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Bring us your experiences of maternity services – Baroness Julia Cumberlege

The National Maternity Review is led by Baroness Julia Cumberlege. At its latest meeting the review team discussed vital work gathering wide ranging views of maternity services:

The national maternity review is gathering pace.

This week I am thrilled to be visiting Sweden and Denmark with review members to see what we can learn from the innovative approaches to maternity services in these two countries. I will let you know what we discover.

The review’s most recent meeting had some difficult but very important discussions, as well as encouraging updates on our work.

Listening to people’s experience of maternity services and gathering insights from midwives, doctors, nurses, managers, commissioners and other health professionals is absolutely central to the work of the review. For that reason, we have worked hard to create a communications and engagement plan that will help us to have these conversations.

At our latest meeting, the review panel discussed and endorsed the plan, I hope to blog about it in the near future.

We had a challenging but important conversation about how best we can hear the opinions and experiences of those who have had very poor experiences of maternity services. It is important that we help these people to contribute to our review, and we have more work to do on this vital aspect of our work.

Finally, panel members provided updates on the following workstreams:

  • Culture and accountability
  • Models of care
  • Choice
  • Levers and incentives

It was fantastic to see that plans are well underway for each of these areas of work. Look out for more details on this blog in the coming weeks.

In the meantime, if you want to be kept informed about the progress of the review, including receiving details of how you will be able to input and have your voice heard, please send your contact details to england.maternityreview@nhs.net

The National Maternity Review team’s terms of reference were published in March.

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21 comments

  1. Dear Julia

    We were commissioned by NIHR to do a project on the outcome of pregnancy by time of day, day of the week and season of birth. If all had gone well, results would have been available now and could have been submitted to the review. A lot of claims are made about ‘out of hours’ births, but there is a dearth of evidence about the situation in England, which is why we applied for funds to do the project. You can find the lay summary on the above web site.

    Unfortutanately, we have experienced extreme delays in getting data from the Health and Social Care Information Centre for the project, making it 15 months behind schedule. We have managed to rescue it from being cancelled, but are only at the early stages, and it will be some months before we have results. As you can understand, this is very frustrating and we are sorry to miss the opportunity of feeding them into your review.

    Best wishes, Alison Macfarlane

  2. Vanessa Barrett says:

    Tariff arrangements for funding ante-natal and post-natal care

    The current NHS tariff funding arrangements for people who need a number of out-patient consultations and investigations before hospital admission for elective surgery means that each element of the patient pathway is costed separately. People requiring elective surgery are actively supported in expressing their choices.

    Choices for pregnant women however are specifically restricted by the NHS funding systems. The whole cost of the many months of ante-natal and post-natal care is awarded to the Trust which provides the single delivery event. This means that women who have to give birth in a consultant obstetric unit because of their level of risk do not have a choice about receiving local ante- and post-natal care, if it is provided by a different Trust. In a rural county, such as Shropshire, this causes a real problem for many families.

    People who live in the West of Shropshire say they would find it much more convenient to go to a consultant unit in Hereford or Wrexham than to the Shropshire Women and Children’s Centre in Telford. However the way the tariff works means the Shrewsbury and Telford Hospital NHS Trust would not get paid for providing their ante and post-natal care. Similarly, women who live over the County borders in Cheshire, Wales, Staffordshire or Worcestershire who would like to have their low-risk delivery in a conveniently local midwifery-led unit in Shropshire may not receive local care throughout their pregnancy and the post-natal period from their local Trust. You have published Angela Clark’s comment about having to go to Stoke from Stafford. The excellent Women’s and Children’s Centre at Telford would be far closer for her family, but such choices are not offered.

    In summary, a decision made for bureaucratic convenience about tariffs is adversely affecting a woman’s right to choose.

  3. LYN says:

    Employed by NHS in maternity services since 1969 to retirement 2012 ,many changes good and bad .90% Of shifts had no proper breaks throughout my working life ,always short staffed and demanding .I loved my job as a midwife and worked in England Wales and Scotland . Firstly ,I believe patients were always priority ,but patients given conflicting advice on breastfeeding ,eg. nipple shields unnecessary as they either could not be bothered to aid latching on ,or did not know how to assist (unqualified maternity helpers) there was always a check list before discharge on baby care eg. bathing ,feeding ,sterilizing,and on early discharge this was followed up at home.Paperwork was repetitive and the computer added to extra work repeating everything on paper. Postnatal wards staff were pulled from when Birthing suite got busy ,Birthing suite staff pulled into theater leaving staff with labouring patients short ,you as a midwife we asked at a moments notice to leave your area and work elsewhere including neonatal ward . Assessment on the phone I could not come to terms with as I told every patient to arrive for assessment ,as no one is text book ,and there are no two labours alike , and different pain threshold varies per patient . Difficulties with too many visitors in the birthing suite ,it was difficult to get a rappor with the labouring patient ,and if you got it ,the patient trusted you and things went well with a more relaxed patient .I can say with my head head high I never lost a baby or mum throughout my career and solved problems before they happened and that is how it should always be .

  4. Daphne Mercer says:

    I write this as my daughter is on holiday. She lived fifteen miles from the West Cumberland Hospital when she went into labour from the wilds of the Wasdale Valley.
    She had a difficult birth which involved blood transfusions and was kept in a week.
    There is no way she could have got to Carlisle fifty miles plus if that had been the only option.
    As for my other daughter, as soon as she went into labour she stayed with a friend ten minutes away from WCH just in case of complications!

  5. Jon Ward says:

    I understand that you wonder why the Carlisle event that you have just hosted had so little representation from West Cumbria.
    It seems nonsensical that you expect people to travel 40 miles to complain about having to complain about travelling 40 miles for maternity care.
    Your approach to this particular aspect of the problem is so clearly flawed that it leaves any findings open to challenge – which would be unfortunate, as I think we all want the best solution.

  6. janine race says:

    I understand there is a National Maternity Review Regional Event on 17 September from 9am to 7pm in Sheffield – venue tbc – can you give me more details and who I need to contact to book Audra Muxlow, Head of Midwifery at The NHS Rotherham Foundation Trust onto the event?
    I’ve been on the Website but it does not show the Sheffield event on 17 September.
    Thanks, Janine Race, PA to Audra Muxlow

  7. Susan Kneill-Boxley says:

    When my daughter was delivered in Stafford Hospital in 2004, I ran into difficulties and ended up having an emergency cesarean. I do not think my daughter or myself would be here today if I would have had to be transferred to Stoke. Please keep a fully functioning maternity unit in Stafford. It is so sad that, even as the county town, we are losing so many of our services and, into the bargain, endangering lives.

  8. Angela Clark says:

    We are finding as a family that we are concerned about not having a Consultant led Maternity Unit at Stafford. My daughter recently had to give birth at Stoke was assured support and the possibility of having her baby in the Midwife led Unit at Stoke but due to shortage of staff and beds ended up doing most of her labour in the Assessment Unit with no pain relief until 10 cms. My daughter coped very well due to support from a Private doula and her husband. What happens to those who can’t afford extra support and also maybe no partner. My daughter has OCD and needed to be in a relaxed environment not on a noisy Assessment Unit. They also live in a Village just outside Stafford and it took them an hour to get to Stoke. My younger daughter is now due a baby at Christmas and certainly it creates more anxiety for mums if they know they have an hours drive before getting to the hospital. At peak traffic time it takes an hour to Stoke. Also as a family who go back generations it seems sad that no more babies are going to have Stafford on their birth certificate or at least very few as the midwife unit is only taking deliveries of those who have no complications even minor ones. Certainly we need more midwives on the wards as they also experience very stressful times due to shortage of staff. The midwife who did deliver my grandson in the end was excellent and they should all be commended for the excellent work they do under difficult circumstances. Any review is welcomed and can only promote good practice. Regards Angela Clark

  9. Jenny Clarke says:

    We have to look back on mistakes made and also positive accomplishments made by those working in maternity services in order to learn and to move forwards . There are lots of driven staff in the NHS who are making a difference by being active on social media check out. http://matexp.org.uk and #MatExp
    We all appreciate these updates as we care and value our maternity services

  10. Mr Brian Valentine says:

    Thank you for the promised up date and I note your desire to hear from the patients who have been through their local systems. At present I’m not sure how the local populations have been notified either of your existence or how ‘easily’ they can access your information input. I only heard because of a link to the Eastbourne ‘Save the DGH’ organisation via our Chairlady.

    Could I suggest that an e flyer to all the national & local papers across the country might not go amiss. I know the setting up of the National Maternity Review was published in the National Press but I think you may be surprised at just how many people have no idea of its existence, do not know of its wish for input from the ‘coal face’ or’ unfortunately’ actually believe it will make any difference to the present way maternity services are being delivered to smaller areas, like Eastbourne.

    Where a once complete hospital service within a reasonably close and accessible proximity has been decimated to the detriment both the clinical and financial disadvantage of many patients; especially those less well off than any of the members of your Committee; in all core services, not just maternity.

    There is a CQC report of ‘No Confidence’ and an East Sussex HOSC report with a similar response having found they were not told the truth by the Clinical organisations that were supposed to protect & provide the populations health. It’s not, generally, the clinical staff that appear to be at fault I should add.

    As a former local obstetrician who worked hard to build up services that could be equated to Nottingham and Oxford at the basic levels I must admit I am horrified at the way things now seem to be working, With greatly increased numbers of staff. My daughter-in-law has just had her second baby and in some ways she and the baby ‘got away with it’ but when she had to return with a problem 3 days later there was no obstetric consultation or even discussion with a Consultant on call in Hastings, or an Eastbourne midwife, before she was discharged to her GP by A & E. {Eastbourne has no Consultant O & G service and the anbulance took her to Eastbourne DGH. But, of course, she was told to get herself to Hastings if anything should recur so nobody could be ‘blamed’ as is so often the way today across so many fields of work.

    Smaller units will always have to ‘ship’ some cases out to better facilities, especially new born babies, but that said ‘big’ is not necessarily beautiful or best although they invariably do have more staff at all levels due to their training roles which does not always mean greater experience in the long run. You can only do one thing at a time even if we often wish that were not the case.

    I would happily answer any questions should you feel it helpful to your deliberations.

    Brian Valentine

  11. stephanie pease says:

    Thank you for the update.

    It is clear that the review body is working at pace to evaluate current services and ultimately develop a proactive, service user focused maternity service which is truly fit for purpose.

    As a Matron for Women’s Health and Maternity Outpatient services in a small DGH i would welcome any opportunity to particulate in this review.

    thank you,

    Stephanie Pease

    • NHS England says:

      Thank you Stephanie. We would love for you to be involved, please keep an eye on this website for details of our local events. There will also be an opportunity for everyone to have their say online.
      Kind regards
      Maternity Review Team

  12. Vicky says:

    When my son was born in 2008 he got stuck and despite being called numerous times a Dr didn’t arrive to assist the midwives. He now has erbs palsy and has a metal plate and screws in his wrist and 2 ops under his belt by 6. We have to do physio and see other specialist to deal with other issues that stem from his traumatic birth. I wasn’t told about his issues and then when I was I was misinformed that it would heal itself. When I complained I would have accepted an apology..Instead I got 4 pages of excuses and lies turning the blame on me. I have now instructed solicitors on my son’s behalf. It’s a shame that due to lack of staff and rising numbers of births thus happens all to often across the UK.

  13. Dick Wallis says:

    As discussed with Baroness Cumberlege in Newick on 1st May 2015, we are particularly interested in the contribution to the safe care of both mother and child which can be made by new technology. In this context, we mentioned our electro-mechanical NextStep neonatal resuscitation device which combats the problem of bronchopulmonary dysplasia, replacing the much less reliable manually-operated bag valve masks and T-piece units. Will your review consider all aspects of new technology in this vital field, and the care of infants as well as mothers?

    • NHS England says:

      Dear Dick, thank you for your contribution. It is not within the remit of the Review to appraise new technology but we will raise the general point about the possibility of new technologies improving outcomes for mothers and babies with Review members.
      Kind regards
      Maternity Review Team

  14. Elizabeth Turner says:

    Thank you for this update – it is much appreciated. I would like to raise several questions:

    As well as visiting Sweden & Denmark to see innovative approaches to maternity services, please can you give an indication of where in the UK you will be travelling to to see the innovative work going on within the NHS?

    As well as listening to experiences of families who have had very poor experiences of maternity care, will you also be engaging with familes who have had exceptionally good experiences? Specifically:
    -families who have had very high risk pregnancies or poor outcomes but who have still recieved outstanding care.
    -familes who have had uncomplcated pregnancies with low-risk physiological births with no intervention & outstanding care.

    I am concered that the Maternity Review may not reflect the majority of experiences. I have sent my contact details via email & twitter some months ago but have yet to hear anything.

    • NHS England says:

      Dear Elizabeth, the points you raise are very important. First, we do hope to share our itinerary of visits to maternity services in the UK and our regional engagement events very shortly. There is lots of innovative practice happening across the UK and it is important that we share best practice. It is vital that we reflect the full breadth of experiences, as you say, and we certainly plan to hear about the scenarios you outline. Finally, we hope you have now received an email communication from us! If not please email england.maternityreview@nhs.net.
      Kind regards
      Maternity Review Team

  15. Hilda Yarker says:

    When/where will the Communications and Engagement Plan be published to,enable service users and citizens to I derby and how they can provide feedback? Are you developing a digital platform? Designing services for the future should also clued conversations with the next generation of maternity service users, how will this cohort be engaged with?

    • NHS England says:

      Dear Hilda, yes, we will share our plans to engage with citizens and service users, including through our digital platform. Please look out for updates on this website.
      Kind regards
      Maternity Review Team