West Hertfordshire Hospitals NHS Trust

Report for Hertfordshire Primary Care Trust

Care Quality Commission - Survey of women’s experiences of maternity services

Action Plan: Start date February 2011

The CQC Maternity Survey was undertaken in May 2010 and questionnaires were sent to all women who gave birth during this month. There were 211 respondents giving a response rate of 52%.

The percentage of first-time mothers as 49% and women who had previously given birth totalled 51%. The age range of respondents matched the demographic profile with 14% of respondents being under 24 years and the largest percentage of 33% reflecting responses from women aged 30-34 years. 29% of women were aged 35 years and over.

Ethnicity showed 84% of women were White; 7% were Asian or Asian British; 4% were Black or Black British.

This Action Plan describes actions that will be undertaken by West Hertfordshire Hospitals NHS Trust (WHHT), in response to recommendations derived from the CQC Maternity Survey 2010 results. The Action Plan focuses on areas scoring in the lower confidence interval level of questions asked.

The Action Plan will run for the course of one year. It will be reviewed through the Maternity Clinical Effectiveness Group, Maternity Services and Risk Management Group; reporting to the Divisional Board.

This Action Plan will be updated on the last Wednesday of each month, and tabled at the following forums for monitoring of progress and escalation where risks to the service arise:
Maternity Clinical Effectiveness Maternity Services & Risk Management Divisional Board Divisional Integrated Standards Executive
RAG Rating definitions:
RedSerious delay or impediment in delivery to target
AmberSome delays in delivery to target or target date not yet reached
GreenOn target to achieve
BlueAchieved/Implemented
Issue / Score for WHHT / Reason for rating / Action needed – Standard of evidence to confirm improvement of rating / Target perform
2011/12 / Target rating / When by
Achieved (on-going) / Who is the lead?
1.0 Care received during pregnancy
1.1Choices in place of antenatal care
1.2Continuity of carer
1.3Combined screening / 73
(65-81)
80
(75-85)
87
(84-91) / 1.1.1The old HCC action plan addressed issues relating to provision of Parent education and access to health professional and choices in place of birth. However choices in place of antenatal care remain an area for improvement.
1.2.1Women considered they had been offered more choice in who would care for them in pregnancy – majority of women still choose to be cared for by their midwife.
1.2.2Significant challenges due to demographic of workforce
1.3.1Previous report WHHT had scored low. Obvious improvement has been achieved due to completion of implementation of Combined Screening interim measures. / 1.1.1Currently working with PCT undertaking a 3 phase community midwifery project to review the current model and gain access to children’s centres as advised in Maternity Matters and the NSF. This is a collaborative project involving users of the service and reporting to the MSLC.
1.1.2Re-run this aspect of the survey in October 2011
1.2.1See action 1.1
1.2.2Quality Assurance lead midwife to proactively seek users views and experiences of the services.
1.2.3Service to undertake a workforce capacity review in conjunction with action 1.1.
1.3.1Interim plan in place from August 2010 including out sourcing. Universal Combined Screening now offered to all women; Review of services with the aim to bring services back within WHHT resources. / 30 09 2011
01 12 2011
01 11 2011
Resolved / Move toward 76
Move towards 82
Move towards 90 / Margaret Cronin/ Julie Juliff
Jenny Fake
Morny Drury
Update
Action / Date / Progress/Issues / RAG rating
1.1.1 & 1.2.1 Improve access to and choice of services / 11 08 11 / Community re-organisation steering group met today (11.08.11) to discuss progress. Progress from each of the Task and Finish groups has been delayed due to clinical hyperactivity and the inability to release staff to complete tasks required. However, cap now proving to be effective and activity reduced.
Provisional start date for new community model now moved forward to 16.01.12.
Trust have now given approval for building work - to commence 12.08.11.
1.1.2 Re-run of Survey / 10 06 11
11 07 11 / To review survey questions in the light of themes to be drawn from complaints and focus groups – Draft survey and methodology for endorsement and ratification at MCE and MSRMG in October. Survey to run in December 2011. Agreement from Trust for electronic access to planned survey.
Development of survey questions in progress.
1.2.2 Additional information from users / 10 06 11
11 07 11
10.08.11 / Change to planned topic of first focus group with the aim of informing process for re-organisation of community services. First focus group commenced to elicit information regarding women’s experience of booking with the maternity services, choices and information given.
Further focus groups planned over next 2 months.
Plan to re-run survey on target for December 2011, however, decision made to run additional targeted survey specifically to obtain further information relating to key issues related to community re-organisation – to commence August/September 2011.
1.2.3 Workforce review / 10 06 11
11.07.11
10.08.11 / Areas for workforce development, identified from risk assessments around Maternity theatres and recovery; Obstetric Observation Bay, are currently underway in the light of an urgent capacity review. Models being presented to the Executive in June for confirmation of preferred options by the end of June. Further developments are awaited on confirmation of Watford community midwifery service review. See 1.1.1
Awaiting sign-off on capacity review project – financial model under review.
Trust currently reviewing midwifery staffing ratios in relation to SHA recommendations. Final model to be confirmed at next steering group meeting.
1.3.1 Access to combined screening / 10 06 11 / The survey was undertaken of women who gave birth in February 2010. In August 2010 the service successfully implemented Universal Combined Screening – this issues is now resolved
Issue / Baseline rating
out of 10 / Reason for rating / Action needed - Standard of evidence to confirm improvement of rating / Target perform
2011-12 / Target rating / When by Achieved (on-going) / Who is the lead?
2.0 Care received during labour & birth
2.1 Involvement of birth partner
2.2. Skin-to-skin contact
2.3. Suture repair time / 89
(85-92)
81
(75-87)
53
(46-60) / More women and their partners considered they were involved in decisions about the care given.
More women offered skin-to-skin contact with their babies immediately following birth
Significant improvement in timing of suturing following birth / 2.1.1Review staff orientation and training
2.1.2Feedback to staff survey results Clinical Governance ½ day.
2.1.3Review guidelines as due for renewal to consider involvement of the birth partner.
2.1.4Re-run this aspect of the survey in October 2011
2.2.1Review staff orientation and training
2.2.2Feedback to staff survey results Clinical Governance ½ day
2.2.3Recruiting to infant feeding advisor
2.3.1Feedback to staff survey results at Clinical Governance ½ day
2.3.2Audit practice bi-annually; as per CNST guidance / 01 11 2011
01 11 2011 / Move towards 90
Move towards 83 / March 11
completed
On-going
01 11.11
01 11 11
March 11
completed
30 09 11
March 11
Completed
Feb 11
Completed / Jenny Fake
Jenny Fake
Jenny Fake
Jenny Fake
Jenny Fake
Margaret Cronin
Jenny Fake
Gill Taylor
Update
Action / Date / Progress/Issues / RAG rating
2.1.1 Additional information from birth partners of users / 10 06 11
11 07 11 / To review survey questions in drawn from themes identified at targeted focus groups for partners.
First focus group completed others planned for see 1.2.1
2.1.2 Re-run of survey / 10 06 11
11 07 11
10 08 11 / Survey to run in December 2011.
Action on hold until September 2011 when survey questions to be agreed for survey in December.
See 1.2.2
2.2.1 Staff survey to ascertain understanding of staff of skin to skin contact at birth / 10 06 11
11 0711 / Area for review and development of staff awareness and knowledge of benefits of skin to skin contact at birth – agree and develop staff survey to run in September 2011.
Survey questions to be agreed by August MCE (19 08 11)
2.2.2 Additional information of understanding of users of benefits of skin to skin contact at birth / 10 06 11
11 07 11 / To review survey questions drawn from themes identified at focus groups.
To address at next set of focus groups – see 1
2.2.3 Re-run of survey / 10 06 11
11 07 11 / Survey to run in December 2011. Agreement from Trust for electronic access to survey via Maternity Services webpage on WHHT website.
See 2.1.2
2.3.1 Suture repair time / 10 06 11
11 07 11 / The survey was undertaken of women who gave birth in February 2010. On-going, bi-annual audit successfully implemented. Feedback of survey and results of continuous audits presented to staff at Clinical Governance meetings in January 2011.
Next audit due in July for reporting at September Clinical Governance ½ day
Issue / Baseline rating
out of 10 / Reason for rating / Action needed - Standard of evidence to confirm improvement of rating / Target perform
2011-12 / Target rating / When by Achieved (on-going) / Who is the lead?
3.0 Care received after birth
3.1 Consistent advice relating to feeding
3.2 Support with regard to information or explanations needed / 53
(48-58)
72
(68-77) / Improvement in consistency of advice with regard to feeding
Improvement in information given following their birth / 3.1.1 Review staff orientation and training
3.1.2Feedback to staff survey results Clinical Governance ½ day.
3.1.3Review guidelines as due for renewal to consider user information leaflets
3.1.4Re-run this aspect of the survey in December 2011
3.1.5Prioritise modules relating to the Releasing time to care programme that identify consistent advice
3.2.1 Please see 3.1 above / 01 11 2011
01 11 2011 / Move towards 55
Move towards 75 / March 11
Completed
On-going / Sue Higginbotham
Jenny Fake
Jenny Fake
Jenny Fake
Colette Chadbourn
Please see 3.1 above
Update
Action / Date / Progress/Issues / RAG rating
3.1.1 Improve consistency of feeding advice given by staff / 10 06 11
11 07 11 / Area for review and development and staff knowledge and awareness of feeding advice – agree and develop staff survey to run in September 2011.
See 2.2.1
3.1.2 Feedback of survey results / 10 06 11 / Feedback of survey results presented to staff at Clinical Governance ½ day.
Action completed
3.1.3 Review infant feeding information for users / 10 06 11
11 07 11 / Review Infant Feeding information given to users and develop new methods of information to be given to users –September 2011.
Review and refresh information given on maternity page on Trust website being undertaken. Revised versions to be presented at MCE in September (16 09 11).
3.1.4 Re-run of survey / 10 06 11
11 07 11
10 08 11 / To review survey questions in light of themes drawn from discussions with users, focus groups and complaints. Survey to run in December 2011.
Provision being made for the Survey to be accessed from maternity page on Trust website.
Trust agreement for redevelopment of maternity pages of Trust website, to include access to maternity service user survey. Redevelopment in progress
3.1.5 Releasing time to care / 10 06 11
11 07 11 / Agree content and Productive Ward (Releasing Time to Care) module relating to consistency of information given to users for infant feeding – January 2012
RTC programme currently on-hold until September due to hyperactivity and staffing issues at present. Being addressed through the capacity plan programme of work.
3.2.1 Improve explanations given to users / 10 06 11
11 07 11 / Area for review of staff awareness of issue – review survey questions in light of themes drawn from discussions with users, focus groups and complaints. Survey to re-run in December 2012.
3.2.2 Feedback of survey results / 10 06 11 / Feedback of survey results presented to staff at Clinical Governance ½ day.
Action completed

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