Agenda item

Senior representatives of North Tees and Hartlepool NHS Foundation Trust (NTHFT) were once again present to give a further update on developments in relation to the Trust’s maternity services. This was the third such update following issues raised by the Care Quality Commission (CQC) in 2022 regarding NTHFT maternity provision, with the Trust asked to also include details of the review of its community midwifery offer after concerns were raised by the Committee in early-2023.

Led by the NTHFT Associate Director of Midwifery and supported by the NTHFT Director of Nursing, a presentation was given which covered the following:

·       Perinatal Organisational Structure: The key difference to the structure outlined during the previous update in November 2023 was the addition of the ‘Group Executive Team’ which reflected the ‘Group’ model NTHFT and South Tees Hospital NHS Foundation Trust (STHFT) was now operating under.  All other roles within the structure remained the same.

·       Maternity CQC Position: Responses undertaken in relation to the five ‘must do’ (and one ‘should do’) actions identified by the CQC in 2022 were highlighted – these formed an important part of the Trust’s maternity safety support programme.  Progress had been presented to the NTHFT Board in order to provide assurance around compliance – sustaining (and continuing to monitor) this was vital.

·       Maternity Improvement Plan: Noting that the North East and North Cumbria Integrated Care Board (NENC ICB) now had oversight of NTHFT maternity service quality, several elements associated with improving the local offer were outlined, including the Maternity Incentive Scheme which saw the Trust compliant for year 5 (the first time this had been achieved for some time – a great credit to staff) and on-track for compliance in year 6.  In response to the results of the CQC Maternity Survey 2023, work around new methods for induction of labour was another key focus, with efforts being made to improve the labour experience by moving away from outcome-driven pharmaceutical interventions, and towards more mechanical methods which enabled women to return home during the process (if appropriate).

From a workforce perspective, there was currently only three whole-time equivalent vacancies within the whole service, a significant improvement on the staffing situation this time last year.  Following responses to previous CQC surveys / inspections, the Trust was also involved in a national perinatal culture and leadership programme.  NTHFT recognised that culture impacted upon recruitment and retention, and this initiative would help identify priorities for the perinatal service.

·       Service Improvement: Continuing the theme of enhancing provision, feedback on work to improve the community offer was relayed.  NTHFT had aimed to expand the choice of community-based appointments (along with how these were communicated / promoted) and had established more flexible service timings to fit in with the contrasting work patterns of pregnant women.  Short bite-sized videos were being produced in conjunction with Teesside University to assist with parental education, and the Chair of the Maternity and Neonatal Voices Partnership (MNVP) was continually involved in discussions to strengthen local provision.

NTHFT was also mindful of its CQC Maternity Survey results and welcomed (and took note of) the CQCs national review on the state of maternity care.  Key issues around personalised care (the Trust was working with Local Authorities in relation to an individuals’ other linked care needs), data intelligence, outcomes delivery and workforce were noted, as was the positive feedback received on post-natal provision (an area which had previously prompted concern).  Fundamental principles for maternity services were being addressed in the current maternity improvement plan (co-produced by the MNVP group), though it was acknowledged that limitations with the estate / facilities impacted upon what the Trust could deliver.

·       Maternity and Neonatal Three-Year Service Delivery Plan: Four themes involving service standards and structures, workforce, culture underpinned this plan.  NTHFT was around 75% through each of these themes – this plan will be re-visited to take into account the Trust’s CQC Maternity Survey results and the CQC national review of maternity care.

·       Maternity and Neonatal Voices Partnership (MNVP): An infographic summarising the MNVPs plan of work for 2024-2025 showed a range of activity which was contributing towards local maternity provision.  This included various engagement mechanisms to hear from those who had experienced services, holding in-person sessions, running local events, and specific focus on bereavement, labour induction, consent, mental health, pelvic health, and infant feeding.

·       Clinical Research and Quality Improvement: As an ongoing process (and to avoid becoming complacent), NTHFT had undertaken 10 research and 14 quality improvement projects involving a multi-professional team approach and multiple principal investigators.  An incorporated graphic demonstrated the Trust’s significant progress on reducing major bleeds following childbirth (an issue for NTHFT in early-2023) – this reflected a focus on ensuring women were fit to go into labour (aided by the development of a risk assessment tool).

·       Successes: The implementation of BadgerNet, an electronic patient record which NTHFT was looking to link to other Trusts who also had this, had been well received by those using maternity services (though the Trust was also conscious of the issue of digital exclusion).  Reducing the workforce vacancy rate, the trialling of a nursing associates’ role, offering more community appointments from family hubs, and refurbishing the bereavement suite (following feedback that it felt overly clinical) was also highlighted.  Staffing-related developments involving the creation of a specialist infant feeding role within the community offer, as well as scoping a project for support workers within the post-natal ward, were further examples of enhanced provision.

The Committee was pleased to see evidence of improved service provision (something the CQC was fully aware of due to its regular engagement with the Trust) and commended the direct link to the NTHFT Board in terms of monitoring quality – the emerging NENC ICB oversight of the maternity offer was also an interesting development.  Welcoming the positive work around recruitment and retention, Members asked whether individuals could access BadgerNet-related information via the NHS app – it was stated that BadgerNet was a separate app which the Trust hoped to link to individual care records next year.

Following a query around apprenticeships, NTHFT noted its ongoing attention on developing the future workforce, with students coming to the Trust for placements.  However, there was no midwifery-specific apprenticeships locally, something NTHFT was liaising with Teesside University to address, with efforts potentially aided by the strengthened voice which the ‘Group’ model between NTHFT and STHFT brings.  Both Trusts offered different training experiences for midwives.

Praising the value placed upon the crucial issue of infant feeding (often a large concern for new parents), the Committee sought assurance that post-natal thinking included considerations around health visitation.  Acknowledging that family support was not the same for everyone, NTHFT stated that health visitors had a key role which also helped with the introduction of antenatal contact, and was just as important from a post-natal perspective as pre-birth.  Whilst improvements had been seen in this element of maternity provision, better links with the health visiting offer was needed.

Finally, Members asked if the new Community Diagnostic Centre in Stockton town centre would include any maternity testing provision.  NTHFT representatives in attendance confirmed that there were no current plans for this, though it had not been ruled out for the future.

AGREED that the North Tees and Hartlepool NHS Foundation Trust (NTHFT) maternity services update be noted.