SOUTHWARK-HEALTH-&-SOCIAL-CARE by sdaferv

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									Maternity Services Commissioning Review
Introduction
A review of maternity services has been taking place across Southwark. This report
summarises what you told us and explains how we will use this to improve maternity
services in Southwark.

Why are we interested in your views?
Southwark Primary Care Trust (PCT) is responsible for planning and purchasing
maternity services in Southwark. We want to make sure we include the views of the
people using the service when planning for the future so that it meets your needs.

We also need to make sure we consider the following national and local issues:

   The rising birth rate in Southwark – making sure we have enough services.
   HealthCare for London - a strategy that asks us to provide care out of hospital.
   Maternity Matters - a national policy that requires improved choice and patient
    experience focusing on antenatal and birth care.
   National Institute for Health and Clinical Excellence (NICE) on Antenatal Care.

How did we collect the information?
The consultation process ran from November 2008 until February 2009. We:

   Attended parent forums and held group discussions.
   Undertook web-based questionnaires and surveys.
   Used parent evaluators to undertake one-to-one peer interviews.

What happened?
   We received 233 responses from women who had given birth and 56 responses from
    women who are currently pregnant.
   61.4% of respondents used KCH maternity services and 33.9% used GSTT services.
   25% of women lived in SE15 followed by 17.1% in SE22.
   57.5% of women had 1 child. This ranged between 1 and more than 6 children.

What did people say?
Antenatal Care
The graph below shows which healthcare professional you saw for antenatal care
compared to who you would like to see if given a choice.

   The proportion of people who saw a hospital based midwife or group practice
    midwife was very similar to the proportion that would pick this if given the choice.
   18.1% less women would choose to see a community midwife if given the choice.
   12.6% would not know how to decide between the options.


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   Only 30% of women said they were given a choice about their antenatal care. Many
    parents at the forums said they did not realise they had a choice.
    100%


    90%


    80%


    70%


    60%


    50%


    40%


    30%


    20%


    10%


     0%
                                   Actual Provider                                                  Provider of Choice

           hospital-based midwives                   midwife at GP practice (community midwives)   midwife group practices - all
           your GP                                   independent midwife                           other
           wouldn't mind which of these options      wouldn't know how to decide



The main factors affecting choice of antenatal care were:
   - Convenience/close to home
   - The possibility of having a home birth
   - Reputation and the experience of friends/family

   76% of women rated the quality of antenatal care as good, very good or excellent.
   Comments showed you value having the same midwife throughout pregnancy and
    that continuity of care improved your experience. This arose at group discussions as
    well.

Birth
The graph below shows where you said you chose to give birth, where you actually gave
birth and where you would choose in the future:

   34.2% of women said they chose to give birth at home before the birth and 18.7%
    said they actually gave birth at home. This is very high compared to the Southwark
    average home birth rate of below 8%.
   13.5% more women would choose to have a home birth in the future.
   23.2% less women said they would choose to give birth in the KCH labour ward in
    the future.
   3.2% less said they would choose to give birth at the GSTT labour ward in the future.
   67.4% of women said they were offered a choice of where to give birth.



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The main factors affecting choice of birth location were:
   - Safety associated with labour ward for first child or a complicated pregnancy.
   - Improved outcomes, less intervention and relaxing environment linked to
     home birth/midwife-led birthing centre.
   - Word of mouth/experience.
    100%
                                                                                     other
    90%


    80%                                                                              private hospital bed


    70%
                                                                                     NHS hopsital labour
                                                                                     ward - other hospital
    60%

                                                                                     NHS hospital labour
    50%                                                                              ward - St Thomas'
                                                                                     Hospital
    40%
                                                                                     NHS hospital labour
                                                                                     ward - King's College
    30%
                                                                                     Hospital

                                                                                     NHS midwife-led birth
    20%                                                                              centre


    10%                                                                              home


     0%
           Chosen Birth Location   Actual Birth Location             Future Choice


    73.4% of women rated the quality of birth care as good, very good or excellent.
    Comments showed that you:
     -  Do not want to wait for a long time before being admitted to the labour ward.
     -  Want courteous midwives and staff who listen to you during birth.
     -  Like the service provided by group practice midwives.

Post-Natal Care
The graph below shows who provided your post-natal care compared to who you would
pick if given the choice:




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    100%


    90%


    80%


    70%


    60%


    50%


    40%


    30%


    20%


    10%


     0%
                            Actual                                                                 Future

                     community midwives   midwifery group practice - All   your GP   don't know   none of the above

   22.3% less women would choose a community midwife if given a choice.
   5.1% more women would choose to have their care from a group practice and 6%
    more would like it from their GP.
   Only 8.4% of women said they were given a choice of who provided post-natal care.
   22.9% said you wouldn’t know who to choose in future

Issues affecting the choice you would make included:
   -  Continuity of care post-natally/same midwife throughout pregnancy.
   -  Availability of midwife time and support and the opportunity to ask questions.

   72.5% of women rated the quality of post-natal care as good, very good or excellent.
   Comments from forums showed you were concerned you did not receive the support
    and time you required following birth, particularly with regards to breastfeeding.
   82.1% of women said they received a home visit within 48 hours of leaving hospital.

Future Maternity Services
Midwife-led Birthing Unit
  55% of women would like a midwife-led birthing unit attached to KCH.
  31% would like it in a community setting. Comments showed this lower figure was
   because of concerns about safety.
  Only 14% would not be interested in a midwife-led birthing unit.

Polyclinics
  You were most interested in using polyclinics for maternity services if:
   -   They offer shorter waiting times than hospital clinics
   -   They are close to home.


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    -   They provide an all-in-one service throughout your pregnancy.

   You were most interested in having antenatal appointments and screening tests at
    polyclinics.

What do these findings tell us?
Choice
The responses show that you are not always aware of the choices available to you
particularly for post-natal care. This suggests that the information available to support
making a choice may not be accessible to women and families at the time they need it.

Antenatal Care
You are very happy with the service offered by group practices but less satisfied with
community midwife services at your GP. Comments show this is because you want
continuity of care throughout pregnancy. We therefore need to consider how we can
make sure all women can access good quality care regardless of who provides it.

Birth
Having a home birth is becoming increasingly popular as it is viewed as a clean and
relaxed environment. We therefore need to make sure support is available to help
women have a home birth where appropriate.

Post-natal Care
Women were least satisfied with post-natal services and were generally not given a
choice. We will need to consider how to improve these services in the future.

Future maternity services
Respondents generally supported a midwife-led birthing centre although only a small
proportion would want this in the community due to concerns about safety.

If polyclinics provide a more convenient way of accessing maternity services you would
be interested in using them. Therefore we need to plan how we can do this when
developing Polyclinics.

Survey Response
The response to the surveys was very good when compared to consultation surveys
undertaken in the past. By attending parent groups we tried to make sure the views of
hard to reach groups were gathered. Comments made at forums and in the surveys
were similar. However the ethnic breakdown of people who completed the survey did
not match the parent population in Southwark so may not show everybody’s views.

What will we do with this information?
Based on what you have told us we will be recommending the following:



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   Improving the information available when you become pregnant so you know what
    choices you have. This may include:
    -  Information leaflets with pregnancy tests about your choices and who to contact.
    -  A central telephone helpline to give you information and book you into maternity
       services when you first become pregnant.

   We will seek to improve antenatal services by:
    - Reviewing the community based midwife service to see how we can improve this.
    - Where resources allow, increase the availability of the group practice midwives.

   Develop a midwife-led birthing unit near Kings College Hospital. This also forms
    part of a national requirement to offer better choice of birth location. Currently the
    level of interest in a community based unit may be too low to support it’s
    development, however we will reconsider this in the future.

   Make it easier to access services such as antenatal appointments and scans by
    making them available in Polyclinics in Southwark.

   Because of national and local policy we currently have to focus on antenatal and
    birthing care. However you have expressed dissatisfaction about post-natal care
    and we intend to review this in the future.

   If repeating the consultation even more effort would be made to ensuring the survey
    represents the entire population of Southwark.


Would you like to let us know your views?
If you have a comment about this report or would like to let us know your views about
maternity services in Southwark you can do so by contacting any of the following
people:

Tamsin Hooton, Associate Director for Acute Commissioning
Southwark PCT, Woodmill Building, Neckinger, London. SE16 3QN
Tel: 0207 525 0455

Keri Lewis or Catherine Flynn, Patient and Public Involvement Facilitator
Southwark PCT, Dulwich Hospital, East Dulwich Grove, London. SE22 8PT
Tel: 0203 299 6444 keri.lewis@southwarkpct.nhs.uk

Southwark Patient Advice and Liaison Service (PALS)
Dulwich Hospital, East Dulwich Grove, London. SE22 8PT
Tel: 0800 58 77 170
Type Talk: 18001 0800 58 77 170
Email: pals@southwarkpct.nhs.uk




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