Workforce Planning Template

University Hospitals Coventry and Warwickshire NHS Trust Section 1 Introduction  Purpose of document The women of Coventry & Warwickshire are able to access maternity services that are able to deliver the choice agenda, set out in Maternity Matters, by end 2009. Specifically: Choice of how to access maternity care; Choice of type of antenatal care; Choice of place of birth; Choic e of postnatal care. The access and quality of these services is not dictated by locality or the diversity of the pregnant women. Quality outcome for pregnant women & the newborn is high as evidenced by compliance to NICE guidance, evidence based practice, Health Commission standards and achievement of PSA targets. The workforce delivering the care to pregnant women and the newborn are skilled, competent and confident to deliver that care in all care settings in a flexible manor. This will reflect in improved sickness & retention rates and staff survey results. Maternity Care features positively in the Organisational Plans of provider services and Local Delivery Plans of commissioning organisations   Description of geographical area The Health Economy of Coventry & Warwickshire is a mixed urban and rural community. See appendix 1 for map Demographics Warwickshire Demographics The total population of Warwickshire is just over 500,000 (ONS mid year estimates 2006) of which just over 101,000 are women aged 15 – 44 years. The table below show the numbers of women aged 15-44 years for Warwickshire and by district council. Locality North Warwickshire Nuneaton and Bedworth Rugby Stratford-on-Avon Warwick Warwickshire Females aged 15-44yrs (Thousands) 11.9 24.1 17.4 20.0 28.0 101.4 Recent projections of ethnicity suggest the following, which will impact on maternity services:   Nationally, the White British population declined between 2001 and 2005, yet across Warwickshire over the same period this population group is estimated to have increased slightly by 1,700. The non-„White British‟ group is estimated to have risen by 10,100 between 2001 and 2005, increasing its proportion of Warwickshire‟s total resident population from 7.3% to 9.2%.   The proportion of the total non-„White British‟ population is highest in Warwick (14.0%), and lowest in North Warwickshire, with 5.1% of the total population. The „Asian Indian‟ group is estimated to be the largest non-„White British‟ BME group in Nuneaton & Bedworth, Rugby, Warwick, and Warwickshire as a whole. Source: Warwickshire Observatory 2007 Deprivation at SOA level: Income Deprivation Affecting Children Index: The percentage of children aged 0-15 living in income deprived householdsChase Cannock Chase Cannock Lichfield Lichfield The map highlights the key areas of and lone parents from the 2007 Index Warwickshire has low income in low-income households. These Warwickshire The teenage pregnancy rate is low in The Health Survey and a quarter obese. for England IMD 2007 Walsall Walsall deprivation in Warwickshire based on income deprivation of Multiple deprivation (IMD) scores. North Warwickshire Wolverhampton Wolverhampton deprivation and child poverty, with 8% of residents living areas are centred around Nuneaton, Bedworth & North Warwickshire in comparison to England. Sandwell Sandwell Birmingham Dudley Birmingham Dudley % living in income deprived households >=40% and <59% >=30% and <40% >=20% and <30% >=10% and <20% >=5% and <10% less than 5% Bromsgrove Bromsgrove (11) (18) (52) (80) (94) (78) Nuneaton and Bedworth Solihull Solihull Coventry Coventry Rugby suggests that 1 in 5 adults in Warwickshire is a smoker, Warwickshire residents has increased from 5322 in 2002 below shows the number of births by locality for years Warwick district council account for nearly 50% of the Warwickshire. The percentage increase in number of 14%. All district council areas have seen an increase in Bedworth an increase of nearly 19% a total of 150 2002. The total number of births to to a total of 6061 in 2006. The table 2002-6. Nuneaton and Bedworth and number of births across births in Warwickshire from 2002- 6 is the number of births: Nuneaton and additional births in 2006 compared to Warwick Wychavon Wychavon Stratford-on-Avon North Warwickshire Nuneaton & Bedworth Rugby Stratford-upon-Avon Warwick Warwickshire 2002 593 1327 969 1116 1317 5322 2003 582 1378 992 1044 1413 5409 2004 641 1497 1051 1176 1430 5795 2005 625 1465 1064 1029 1430 5584 2006 Increase 659 11% 1577 19% 1113 15% 1189 7% 1523 16% 6061 14% Total Number of Maternities across Warwickshire and District Council 2002-6 Source: ONS Fertility rates are used as a more accurate predictor of birth rates. The rate is the number of births per 1000 resident women aged 15-44 years. There has been a steady rise in the fertility rate for Warwickshire, from 10.5 to 11.4 between 2002 & 2006, which parallels the national picture. However Warwickshire is consistently a factor of 1 lower than the national rate. See appendix 2 for graphic representation. By 2020 there is a projected increase of 420 births (7%) across Warwickshire. With Warwick having the greatest total projected increase of 280 a result of the projected increase in the female population aged 15-44. See appendix 2 for graphic representation. The fertility rate projections do not reflect the current trend of a 16% increase in the number of births, total of 739 from 2002 to 2006 with t he biggest increase of 19%, 350 live births, for Nuneaton and Bedworth. Therefore caution must be taken in projections in live births. It must be noted that projections of increases in the birth rate are subject to fluctuations due to increase migration, economic factors and changes in the local demographics of the local populations. Warwickshire can therefore expect a year on year rise in births of between 0.5% and 3% or between 33 & 181 extra births. Coventry Demographics Variations in percentage population on low income as compared with whole of England Coventry residents are more likely than average to experience income deprivation or child poverty. The teenage pregnancy rate remains above average in comparison to England. Coventry PCT population expansion This is a first cut look at changes to the population since 2001. ONS have recently released revised annual mid year population estimates. These have been published as a result of a substantial and long- term programme of work to improve the population statistics ONS produce, and have increased the Coventry resident population by about 1000. “Ghost” patients The DH recognises list inflation – where GP registers are in excess of ONS estimates. The excess are often referred to as “ghost” patients, and represent individuals who fail to deregister when leaving an area and do not reregister elsewhere (often young adult men), or people returning to the UK for intermittent care, among others. Effectively they are “on the books” but not in contact wit h the service. In 2006 the national (England) GP List figure was 53211253 against an ONS mid year estimate that year of 50762900, giving a national list inflation figure of 4.8%. In Coventry in April 2006, there were 327255 patients on the register compared to the ONS esti mate of 306600, giving a list inflation of 6.7%. List inflation may be higher in urban areas, although we cannot find comparative data. These 2 figures have been used to prepare estimates of actual population size. Registered Resident population This considers:    Exeter Registered resident population Exeter Registered resident less “ghosts” (4.8% and 6.7%) ONS (census and revised mid year projections) Raw counts are given in the table and first graph, and percentage changes in the second graph. Jul-01 Persons (Exeter) Persons (Exeter-ghosts at 4.8%) Persons (Exeter-ghosts at 6.7%) ONS % change (Exeter) % change (ONS) 319390 Jul-02 319961 Jul-03 320489 Jul-04 321931 Jul-05 321542 Jul-06 326097 Jul-07 328162 304059 304603 305106 306478 306108 310444 312410 299268 302,800 .0 0.00 0.00 299803 303,200 .0 0.18 0.13 300298 304,400 .0 0.34 0.53 301649 303,600 .0 0.80 0.26 301285 305200. 0 0.67 0.79 305553 306,600 2.10 1.25 307488 UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST MIDWIFERY SERVICES MANPOWER FIGURES AT 31 MARCH 2007 (Excluding Neonatal Unit Staff) IN POST (WTE) FULL TIME PART TIME 2 3 TOTAL IN POST (HEAD COUNT) 5 STAFF FUNDED ESTAB. (WTE) 1 TOTAL IN POST (WTE) 4 MIDWIVES – BAND 9 MANAGERS AND NONCLINICAL MIDWIVES: MIDWIVES – BAND 8D MIDWIVES – BAND 8C MIDWIVES – BAND 8B MIDWIVES – BAND 8A MIDWIVES – BAND 7 CONSULTANT MIDWIFE MIDWIVES: BAND 7 BAND 6 BAND 5 BAND 7 NON MIDWIVES: BAND 6 BAND 5 NURSERY NURSES MATERNITY CARE ASSISTANTS Please note: ALL GRADES ALL GRADES 28 7 15.74 22.74 35 1.0 1.0 1.0 1 58 80 10 37 22 11 19.40 52.67 3.20 56.40 74.67 14.20 65 108 15 3.0 3.0 0.80 3.0 0.80 3 1 1.0 1.0 1.0 1 Columns 2 and 3 - Column 4 TOTAL MIDWIVES ALLOCATED TO COMMUNITY (WTE) (INCLUDED ABOVE) 32.70 UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST MIDWIFERY SERVICES MANPOWER FIGURES AT 31 MARCH 2007 - NEONATAL UNITS ONLY IN POST (WTE) STAFF FUNDED ESTAB. (WTE) 1 MIDWIVES: ANNP BAND 8A 1 BAND 7 2 BAND 6 1 BAND 5 5 NON MIDWIVES: ANNP BAND 8A 8.2 BAND 7 15.05 BAND 6 21.25 NURSERY NURSES HEALTH CARE ASSISTANTS BAND 5 ALL GRADES ALL GRADES 9.74 3.31 11 1 1 7.4 8.65 1.71 18.4 9.65 2.71 3 4.64 7.64 2 5.02 7.02 3 0 3 0.60 1.06 4 6 1 FULL TIME 2 2 PART TIME 3 TOTAL IN POST (WTE) 4 2 TOTAL IN POST (HEAD COUNT) 5 2 WITH RELEVANT QUALIFICATIONS WTE HEAD COUNT 6 7 2 2 1 8 2 3 1 6 1.6 3 1 8 2 3 10 10 25 15 5 7.02 7.64 18.4 10 10 25 INTENSIVE CARE COTS HIGH DEPENDENCY COTS SPECIAL CARE COTS TOTAL 8 3 16 27 Coventry & Warwickshire Maternity Matters Workforce Planning Report UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST MIDWIFERY SERVICES - WORKLOAD FIGURES AT 31 MARCH 2007 Workload Statistics 1. Total number of births: (a) (b) Hospital Home (planned) (unplanned) (c) 2. 3. TOTAL 5109……... 58……... 27……... 5194……... 3199……... Total number of spontaneous vaginal births Total number of Caesarean Sections (a) (b) Emergency Elective 728……... 494……... 1857……... 4. 5. 6. Total number of epidurals & spinals (Including caesarean sections) Number of midwives qualified to undertake 5……... examination of the newborn 7 more in training Number of midwives performing examination of the newborn 5……... Uhcw/cmc.aor -8- march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Uhcw/cmc.aor -9- march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Number of Mums Delivered 1st April 06 - 31st March 07 by Ethnicity and Age at Delivery Grouped Mum's Age @ Delivery Total 9 31 62 112 191 198 236 234 252 284 262 325 359 283 309 279 269 263 243 230 222 155 129 293 5230 Count of PID Grouped Mum's Age @ Delivery 15 & Under 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 & Above Grand Total (All) Count of PID Ethnic Desc Total Bangladeshi 56 Black/Black Brit Afr / Brit Car 326 Black/Black Brit Oth 29 Chinese 19 Indian 405 No Response 38 Other 195 Other Asian 129 Other Mixed 43 Pakistani 214 White British 3229 White Irish 22 White Other 157 White/Asian 17 White/Black African 58 White/Black Caribean 25 (blank) 268 Grand Total 5230 Uhcw/cmc.aor - 10 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Relationships/networks/stakeholders within the area         Key Stakeholders for the maternity workforce planning events: Midwives – Heads of Midwifery – UHCW, GEH, SWGH Commissioners – Woman & Children‟s – Coventry PCT, Warwickshire PCT Obstetricians – pathway development Maternity Network – Lead, Chair Public Health- Warwickshire PCT, Coventry PCT Health Visitors – Leads – Coventry PCT, Warwickshire PCT Higher Education Institutions – Coventry University See Appendix 3 for Coventry & Warwickshire stakeholder matrix. Section 2 Overview of Current Service National Context Paragraphs for Maternity Workforce Plan 1. National context Maternity Matters: Choice, access and continuity of care in a safe service builds upon the maternity services commitment outlined in Our Health, Our Care, Our Say and is an important step towards meeting the maternity standard set out in the NSF for children, young people and maternity services. The priority is to provide a choice of safe, high quality maternity care for all women and their partners. This is to enable pregnancy and birth to be as safe and satisfying as possible for both mother and baby and to support new parents to have a confident start to family life. For some, especially the more vulnerable and disadvantaged, the outcomes are sometimes unacceptable. Some women are up to 20 times more likely to die from a pregnancy related complication than other women and infant mortality rates are higher in more deprived areas of the country and in more vulnerable or disadvantaged groups. Uhcw/cmc.aor - 11 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Maternity Matters sets out a strategy for improving choice, access and continuity of care that will put women and their partners at the centre of their local maternity service provision. It highlights how commissioners, providers and teams of maternity care pr ofessionals will be able to use the health reform agenda to shape the provision of services to meet the needs of women and their families. The national choice guarantees described in the maternity matters policy are:  Choice of how to access maternity care  Choice of type of antenatal care  Choice of place of birth – depending upon their circumstances, women and their partners will be able to choose between three different options: o A home birth o Birth in a local facility including a hospital, under the care of a midwife o Birth in a hospital supported by a local maternity care team including midwives, anaesthetists and consultant obstetricians. For some women this will be the safest option  Choice of place of postnatal care Future maternity services must be planned to address current challenges including improving outcomes for more vulnerable and disadvantaged families, the reduction in working hours of doctors as a result of the EWTD and demographic and lifestyle chang es. At the same time, the principle should be that pregnancy and birth are normal life events supported by midwives. These changes cannot happen without carefully planned workforce development programmes to ensure that units have the capacity and the skills to deliver services designed around the needs of mothers. In January 2008 the Healthcare Commission published their Review of Maternity Services. A number of components of the review focussed on workforce and provide useful benchmarking data for Trusts and Commissioners to address workforce iss ues. 2. West Midlands’s overview Currently maternity services in the West Midlands provide safe and effective care to the majority of women. The diverse nature of the population poses challenges in providing services which balance finite resources with needs of the individual. In an effort to maximise effectiveness, provision has been historically based on the medical model, centralising care away from communities. The curr ent systems can be inequitable, particularly for vulnerable women and their babies which can be demonstrated by the continuing high perinatal mortality rates of some communities. Uhcw/cmc.aor - 12 march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report The West Midlands "Darzi" Clinical Pathway Group for Maternity and Newborn are recommending that maternity services should b e planned and delivered as a community based service, integrated with primary care, embedded in the wider community provision, with a focus on health and wellbeing. Consideration should be given to meeting future demand growth with community based birthing units. Care should be based on an ongoing assessment of social as well as clinical risk, with targeted outreach support for the most vulnerable women. Midwives should be the lead professional for normal pregnancies, with enhanced public health skills, a new support wor kforce and work within clear pathways to provide women with a network of social and clinical support. There should be rapid and equitable access to specialist services for high risk mothers and babies. This should result in improved satisfaction, stronger engagement with self care support systems, fewer interventions and improved perinatal mortality. The SHA commissioned a review of configuration and sustainability of maternity, neonatal and paediatric services. Health economy reports have been produced to inform local commissioners in terms of the future configuration of these services. West Midlands Workforce Overview In January 2008 the Department of Health announced its intention to increase the number of midwives within the NHS in England – a 1000 by 2009 with a further 3,500 by 2012. This is in part a response to the rising number of births and partly because of the intensified focus on Maternity Matters as outlined in the Operating Framework. NHS West Midlands has forecast overall growth in Midwives of 154 (HC) from 2006- 2009 and of 263 (WTE) from 2006-2012, following returns from all trusts. This is supported by a projected increase of 137 (WTE) in the wider maternity workforce which includes the appropriate deployment of registered nurses and maternity support workers. This creates a total growth of 394 (WTE) in the maternity workforce. The data suggests there is no problem reaching growth in headcount numbers, but given the working patterns of Midwives at present obtaining the estimated 390 WTE by 2012 will require the creation of additional posts within trusts, skill mix changes and increasing return to practice programmes. The two main factors which will have an influence on the availability of Midwives in the future are the current trend in part-time working and the age profile of the workforce. There is an ageing workforce profile within midwifery across the West Midlands with jus t under 23% of the workforce aged 50 years and over in 2007, this reflects the latest national picture. Both of these factors have been considered when developing the MPET commissioning plan. For 2008/9 there has been an increase in the number of midwifery education commissions by 15% that will support the continued growth of the maternity workforce. Uhcw/cmc.aor - 13 march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report There are currently no reported problems in recruiting midwives within the West Midlands. Indeed anecdotal evidence suggests a high ratio of applicants to posts. The West Midlands Workforce Deanery has a comprehensive Maternity Workforce Programme to help units develop the capacity and the skills to deliver services designed around the needs of mothers. This programme includes the following initiatives.  Return to Practice A pilot programme offering 10-20 places will take place in 2008/09. Subject to a successful review this will be rolled out as a phased piece of work. Applicants will be given financial remuneration to contribute towards funding of travel, accommodation and child care arrangements during this programme. EU midwives A training programme is being developed with the Higher Education Institutions to develop EU midwives so they are competent to practice as midwives in the UK. It will cover areas such as, the statutory requirements of a Midwives practice and engagemen t with Supervision, English literacy and effective communication methodologies, decision making, and to support adaptation of clinical skills in to the context of practice environments in the UK. Maternity Support Workers The West Midlands SHA supports the need to make more effective use of the existing workforce and the benefits of skill mix with Maternity Support Workers including the Obstetric Theatre MSW. A West Midlands competency framework for MSWs will be developed in 2008/09 to ensure consistency of approach, transferability and sustainability of the role across the West Midlands. The Programme will include areas such as the public health agenda, working with teenage mothers, breastfeeding (UNICEF training), assisting at home births.   Local Context Access University Hospitals Coventry and Warwickshire NHS Trust serves the populations of Coventry and Rugby. The population is varied and Coventry is a dispersal site for asylum seekers and refugees. The birth rate has risen to more than 5,300 since the opening of the new hospital. Both low risk and high risk services are available within the area. Women are able to refer directly to a midwife at booking and the majority of women are booked for antenatal care by 12 weeks. Each woman is allocated a named midwife to offer continuity of both antenatal and post natal care. Women can access care in their locality at health centres, GP surgeries. All midwives can refer women directly to a Consultant Obstetrician as required. Uhcw/cmc.aor - 14 march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Women requiring Consultant led care can access the antenatal clinics based at UHCW or at Rugby St Cross. Parent education sessions are available to women in a number of settings including local health centres, children‟s centres, hospital centres and in local community projects. Targeted parent education is available for hard to reach communities. Parent education is open to couples, women only, teenagers and to Polish and French speaking women. Choice. Choice is important for women and the majority of women choose to have antenatal care in their locality clinics. Women carry their own pregnancy health care records which contains a wealth of information to enable women and their families to make choices a bout care. Within this document the plan for care is reviewed with women and updated as required with the relevant practitioners. A robust interpreting service is in place and well utilised to enable equity of information sharing and decision making by women. Women can book antenatal appointments that are convenient for women and their partners. Specialist clinics are also avai lable such as joint diabetic clinics, joint obesity clinic, hypertensive clinic etc protocols for referral are clear and accessible to all profes sionals. Ultrasound scans are performed on both the Coventry and Rugby sites, midwife sonographers practice in both areas. Women are offered a choice of place of birth including home birth. 98 women delivered their babies at home in the financial y ear 2007-2008. A set of multi professional guidelines supports health professionals to support women in their choices and to refer women to specialist services for care. Multi-professional working is vital for women with high social risk and complex needs. The maternity unit opened in 2004 and it is a spacious new building. Birthing aids are available, however it is recogn ised that the environment does appear clinical. A birthing pool is available and all rooms have en-suite facilities. Women have a choice about length of hospital stay. A 24 hour epidural service is available from a team of dedicated obstetric anaesthetists . A neonatal intensive care unit designated as level three by the CNN is located adjacent to the labour ward. A transfer team also operates within the Central Newborn network and this is supported by Coventry and Leicester neonatal units. If women require transfer outside of the local service the West Midlands Ambulance Service supports the transfer. The aim is to transfer within the local network where possible. The maternity service has a robust recruitment and retention strategy, however over 2007/2008 a skill mix review has been undertaken and flexible working across hospital and community settings have been developed. It is anticipated that a large number of midwives will be eligible for retirement within the next 5 years therefore driving an up skilled workforce is essential for succession planning. The trust works in partnership with Coventry University to train and retain midwives for the future. Post graduate study is heavily subscribed by midwives of all grade and experience. The neonatal course is also well subscribed. The Trust is committed to Uhcw/cmc.aor - 15 march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report ensuring that staff are updated and normality workshops are delivered in house. Three midwives are currently undertaking the normality module funded by the SHA which is delivered in Shrewsbury. The majority of women currently have postnatal care delivered in the home however the service is currently developing a choice of some post natal care being delivered in children‟s centres and in a local community project. The named community midwife delivers continuity of care and leads the handover of care to other relevant professionals. Breast feeding is promoted in the area and two infant feeding advisors support midwives and mothers to sustain breast feeding . Breast feeding cafes also operate in localities by children‟s centre midwives and peer support workers along with core service midwives. The Trust has been awarded the certificate of commitment from UNICEF. It should be noted that Coventry is a dispersal site for asylum seekers and Refugees, the maternity ser vice accessed interpreters in 47 languages last year reflecting the diverse population accessing the maternity service. Resource has had to be used flexibl y in order to respond to the changing population in the city. This is also borne out in the project reducing Perinatal mortality in improving midwifery practice. Local challenges The maternity service has faced many challenges since moving into the new facility, not least the rising birth rate, challeng es are listed below: 1. Ensuring an appropriately skilled workforce with regular continuing professional development in place Maternity service constantly reviews and reflects upon the recruitment and retention of midwives. It has been highlighted that 47 of the 153WTE midwives will be eligible for retirement within the next 5 years. In 2007/2008 13 experienced midwives retired from the service. UHCW works closely with Coventry University to ensure that appropriate commissions of students are recruited and strategies have been put in place to reduce attrition rates. The University works closely with the Trust to ensure that highly skilled, motivated midwives are fit for practice and employment. All new starters are given a robust induction to the Trust and the department and all midwives, support staff and doctor s are supported into the department A strong in house mandatory training programme is available and accessed by all staff in the department. 1. Healthcare commission, Kingsfund, Durrow, Doctor Foster, Local Supervising Authority review. Uhcw/cmc.aor - 16 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report During 2007/2008 maternity services appear to have been heavily assessed however the Trust scored Best Performing by the HCC and achieved an excellent LSA report. The challenge for the next year is to sustain these excellent ratings as well as improve on the results. 2. Recommendations from National Bodies The Department is working to implement the recommendations of the confidential enquiries paying particular attention to Saving mothers Lives (December 2007). Health inequalities have been identified as an issue and this is important to address due to the changing population in Coventry and Rugby. Obesity has also been noted and a obesity clinic has been set up and will need to be sustained. The maternity service has set up a modified obstetric early warning system which h as been developed locally and shared with neighbours, this will need to be continually reviewed 3. Caesarean section. The maternity team have recognised that caesarean section rates are increasing and need to be reduced. The challenge for the service is to set up a midwifery led (MLU) unit in 2008 and to normalise birth. Midwives are currently undertaking the normal birth module in order to lead the implementation of the MLU. The recommendation for performing 100% placental localisation scan for women who have had a previous caesarean section will be a challenge for the sonography service within the maternity unit. 4. Antenatal screening One local challenge for the maternity service is to implement combined testing, i.e. 1 st trimester screening for downs syndrome (blood test and nuchal translucency screening) This will be challenging for an already stretched scan department, counselling will be more time consuming. There is a need to develop a pathway for diagnostic testing with Chorionic villus sampling (CVS) A fetal Medicine consultant has been appointed and will commence in June 2008. A business case has also been made to appoint a deputy to the current screening midwife The NICE guidelines on antenatal screening (March 2008) also recommends that information on screening should be given before the booking appointment. This is a huge challenge for the local maternity service. Uhcw/cmc.aor - 17 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report 5. Perinatal Mortality Coventry is recognised as having a high Perinatal mortality rate and it is vital that reducing this rate. The reducing Perinatal mortality project is due for evaluation by Coventry University and has been funded for a further period in order to evaluate this. 6. Rising birth rate Coventry has experienced a significant increase in the birth rate since moving to the new University Hospital in December 2004. Coupled with this is that Coventry is a dispersal site for asylum seekers and refugees, this brings women who have altered health issues and are often seen as high risk pregnancies. The number of non- English speaking women has increased and the city has seen an increase in eastern European communities and the polish population in the city has developed. This means that the use of interpreters has expanded and antenatal appointments have lengthened to ensure that information is delivered efficiently and effectively to enable women to make informed decisions about their care. Uhcw/cmc.aor - 18 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Appendix 1 – Local Area Maps Coventry Teaching PCT Uhcw/cmc.aor - 19 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Uhcw/cmc.aor Warwickshire PCT - 20 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Appendix 2 - Chart relating to demographics Warwickshire Crude birth rate 2002-6 Warwickshire and England 13 births per 1000 popualtion 12.5 12 11.5 11 10.5 10 9.5 9 2002 2003 2004 2005 2006 Eng Warks crude birth rates years 2002-6 by district council live births per 1000 resident population 14 13 12 11 10 9 8 2002 2003 2004 2005 2006 NW NB RU SA WK Uhcw/cmc.aor - 21 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Three year rolling average teenage pregnancy rates 19982000 to 2003-5 England and Warwickshire 46.0 44.0 42.0 40.0 38.0 36.0 34.0 32.0 30.0 1998-2000 1999-2001 2000-2 2001-3 2002-4 2003-5 England Warks Three year rolling average teenage conception rates per 1000 aged 15-17 years 1998 - 2005 by district council 60.0 55.0 50.0 45.0 40.0 35.0 30.0 25.0 20.0 1998-2000 1999-2001 2000-2 2001-3 2002-4 2003-5 Warks NW NB RU SA W Uhcw/cmc.aor - 22 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Crude birth rate 2002-6 Warwickshire and England 13 births per 1000 popualtion 12.5 12 11.5 11 10.5 10 9.5 9 2002 2003 2004 2005 2006 Eng Warks Projected live births 2007-2020 by district council 2.00 1.80 1.60 1.40 NW NB RU SA WK thousands 1.20 1.00 0.80 0.60 0.40 0.20 0.00 Uhcw/cmc.aor 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 20 19 20 20 - 23 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report 0 0 Number of live births 00 ward (2006) by 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 33 0 0 0 0 0 0 0 0 0 0 0 0 43 43 0 0 38 38 0 0 0 0 0 0 0 0 35 35 52 52 42 42 31 31 55 55 43 43 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39 39 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27 27 0 0 0 0 0 0 36 0 0 36 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23 0 0 0 0 0 0 0 0 00 23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 31 23 23 0 0 0 0 0 68 68 40 40 54 54 123 123 125 125 104 58 104 58 95 84 95 84 119 119 130 61 130 61 94 94 36 36 31 31 0 0 77 73 77 73 34 34 101 124 101 124 110 110 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 61 61 9 9 68 68 107 107 9490 94 90 99 99 51 51 104 104 124 124 144 144 37 37 114 114 51 51 17 17 33 33 40 40 78 78 79 79 52 52 10 10 0 0 0 0 0 0 0 0 0 00 0 00 0 0 0 0 0 0 0 0 52 52 49 49 75 80 75 80 82 118 82 118 57 118 118 60 57 45 45 306056 51 30 56 51 39 39 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17 17 57 57 0 0 0 0 40 40 22 22 66 66 142 142 23 23 30 30 67 67 12 12 30 30 41 41 11 11 25 25 73 31 73 31 86 86 75 75 18 18 25 25 21 21 0 0 55 55 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 71 71 58 58 32 32 28 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 28 37 37 17 17 16 16 20 54 20 54 Births trend 2002 to 2006 Increasing (49) Decreasing (19) 18 18 Source: Public Health Births File 2002-2006 Uhcw/cmc.aor - 24 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Projected population: Females aged 15-44 2007 - 2020 35 30 25 Wk SA RU NB NW Thousands 20 15 10 5 0 2007 2008 2009 201 0 201 1 201 2 201 3 201 4 201 5 201 6 201 7 201 8 201 9 2020 Uhcw/cmc.aor - 25 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Coventry Appendix 3 - Coventry & Warwickshire Stakeholder Matrix HIGH LMC GP’s POWER SAFE GUARDING CHILDREN BOARDS ACUTE TRUSTS LOCAL AUTHORITY AMBULANCE TRUST WOMEN / CLIENTS NCT TRADE UNIONS HEI’S VOLUNTARY SERVICES LOW INTEREST HIGH MEDIA COMMISSIONERS OBSTETRICIANS MIDWIVES HEALTH VISITORS PROFESSIONAL BODIES SHA Uhcw/cmc.aor - 26 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Current workforce Staff by ethnicity (Midwives and support workers) Ethnic Group Black/British African/ British Caribbean Chinese Indian Other Asian Other mixed Pakistani White British White Irish Total staff (Head Count) Band 8 1 Band 7 Band 6 2 Band 5 Band 2 1 Total 4 2 2 2 3 3 8 3 1 29 4 116 3 16 36 200 8 222 Uhcw/cmc.aor - 27 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Appendix 4 – Workforce profiles Insert charts for workforce by pay band; age profiles; Length of services profiles; ethnicity; part-time v. fulltime Maternity Workforce Age Profile AGES 21-30 YEARS 31-40 YEARS 41-50 YEARS 51-60 YEARS Over 60 YEARS Total TOTAL 28 48 110 27 9 222 Midwives Support 20 36 98 23 3 8 12 12 4 6 Length of Service- Midwives and support workers >10 years 104 >5 Years 98 <5 years 20 Uhcw/cmc.aor - 28 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Pay Bands UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST MIDWIFERY SERVICES MANPOWER FIGURES AT 31 MARCH 2007 (Excluding Neonatal Unit Staff) IN POST (WTE) FULL TIME PART TIME 2 3 TOTAL IN POST (HEAD COUNT) 5 STAFF FUNDED ESTAB. (WTE) 1 TOTAL IN POST (WTE) 4 MIDWIVES – BAND 9 MANAGERS AND NONCLINICAL MIDWIVES: MIDWIVES – BAND 8D MIDWIVES – BAND 8C MIDWIVES – BAND 8B MIDWIVES – BAND 8A MIDWIVES – BAND 7 CONSULTANT MIDWIFE MIDWIVES: BAND 7 BAND 6 BAND 5 BAND 7 NON MIDWIVES: BAND 6 BAND 5 NURSERY NURSES MATERNITY CARE ASSISTANTS ALL GRADES ALL GRADES 28 7 TOTAL MIDWIVES ALLOCATED TO COMMUNITY (WTE) 15.74 22.74 35 1.0 1.0 1.0 1 58 80 10 37 22 11 19.40 52.67 3.20 56.40 74.67 14.20 65 108 15 3.0 3.0 0.80 3.0 0.80 3 1 1.0 1.0 1.0 1 32.70 Uhcw/cmc.aor - 29 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Section 4 Delivering the vision. In order to deliver the vision for maternity matters Coventry and Warwickshire have set up a Maternity Matters Network in order that all areas can deliver the vision across the healt h economy and share good practice. The Coventry maternity service has been reviewing skill mix, roles and responsibilities and developing a flexible workforce over the last three years. There has been excellent partnership working with Coventry university in order to commission an appropriate number of student midwives in order to fill the expected shortfall of qualified midwives in the future. The UHCW midwifery team have been actively involved in curriculum planning with the university in order that midwives have the appropriate skills to implement and continue the maternity matters agenda for the future. The midwifery team have committed to enabling midwives to practice the art of midwifery by removing non-midwifery roles from midwives and this will be further developed over the next year. Midwives are being supported to normalise birth and there is a plan to develop a midwifery led unit in the West Wing. Choice. In order to deliver the choice agenda several areas are currently under exploration:     Increasing the choice of place of birth including home birth by reviewing on call systems and developing the night midwifery practitioner. Developing postnatal clinics in children‟s centres in order that women have a wider choice about postnatal care and sign posting to the multi-professional team. Ensuring that midwifery led care is fully implemented The community midwifery team delivers continuity of midwife in both the ante and postnatal period, this needs to continue with the integration of rotational midwifery posts. Access The midwifery team are committed to ensuring that women can access local care. It is vital that both midwifery and obstetric care is available in both Coventry and Rugby. There are 19 children‟s centres in Coventry and midwifery supports the children‟s centres parent education is also available in locality centres. Currently there are 87 antenatal clinics in GP surgeries and health centres across Coventry and Rugby each week. There are 7 parent education sessions held in a variety of s ettings including Uhcw/cmc.aor - 30 march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report children‟s centres. The vision is to review the timings of services in the community and to make access easier for hard to reach communities. Action Plan        Continue to recruit as posts become available Retention of staff remains robust Work with the Trust to implement the recommendations of the birth rate plus assessment Continue to review student commissions annually Expand on the normal birth commitment and develop the midwifery led area. Continue the robust mandatory training programme which is in place and constantly review the training needs of midwives and support staff Develop the maternity care support worker particularly in community Implementation and review.       Staff consultation and focus groups for midwifery led unit. Ensure risk manager is involved in implementation Work with local communities and centres to enable more access to flexible antenatal and postnatal clinics Continue negotiation with Trust to increase staffing establishments as recommended by birth rate plus Continue to review skill mix and roles Review training needs and programmes Uhcw/cmc.aor - 31 - march2008 Coventry & Warwickshire Maternity Matters Workforce Planning Report Appendix 5 – Local Choice Agenda Current Position across Coventry & Warwickshire for Place of Births (figures are for annual total births in each unit) Home Births – 4% Midwifery Lead Unit Births – 0% Hospital Births – 96% Position in 1 year Across Coventry & Warwickshire for Place of Births Home Births – 4% Position in 2 years Across Coventry & Warwickshire for Place of Births Home Births – 5% Midwifery Lead Unit Births – 20% Midwifery Lead Unit Births – 40% Hospital Births – 50% Hospital Births – 50% Position in 5 years Across Coventry & Warwickshire for Place of Births Home Births – 10% Midwifery Lead Unit Births – 50% Hospital Births – 40% Uhcw/cmc.aor - 32 - march2008