff and developing the service, focusing on building a cohesive team and fostering interpersonal relationships. A dedicated psychologist was also available to support staff, acknowledging that maternity work could be challenging at times.

Members inquired about the frequency of routine antenatal scans for babies and the actions taken when scans showed unexpected results such as poor growth or death. Officers explained that all women routinely had three scans during their maternity care. If any scan indicated an issue, an individual care plan was created for both the mother and baby. This plan included specific interventions to monitor and ensure their safety and well-being. For conditions like poor intrauterine growth, there were dedicated pathways with specific interventions based on evidence-based guidelines to ensure the safety and well-being of the infant and mother.

Members inquired about the implementation of co-production within the service, future plans for its development, and the anticipated benefits for maternity services with a focus on co-production. It was responded that the Oxfordshire Maternity and Neonatal Voices Partnership (OMVP) played a pivotal role in co-production efforts. The Partnership consistently engaged with the maternity services team, offering valuable feedback from patients and families' perspectives. OMVP conducted site visits to maternity and neonatal services to assess and report on the patient and family experience. Additionally, the Chief Nurse held monthly meetings with the OMVP chairs to review their findings and discuss strategies for enhancing service delivery to be more person-centred.

Using the example of birthing pools, members questioned what precautions were in place to ensure staff adhered to established policy, procedures and guidelines to ensure that equipment was used correctly and safely. Members were informed about the installation of a new birthing pool at the Horton. Maintaining the cleanliness and safety of birthing pools was crucial, and the cleaning and decontamination processes are rigorously monitored. The Trust had implemented a digital system called 'MyKitCheck' to oversee the cleaning and decontamination of birthing pools and other equipment. This system provided immediate visibility into compliance rates and ensures that procedures are followed accurately. The digital system enabled real-time monitoring and had demonstrated compliance rates exceeding 90% in all areas. This transparency helped promptly address any issues and ensures that the equipment was maintained according to established guidelines.

Members requested further details on the overall evaluation process of the CQC concerns, including the parties involved in assessing the improvements related to maternity services. The Trust formed an evidence group to monitor and evaluate the CQC actions' progress and effectiveness. This group assessed the assurance level for each action, categorising them as limited, medium, or fully assured, and met monthly to review data and address challenges. Chaired by the Chief Nurse, it included the assurance and maternity teams. Reports were given to the delivery Committee, chaired by the Chief Executive, ensuring sustained improvements. External review support came from the Maternity and Newborn Safety Investigations department for specific cases, adding further scrutiny.

The Committee asked whether within this there was a clear process of learning from errors which were made in the quality of maternity care, and what the learning journey was from mistakes made. It was explained that the trust had a strong reporting culture, classifying incidents like third or fourth-degree tears as moderate harm from the start. This proactive approach helped identify safety risks early. Each incident was thoroughly analysed to understand the context and find learning opportunities. Clinicians had open conversations with patients and families, following duty of candour by informing them of any issues and investigation processes. Complaints were taken seriously, broken down for detailed analysis, and responded to comprehensively, highlighting learning points and planned improvements. These responses, approved by the Chief Nurse, could involve follow-up meetings with patients and their families.

The Committee sought clarity over the plans to implement a sharing platform between OUH and London hospitals, and whether it would be a maternity service platform or if wider records would be shared with London hospitals.  It was clarified that this platform was specifically for maternity services and involved sharing relevant records and information pertinent to the maternity care pathway or the individual patients themselves.

An update was requested regarding the introduction of the telephone triage phone service. This service was highlighted as a significant development in maternity services. Planned to be operated by the South Central Ambulance Service (SCAS), it would feature dedicated and trained advisors for maternity triage. The service aimed to direct patients efficiently and included the capability to record and audit the triage process using specific algorithms. A business case was being developed to implement this service.

The Committee inquired about local improvements for maternity services in Oxfordshire. The ICB decided to invest transformation funds directly into supporting the Trust rather than simply adding more resources at the BOB system level. They were collaborating with NHS England on the Trust's improvement and aiming to increase capacity within each trust. Additionally, the ICB was focusing on system-wide shared learning, like enhancing translation services.

The Committee AGREED to finalise a list of recommendations to be issued outside the meeting.