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					                                                              AGENDA ITEM 19
                                                               ENCLOSURE 15


           REDDITCH AND BROMSGROVE PRIMARY CARE TRUST


REPORT TO            PCT BOARD

REPORT FROM          ALISON WALSHE, DIRECTOR OF COMMISSIONING
                     AND MODERNISATION

SUBJECT              WORCESTERSHIRE MATERNITY SERVICES REVIEW

Recommendation
This report is for information.


Attached are the draft terms of reference for the maternity services review being
undertaken by the three Worcestershire PCTs and acute hospital. It is being
led by a management consultant.

The preliminary meeting was held on 1 September and the two review days are
on 9 and 10 September. I will be able to report more at the Board meeting if
required.




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                                                             AGENDA ITEM 19
                                                              ENCLOSURE 15

                    Worcestershire Maternity Services – A Review

1      Reasons for the Review

       There are two main reasons why this Review of Worcestershire’s
       maternity services is taking place:

       1       Worcestershire Acute Hospitals NHS Trust and the three
               Worcestershire PCTs want to make sure that maternity services
               throughout the county continue to be safe and of the highest
               possible quality.

       2       Services cannot continue as they are now because:
                  Working hours of all doctors have to be reduced in order to
                   comply with the European Working Time Directive. This must
                   mean changes to the number and organisation of medical
                   staff working in maternity services.
                  Several recent national reports about maternity services must
                   be taken into account and their recommendations
                   implemented.

       The need for this Review was confirmed by the Clinical Convention held
       in June 2004. This Convention involved Worcestershire Acute Hospitals
       NHS Trust and the three Worcestershire PCTs. It looked at acute
       hospital services across the county and work has already started on
       ophthalmology services, with other areas being addressed in the near
       future.

       This review is not about saving money. All NHS organisations must,
       however, ensure that they are using their financial and human resources
       most effectively and the financial position of Worcestershire’s NHS
       organisations make this particularly important locally.

2      Terms of Reference

       The Terms of Reference proposed for the Review are:
           To understand and describe the strengths and weaknesses of
             current services, including comparisons with national standards.
           To understand and describe the main influences on future
             services, including:
                o Trends in birth rates, interventions and outcomes
                o Preferences of women and their partners
                o Trends in clinical care
                o Changes in national policy
           To consider options for the future organisation of maternity
             services.
           By the end of September 2004, to recommend actions that should
             be taken, with timescales, for achieving responsive, sustainable,


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                                                                  AGENDA ITEM 19
                                                                   ENCLOSURE 15

               high quality maternity services within realistic financial and staffing
               assumptions.

       The review will focus on maternity services provided by Worcestershire
       Acute Hospitals NHS Trust. Maternity care provided by Worcestershire’s
       general practitioners and by specialist centres outside Worcestershire is
       not part of the Review. The impact of the Worcestershire Acute
       Hospitals’ services on general practitioners and specialist centres will,
       however, be considered. Similarly, community midwifery and paediatric
       services provided by Worcestershire Acute Hospitals NHS Trust are not
       the focus for the Review. The interface with and impact on these services
       will be considered.

3      Approach

       A Review Team made up of the major stakeholders in Worcestershire’s
       maternity services will look at available information, meet key groups and
       individuals and draw conclusions and recommendations. The approach
       may change as a result of discussion with relevant stakeholders (see
       ‘preparation’ below).

       The work will have five phases:

A      Preparation

          The proposed approach will be discussed with relevant stakeholders,
           including Maternity Services Liaison Committee Chairs, Patient
           Forum Coordinators, staff within Worcestershire Acute Hospitals NHS
           Trust and the three Worcestershire PCTs and the Worcestershire’s
           Health Scrutiny Committee. Changes may be made to the approach
           as a result of these discussions.
          A press release will be issued. This will include an address to which
           any comments about Worcestershire’s maternity services should be
           sent. MPs will also be briefed.
           Arrangements for the Review Workshop will be made.

B      Gathering information

          Relevant information will be gathered, including local and national
           reports on maternity services. Activity, staffing and financial data
           about current services, trends in these data and national comparisons
           will also be collected. This information will be brought together in a
           Briefing Report.
          The Review Team will meet to consider the Briefing Report and agree
           the main questions that should be asked of the groups and
           individuals.
          Users’ experiences and the issues that service users consider are
           particularly important will be gathered through:


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              o Focus groups with service users in Worcester, Kidderminster
                 and Redditch.
              o Surestart Coordinators will be asked to obtain views of families
                 with young children in each of their areas.
              o A meeting will be held with chairs of groups representing
                 service users (AIMS, NCT and Maternity Alliance)
           Other questions for these groups may be identified at the Review
           Team’s initial meeting. The findings will be presented to the Review
           Team during the Review Workshop (see below).

C      Review Workshop

          A two-day workshop will be held. The Review Team will look again at
           the Briefing Report, meet key groups and individuals in order to listen
           to and understand their perspectives, and reach conclusions and
           recommendations.
          At the end of the Workshop there will be feedback on the initial
           conclusions and recommendations.
          A draft report will be written summarising the findings, conclusions
           and recommendations of the Workshop. This will be circulated for
           comment to members of the Review Team and those people who
           gave information and views to the Team.

D      User views on conclusions and recommendations

       The purpose of this phase of the work is to check whether the Review
       Team has missed any issues or concerns from service users – and
       therefore whether these issues have not been taken into account in
       reaching the conclusions and recommendations. The findings,
       conclusions and recommendations of the Review Workshop will be
       discussed with:

        Focus Groups in Redditch, Kidderminster and Worcester – ideally
       with the people who were involved in the initial meetings. .
        SureStart Coordinators will be asked to obtain comments from
       families with young children.
        A meeting will take place with groups representing service users
       (AIMS, NCT and Maternity Alliance)

       The views of users will be presented to the final meeting of the Review
       Team (see below).

E      Finalising report

       The Review Team will meet in order to consider the draft report.
       Feedback from the user views (see phase D above) and any other
       comments will be received. Changes may be made and the Review
       Report will be finalised.


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                                                              AGENDA ITEM 19
                                                               ENCLOSURE 15

4      Timetable

       The Review will be conducted according to the following timetable:

          July / August         Preparation
                                      discussion of approach with key stakeholders
                                      preparation of Briefing Report
                                      arrangements for Focus Groups & SureStart
                                  involvement
                                      arrangements for meetings with organisations
                                  representing users
                                      arrangements for Review Workshop
          1st September         Review Team consider Briefing Report and agree main
                                questions
          2nd – 8th September         Focus Groups with service users
                                      SureStart Coordinators obtain views
                                      Meeting with organisations representing users
                                      Focus Groups with community and hospital-based
                                  midwives
                                      Briefing, including main questions, sent to all who
                                  will meet the Review Team
          9th & 10th            Review Workshop
          September
          13th September        Briefing produced for Focus Groups, SureStart
                                Coordinators and organisations representing user views
          14th – 22nd                 Focus Groups with service users
          September                   SureStart Coordinators obtain views
                                      Meeting with organisations representing user
                                       views
          17th September        Draft report circulated
          23rd September        Review Team agrees final report
          30th September        Final report completed

       NB. More detail of each phase is given in section 3 (above).




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