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

 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:

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

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

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. Even NHS is getting it wrong – so Shrewsbury Mum gives birth in MLU at Telford and is then given info of other services for Telford not Shrewsbury – they didn’t check mum’s postcode!

Is there anything missing?

Please check what size the T&W MLU needs to be and whether its needs expanding within these plans to take the no of patients we expect to go there – as the current model was based upon calculations done 15 years ago when the MLU was moved from Haygate Road to PRH – suspect this doesn’t now reflect the numbers going through now.

Oswestry on a % basis is growing faster than Telford – but in this model we are suggesting that the hub is not sited there. Please can the basis on which the options have been scored includes an economic evaluation of each area to take into account growth in the future?

Communication – need to think through as part of this redesign how we will be better at communicating with Mums to be before, during and afterwards – so there is something about OD with staff, looking at communication models and utilising IT better and more innovatively.

Orange Table (Facilitator Helen White)

What do you like about the proposed new service?

 One stop shop model – better for women - a modern model – opportunity to speak to other women and should promote breast feeding and perinatal mental health services  Nice for women to have everything in one place  Improve workforce – improve and retain skills and roles will be used effectively  More preventative opportunities  Opportunity to increase continuity of carer  Potential opportunity to do joint working with other organisations  Opportunity for band 3 development  Care closer to home

Do you have any ideas for improvement?

 Mini hub/outreach services in Oswestry and other rural communities using other organisations premises i.e. early help hubs  Linking in with early help family hubs  One additional hub to make it 4 instead of 3

Is there anything missing?

 Travel times for both women and staff – those who deliver services in Oswestry If there is no hub in Oswestry what will the staff do? Need to include detail around where they will be based and where clinical notes will be  Oswestry GP practice only offers 6 antenatal appointments over a 4 day period – is this worth having still or would it be better to remove altogether and have a proper outreach service instead. Other rural areas don’t have many appointments in GP’s and wouldn’t be able to just have those alone – would need extra outreach  More detail around band 3 development to be included – what are the timelines – how will they access the women in the community  Outreach for those rural areas like Woodside/Brookside/Oswestry/Bridgnorth  Use of telehealth/IT/Social Media

Other issues discussed

 Band 2’s are unhappy in the rural MLU’s at the moment – not doing much clinical work – just admin  How will continuity of carer work in the hubs  Some staff are bitter as some are overworked and others aren’t  Some staff feel they are losing skills

Purple Table (Facilitator Maggie Kennerley)

What do you like?

 Good to talk  Improving range of service in hubs (in line with better births), multi–professional and a positive thing  Need to progress – no option to do nothing!

Don’t like….

 Rural areas – attracting people to areas – reduced healthcare options  Reducing services in South Shropshire – not enough  Consider public transport networks

Improvements?

 Consider birth in hubs (Powys model) – facilitate all options in rural areas  Upskilling all professionals in rural areas to be responsive to individual needs  Seamless movement between services  Positive encouragement for MLU  Training for all midwives on birth trauma and perinatal mental health  By the midwifes offering intrapartum care in the rural hubs with an on call system not shifts. These midwives would keep their intrapartum skills up to date and be able to facilitate a home birth service

Anything missing?

 Details about what service are in the hubs  Transport details

Pink Table (Facilitator: Sharon Smith)

What do you like about the proposed new service?

 They are TRYING to get equality across the county i.e. Scanning  Hopefully reduce the sick rate (through better working)  Like idea of hubs, thinking bigger around just giving birth  Need to have the infrastructure behind what’s proposed i.e. scanning/phlebotomy  Removing choice has not been acknowledged – National guidance identifies where people are delivering  Resources that we have, use them effectively to use them safely for our women  What can we do with what we have – where we have the most activity  Work in progress – listen to what feedback is given  Service users can manipulate even though there is no risk i.e. foetal movement  Largely led by demographics and statistics (influenced by the closure of the MLU)

Do you have any idea of improvement?

 Joint pathways, continuity of care through to parenthood (midwife + health visitor)  Those patients who need help with MH, They won’t go to a hub, need to have a balance of services  Figure out ways that patients with MH are going to get to those hubs – won’t happen (no bus routes)  Education to people, way before conception – reducing their risk  Decent hub – start to get the messages out to the public  Find something in the system to be able to educate people especially through the hubs  Improved engagement between the different health professionals by using the hubs  Working together – how do we make sure that voices from the health professionals are being heard. Difficult when staff are now under different organisations.

Is there anything missing?

 Yes  Distance and travel incorrect – what else is wrong with the proposal?  Acknowledge that the hard work is currently going on in the units – no acknowledgement felt by the staff.  Quite a punitive service, if there are errors, staff need to be supported throughout  Mitigation – staff not able to comment  Think about what public transport is currently available  Equally a difficult time if the distance is not far  Mums cannot get on a bus with a buggy if there is a buggy already on there.  Demographics + statistics (influenced by closure of some of the MLUs)

Red Table (Facilitator Pam Schreier)

What do you like?

 Levelling up has been referred to in the past, now using the word equitable, we need to worry about the most vulnerable. Feels as if we are levelling up with Whitchurch.  Feels as if we’re creating more winners rather than losers. It appears fairer to more people.  Good that we’ve looked at deprivation and risk.  Young mums (under 21) support group in Telford, there are many issues and therefore the South Telford hub is welcomed.  We’re currently staffing empty buildings. There are high risk mums in the CLU where we are not delivering 1:1 care. Midwives need to follow the women.  The service spec. is more flexible to deliver future need.

Improvements?

 Look at travel and transport  Get the travel times and figures right.  Should we be looking at Craven Arms or Church Stretton rather than Ludlow?  We have an opportunity to build up community hubs, breastfeeding groups (there isn’t a single funded one in Shrewsbury, the nearest is Wellington).  There are no lifelines like there used to be in terms of community services, need a holistic approach.  Missing some of the seldom heard groups. There’s a lack of diversity in this room. There is a Nigerian community in Telford we need to reach out to.  Mums in labour can’t get taxis, they have to lie or they won’t be taken.  Need to operate like streetcleaners! Turn up for work and find out where the women are and go to them.  Pay attention to language – moving services not losing services.

Anything missing?

 ‘Losing’ existing MLUs – Oswestry and Bridgnorth  Inaccurate timings will influence scoring  Need more clarification on the detail around community offer and the hubs to be able to give informed comment

White Table (Facilitator Harriet Hopkins)

What do you like?

 It offers stability for both staff and women and this would be very welcome  The new model would offer sustainability  However, concerns over whether it is being financially driven? o The commitment of the commissioning is questionable – how is it driven? o There needs to be transparency over what is informing the decisions  Does it fit in with Better Births?  Is this achievable?

Improvements?

 It doesn’t feel like the service model has being driven by the number of women using antenatal or post-natal care  They have based their decisions on the number of births delivered / delivery activity but where the hubs are being located it’s not about delivering births it’s about delivery antenatal or postnatal care. We are not talking about one interaction; we are talking about multiple interactions between women and their midwife ranging from 10-15 contacts depending on whether they are low risk or high risk patients. Patients who need more contact tend to be those that live in areas of high deprivation like Oswestry/Telford.  Increasingly very few women remain low-risk and these needs to be taken into consideration. Rising number of high risk women who need more antenatal and postnatal appointments.  Distance and travel times need reviewing – clearly incorrect – will this effect proposed locations when corrected??

Anything missing?

 Future Fit has not yet been decided so we don’t know the location of the Consultant Led Unit.  How is this model going to link to Better Births?  The role of the midwife if very specialised. GPs don’t have that knowledge esp. relating to foetal movement etc we need to strive towards midwifery led care. Lack of acknowledgement role of the midwife and the hard work they deliver.  Need more detail about the hubs – more detailed discussion – more time

From Yellow table (Facilitator Vicki Pike)

What do you like?

 Recognising need for T&W antenatal and post-natal care. One south and one north  Location of hubs based on need  Scans and offer in hubs boarded and wider  Consistency of what’s in a hub - standard offer and services  Variety of access - video appointments and apps

Improvements?

 Specialist Ob’s – how do you ensure they are available across the hubs? Each observation has a different speciality  Offering evening appointments with Ob’s  Day assess “Fetal movements” need to return to hubs  Detail on role of Women Support Assistant (WSA) and what the midwifery staff are doing – WSA are doing nice roles, and midwives and ob nurses worn out and not liking their jobs – high risk areas  Explain that the hubs are not for delivery  Offer breast feeding support and antenatal classes at all hubs

Anything missing?

 Hubs offer wider family support – e.g. Scans and other outpatient services can be there  Child friendly hubs – offering crèche etc.  To link to local authority services  Ensure neonatal screen test can be carried out in the hubs ( and hearing test) – missed screens and repeats  Amount of postnatal bed space  Breast feed support  IT – good enough for each hub  Provide everything such as ………..  Housing projections for new growth areas in whole county – links to economic growth

APPENDIX 2: CONSULTATION PLAN FEEDBACK

Blue table

1) Our target audience Royal College of Midwives People with an interest - including dads Homelessness Vulnerable Thrive (Telford) & Shropshire’s equivalent ??Greaves spread – follow up dissemination. Should GP members be Primary Care

2) Consultation materials Easy Read Social media – esp facebook and instagram Reader panel for information – including mums

3) Consultation engagement activity Attending existing groups Social media Much better communication with staff – check system to ensure front line engagement

4) General feedback n/a

Orange table

1) Our target audience Education: - Schools - Colleges Community midwives + the reality of travelling while in a rural area time / resources Think lean and smart!

2) Consultation materials Social media incl. facebook & twitter TV Screens in public areas GPs / Supermarkets

3) Consultation engagement activity Schools / colleges Gyms / sports centres Mummy classes – anywhere where mums/babies go Nurseries Ask professionals to engage with hard to reach groups

4) General feedback When will the consultation happen & finalise? What would happen to staff who currently work in Oswestry? Where would the notes be?

Pink table

1) Our target audience National Values? League of Friends MLU campaign groups (FB) Church based toddler / baby groups Village based Parents who have learning difficulties

2) Consultation materials Make sure the material gets out to the groups i.e. village groups Media (radio/paper)

3) Consultation engagement activity Make sure people know about the focus groups No cockups! No time changes / taking things down

4) General feedback A/n clinic – looped material on TV screen (user feedback) Buses Advertising Entrance @ PRH screen and posters

Purple table

1) Our target audience Campaign groups Parish councillors Women who have experience of social care (changing futures) Sexual Health services

2) Consultation materials Videos Leaflets Use videos and leaflets in GP surgeries

3) Consultation engagement activity n/a

4) General feedback Cross-section of individuals on tables is good

In terms of consultation, the group wanted to feedback the following:

1) Be careful using Future Fit consultation as a model – criticism of how it had been rolled out in Bridgnorth – basically almost invisible! 2) Use local press/radio but don’t rely on it – make sure you are using all local papers and local paper editions of the same paper – Bridgnorth for example does not get the same version of the Shropshire star as the rest of Shropshire. 3) Facebook advertising (one mum said that when her baby is feeding she uses the time to check facebook as she is not able to do much more!), advertising in pubs, sports venues, gyms (private and public), leisure centres coffee shops, schools – via the school themselves or face to face engagement with mums and dads at school gates for pickup. Access support offered to parents like baby massage, baby swimming clubs. All patients in the system currently via SaTH, Antenatal classes, NCT network, sure start where it exists, WI, Parish Councils, Rotary, Churches – they often run “messy church” play groups for young children in their areas, Night clubs 4) Think about house drop of leaflet to get a sample size (around 18000 households) 5) Posters GP surgery/community halls/play groups/toddler clubs TV screen in GP surgeries

Red table

1) Our target audience Diversity, languages, BME, polish, Chinese etc – EIA, travellers, LGBT, farming community Town & Parish Councils RCM VCSA

2) Consultation materials Video to capture different views

3) Consultation engagement activity Openness, real consultation. Health Champions Telford Consultation champions Workshops Freebies Essential items Your view counts

4) General feedback Need the right people to talk to the groups Telford (Recharge?) People are upset

White table

1) Our target audience - Individual women & partners - Education of future midwives - Staffordshire University midwifery academies - Hereford & Worcester - Cheshire - Early Help Services - Women’s Aid - Military Wives / personnel - Public Health England - RCM / RCN - West Midlands Network Group

2) Consultation materials n/a

3) Consultation engagement activity n/a

4) General feedback Public at large? Who?

Yellow table

1) Our target audience Schools & nurseries Homeless groups Refugees Cultural buildings Farm settings Workplaces Colleges University School holidays in shopping centre

2) Consultation materials Ensuring you go to volunteer groups Go via schools / nurseries Refuges across county Ensuring online & hard copy Social media incl. facebook Send into via initial booking

3) Consultation engagement activity Significant notice of events Long lead times to events Good campaign to enable engagement – using above

4) General feedback Using other sources to promote Sexual health services Cervical screening Focus more on engagement of hotspots Leaflets about the hospitals for new builds or people moving to area

APPENDIX 3: OPPORTUNITY FOR QUESTIONS

Group 1 - People who have recently used or are likely to use services in the near future

Q: Mum in Oswestry and GP

How have you calculated how long it takes to travel from Oswestry to Royal Shrewsbury Hospital in 17 mins? It takes 40/45 mins in a car if you own a car.

Midwives going out from Shrewsbury to Oswestry in the middle of the night take longer than 17 minutes.

Q: What about those people who can’t make it to hospitals? One hour from family to look after other children and then an hour from hospital. (Clee Hill)

(GP in Cleobury and midwife comes from Herefordshire)

Group 2 - People involved in the delivery of services

Q: worked in Shropshire for 4 years, been in Powys for 14 years – assistant head of midwifery

36 midwives down in terms of recruitment. No mention of appointing additional midwives. If you are trying to achieve 1:1 care as we do In Powys which matches birth rate plus

A: 36 – is about running the service as it was i.e. 24/7. Doesn’t take into account skill mix (developing support worker at a band 3 level) we are behind the curve with this in Shropshire. If we change in accordance to where our women are, we will need to recruit into 12 midwifery posts and 16 band 3 support worker posts. We are recruiting 20 band 3s (development for band 2s).

Q: We need to commission the service we need, rather than what SaTH as the provider can provide.

Q: Midwife across Shropshire, currently at Shrewsbury, ageing population of midwives, £27K to train as a midwife, burn out rate of young midwives is high, struggle to recruit younger people

Not just about the number of midwives, but how we work

Group 3 - People involved in making decisions about the future arrangements

Q: Interested in the slide around how you scored the options and the PH data used. What was missing was rurality as a measurement. The measurement tools being used. If this is coming to JHOSC on 3 Dec you have a piece of work to do and I’m happy to take questions not raised here for JHOSC.

Group 4 - Others

Q: This should be a responsive service. Three campaigns to save the MLUs did a survey of 500 women. Only 2% chose to use the Consultant Led Unit. Nothing about rural proofing, access etc. this must not be neglected.

Q: Ockenden review. Widespread and comprehensive recommendations. Is this the right tie for the CCG to carry on with its own recommendations, shouldn’t they wait for the outcomes.

A: Ockenden Review into avoidable baby deaths. Date for outcomes has changed four times and we need to move forward to get our services right. If current configuration is contributing to safety issues we need to address it.

A: Rural proofing. It’s a review for the whole county incl. rural locations. We used info from the survey of 500 in the first phase of our development.

APPENDIX 4: WHAT MATTERS TO ME QUESTIONS

Participant 1 Questions:

 As there will need to be an on call midwife for home births – why can they not delivery in hubs as well?  What is the cost of setting up a new hub? Can existing facilities be better utilised?  How do you propose informing people of any future meetings in plenty of time?  Will you please send me details of how your calculation has been made with regard to local need (are the deprivation stats based on NHS England? How up to date are these?)

After talking to Jess:

 Do we need 7 day access to hubs to provide all the services 7 days / week  Would we be better staffing 2 hubs in the north 5 days /week with community access at the weekends  Consider who is providing services. Utilise community groups eg breast feeding / peer support trained teams at weekend

Participant 2 Questions:

 What rural proofing of the proposal has taken place? Heard nothing on rurality or access; somewhere being geographically central doesn’t make it accessible  Why was the 2013 CCG maternity review not implemented? Configuration remained similar over a 30 year period for precisely this reason  Escalation wrong and unfair to women and staff o But a survey by MLU campaigners of 500 women in Ludlow, Oswestry and Bridgnorth areas – women either pregnant or had given birth in previous year – that survey found on 2% of women had chosen to use CLU though most ended up there  How about employing more midwives? Should we be matching clinical need and birth place more carefully? Respecting choice more carefully?  Fall off in numbers using MLUs was primarily at the urban MLUs, wasn’t it, not the relatively static rural ones?  I know you say can’t please everyone – but went to so many engagement meetings where rural women said they valued MLUs and valued inpatient postnatal care – those views not taken on board at all as far as I can see  Complete double whammy for Oswestry & Bridgnorth isn’t it? Lose MLU & don’t get a hub either. Ever tried getting from Bridgnorth to Ludlow by public transport?

 Sounded like public allowed to comment on where the hubs should be but not on core model, very much a done deal! Can you comment?  Obviously quite a troubled service; CQC regulations yesterday; most importantly Ockenden Review into well over 100 deaths / adverse events  Ockenden Review will be making widespread & comprehensive recommendations confirmed yesterday. Is that right time to be undertaking major reconfiguration??

Participant 3 Questions:

 What sort of provision has been allowed for in rising housing population around some town locations in Shropshire? In terms of measuring birth rate and then required capacity as a staff reserve (midwives)??

Participant 4 Questions:

 Please inform Bridgnorth Staff about the proposed loss of being hub and why!  Are the figures of 12 births at Wolverhampton due to fertility services - will this affect future figures?  The travelling times are incorrect to Bridgnorth  The League Of Friends have provided a pool which is not used please can we know how valuable resources can be used elsewhere in the county?  Please keep us informed!

APPENDIX 5: FEEDBACK FORM SUMMARY

1. Overall, how would you rate the MLU Review Stakeholder Briefing event?

 84 % of people rated the meeting as good or above

- Excellent – 1 (2%) - Very Good – 20 (47%) - Good – 15 (35%) - Fair – 6 (14%) - Poor – 1 (2%)

Total responses: 43

2. Did the event cover everything you expected?

- Yes – 32 (75%) - No – 11 (25%)

Total responses: 43

If no, give details:

o This was due to my misunderstanding – I realise the ‘detail’ of providing the service will be part of another workshop. There was conservations on the table about how the midwifery service should be offered i.e. Learn/on call for deliveries in the hub o Should have given more detail on anticipated workforce o Funding? o More consideration for working staff – work/life balance – retaining staff – experienced at night level – encouraging public to back us as well o Limited chances to ask questions – put points across o Data on which the hub sites have been chosen seems to be delivery activity and no on the amount of women seen. More need in terms of deprivation in Oswestry rather than Whitchurch o Would have liked to have see an example of staffing of MLUs need to relook at data as currently on births but not on postnatal/antenatal activity which is what will be happening in hubs o Chair was too rude o More ideas / comments from attendees to help shape overall model as well as improved care for rural areas o Expected there to be more accurate understanding of work undertaken o I thought there would be more opportunity for people to ask questions and discussion

o No details of where the data was collated accurately o Information on how to compare Urban vs. Rural areas and transport o Housing projections and potential changes to provision and staffing

3. On a scale of 1-6, where 1 is ‘Not easy to understand’ and 6 is ‘Very easy to understand’, how do you feel about the information presented today?

- 1 (Not easy to understand) - 0 responses - 2 – 2 responses (5%) - 3 – 0 responses - 4 – 9 responses (21%) - 5 – 24 responses (56%) - 6 (Very easy to understand) - 8 responses (19%)

Total responses: 43

4. Is there anything else you would like to share about the information presented today?  Thank you for the opportunity to be involved  I would like clarification of what services will continue on those areas which loose an MLU  Future Public Transport  When is the predicted / expected implementation  Very useful. Unclear if some individual came to ‘score political points’ rather than listen to women in our care.  Meeting chaired brilliantly by Meredith & GP & Fiona. Thank you  Area profile needs more work to be accurate  Well chaired  I feel that the accuracy of the data used was not explained properly  I think the Doctor who presented needs to consider the role of the midwife and that it is not “dipping wee and all that jazz” and that it is not just about deliveries but other activities delivered by maternity services.  Midwifery involvement in commissioning  Apparent lack of transparency of event and motivation – service driven identifies, however, poor assessment of service delivered  Medic is not best placed to offer clarity to midwife role and service  More details please on staffing and access as well as reducing emphasis on CLUs and alongside MLUs  Mileage & time to travel really distorted eg Bridgnorth are would have thought the GP taken from would be Bridgnorth medical practice this will in no way be 7.6 miles to nearest MLU.  A bigger voice of role of midwife and recognition and understanding of role conveyed  How will this work link into the continuity of care model as proposed by Better Births??

 Please consider midwives – as mothers – as well as professionals. Realistic service that we feel safe and confident that we can provide  Local communications  Ensure patients only use CLU when clinically justified – cannot accept that 97% fall into this category  Well facilitated – need more opportunities to work / share together  A really good mix of people / feedback on the whole (midwives/parents/facilitators etc)  Really well organised, facilitated and mix on tables  As a public health person I struggled with the volume of information and the way some of it was presented so maybe this could be improved  A little volatile with the invited audience at times!  Unclear at first as to the model proposed  Some concerns regarding statistics which are skewed. Deliveries in MLU’s were already severely affected by constant short term closures. Therefore, these are unreliable. Distance from GP’s to CLU need to be recalculated  Detail lacking “we will get that information to you” – how?  There were some angry people in the room  Lots of time it was mentioned about peer support, where will funding come from!  No breastfeeding groups  A less than accurate series of presentations with the intention of a pre- determined outcome  The late exclusion of invited participants was extremely disappointing  Is the consultation reduced to where the hubs are sited? That’s the impression given today.  A well organised clear consultation process  Parking was a nightmare

5. If you would like further information or an informal conversation, in complete confidence, please leave your name and contact details below:

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