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ENGAGEMENT REPORT Midwife Led Unit Review Stakeholder Briefing

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ENGAGEMENT REPORT Midwife Led Unit Review Stakeholder Briefing ENGAGEMENT REPORT Midwife Led Unit Review Stakeholder Briefing – 24 October 2018 On Wednesday, 24 October, 2018, a Midwife Led Unit (MLU) Review stakeholder briefing organised by NHS Shropshire Clinical Commissioning Group (CCG) and NHS Telford & Wrekin CCG took place which was attended by over 60 people. This included people involved in the MLU Review decision making process (27), working in or with midwifery led services (26), those who have recently used or are using maternity services (7) and other people who didn’t fit into any of these specified groups (2). The workshop aimed to provide a reminder of the rationale for the review, what’s happened so far to bring everyone up to date, what the evidence is telling us and describe what local clinicians believe is the vision for the future. There was one main group exercise during the day where attendees were asked to feedback on the proposed new service, ideas for improvement, and if there was anything missing. There was also the opportunity to inform the consultation plan with group work on helping to inform target audiences and methods of communication. In addition, the ‘What Matters to Me’ approach was used with a dedicated stand allowing people the opportunity to make any comments and suggestions. An evaluation form collated people’s general feedback from the briefing. The outputs captured are detailed in the attached appendices in the following order: Appendix 1: Group reflections by table Appendix 2: Consultation Plan Feedback Appendix 3: Questions raised Appendix 4: What Matters to Me Questions Appendix 5: Feedback Form Responses For ease of reference, a general, top line summary of the group exercise has been compiled and for full details of the feedback please refer to the relevant appendix. Reflections from the Stakeholders What do you like about the proposed new service? Common themes fed back include: - Feels more equitable - The broad range of services in hubs is really positive - Will be more sustainable - Will be better for more women 1 Do you have any ideas for improvement? Common themes fed back include: - Consideration of additional/alternative hub locations, particularly with regards to Oswestry - Consider looking at data on postnatal/antenatal visits rather than births (more visits for higher risk patients, more high risk patient in more deprived areas) - Travel times need reviewing and need to also consider public transport - Joint pathways/linking in with other services including early help hubs Is there anything missing? Common themes fed back include: - More detail on exactly what will be available in hubs and wider community - More detail around staffing - More detail on how this links to Better Births - Information on public transport to hubs - More information about IT to support the proposed service model For full details please see appendix 1 Common Questions Raised - How have you calculated the travel times? - How will you achieve 1:1 care if you are not appointing more midwives? Struggling to recruit young midwives. - How will you ensure the model works for all rural populations? (rural proofing) - What sort of provision has been allowed for in towns with a rising population in Shropshire? For full details please see appendix 3 and appendix 4 Communications & Engagement Plan Feedback Our target audience The group was given a list of the target audiences, asked to feedback and identify any missing groups. These have been captured, reviewed and will be added to the Consultation Plan if appropriate. Consultation materials and activity Stakeholders were asked to list any consultation materials and / or activities which were not mentioned that may be a valuable addition to engaging with our stakeholders. All suggestions will be considered and added if appropriate and budget will allow. Common themes fed back include: 2 o Consider facebook and Instagram o Consider TV screens in public places o Consider using volunteer groups, nurseries /schools / colleges and other groups / organisations to cascade messages out etc o Consider house drop of leaflet o Consider consultation champions o Consider consultation freebies o Improve communication and engagement with front line staff o Promote engagement activities well in advance General feedback on the communications and engagement plan Additional comments on advertising, leaflets, timing etc. Common themes fed back include: o Timing of the public consultation o More detail on what will happen to staff o Be mindful people are upset o Use a wide variety of channels to promote / raise awareness of the consultation For full details please see appendix 2 Feedback Summary from the Evaluation Forms Overall, 84% of people rated the meeting as good or above. 75% of people agreed that the event covered everything they had expected. General feedback included that the meeting was well organised, facilitated and chaired with a good mix of people. For those 25% where the meeting didn’t meet expectations common themes included more detail on staffing, a review of the data in terms of the postnatal/antenatal activity rather than births was necessary, a need to take into account housing projections and areas of deprivation, and there seemed to be a general feeling that more opportunity for questions / idea sharing would have been valuable. Key themes delegates shared about the information presented at the briefing included they would like improved accuracy of the data, more midwifery involvement in the development of the model and recognition of the role of the midwife, increased transparency/motivation behind proposed model, ideas of how to reduce the number of patients requiring a Consultant Led Unit (CLU), how the newly proposed model links to Better Births and more information on timings and when the expected implementation date would be. For full details please see appendix 5 3 APPENDIX 1: GROUP REFLECTIONS BY TABLE Blue Table (Facilitator: Kate Ballinger) What do you like about the proposed new service? More equitable offer Offers full range of birth options – CHOICE Adheres to Better Births Really useful to recruit band 3 Women Support Assistant (WSA) role o Requires supervision and competency review More time available to spend with women Deals with changing demographics Concerns raised about recruitment and retention Certainty that units will be available as advertised Mental health (and all other) support increase is really positive, especially in hubs Variety of access Do you have any ideas for improvement? North Shropshire/Oswestry hub – Wem could be a better site for hub as it is not as north as Whitchurch Could we have pop up hubs in other areas? These could respond to needs and birth rates How is review interfacing with other areas? Day assessment Communication and signposting Is there anything missing? Recognition and appropriate banding for midwives in specialist roles – esp. lactation midwives Succession? Smoking cessation Lack of equity in banding across midwifery Range of specialist roles within the system Video consultations – need to ensure facilities are available. ? North Shropshire/Oswestry – could hub be in Wem? Mini hub in Oswestry How is information about birth options being presented? Attitude of midwives to home births! Staff concerns about financial drivers Need a home birth team IT Systems 4 Green table (Facilitator Alison Smith) What do you like about the proposals? The support available in the hub is very positive. This is an issue at the moment in that mums are experiencing inconsistency of support between the Midwife Led Unit’s (MLU’s) and obstetric unit – when staff have being pulled from MLU to Consultant Unit (CU) this means there is greater stress on those staff remaining in the MLU and so less time to provide immediate support to new mums on breastfeeding in those crucial first hours. By enhancing the workforce and including a hub model this will help drive forward successful breastfeeding. Linked to this is the fact that early identification of issues that prevent breastfeeding by a midwife or trained support worker means baby gets early intervention to prevent issues escalating i.e. one mum had second baby which was tongue tied – it was only the early identification by the midwife on a Sunday that meant baby was referred into specialist service on Monday morning and had issue sorted out within 48 hours of birth – if baby had been born later then there would not have been a referral slot in the specialist service for baby to be seen as quickly as there are currently waiting lists. It’s important that in providing greater support workers in MLUs that other specialist services in hospital that may need to intervene quickly are also linked in for a flexible/ responsive service. The hub model sounds good particularly if it will provide a drop in model – mums value ability to drop in at a time to suit them which has better parking than the hospitals and is cheaper to park or free! Midwife on our table had worked in Oxfordshire where they had a drop in breastfeeding clinic which had been very successful – the group thought this was great idea, particularly for mums who are continuing to struggle with breastfeeding – and all they may need to keep trying is that caring, nudging of a trained support worker. Ideas for improvement? However, please make sure that the staffing/workforce planning is robust around final staffing model as no one wants midwives or other support staff to be robbed from MLUs or Hub duties to backfill in consultant led units at times of escalation. Plea from ex A&E nurse was that we also need to factor in calls on midwives from other services like A&E in an emergency. The hub model means also it’s much easier to signpost mums to as it will be a consistent offer – at moment it’s fragmented and difficult to know what is out there.
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