Agenda item

Committee Members will receive an update on the proposed model for improving maternity services in Buckinghamshire.

Contributors

Nr Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust (BHT)

Ms Heidi Beddall, Director of Midwifery, BHT

Mr Ian Currie, Chair of the Women’s, Children’s and Sexual Health Division (BHT)

Ms Ashleigh Skinner, Co-Chair, Maternity Voices Partnership

Paper

Improving Maternity Services in Buckinghamshire

The Chairman welcomed Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust (BHT), Karen Bonner, Chief Nurse, Heidi Beddall, Director of Midwifery, Ian Currie, Chair of the Women’s, Children’s and Sexual Health Division and Ashleigh Skinner, Co-Chair, Maternity Voices Partnership.

During their presentation, the following key points were made:

·       Women currently had the choice to have their baby either at home, in a midwifery led birthing unit at the Aylesbury Birth Centre (within Stoke Mandeville Hospital) and obstetric led labour ward at Stoke Mandeville.  Ante-natal and postnatal outpatient care was offered at both Wycombe and Stoke Mandeville.

·       Births had been suspended at the Wycombe Birth Centre (WBC) since 2020 which had originally been due to the Covid-19 pandemic and the need to reorganise the service and more recently due to the shortage of midwives.

·       The WBC was originally established in 2009 and 350-400 births a year were expected.  In 2019/20, the last year it was operational, only 169 women, out of the 4,737 deliveries at BHT, chose to give birth at WBC.  Out of the 169 women, 39 were transferred to Stoke Mandeville Hospital at the start of, or during labour with a further 33 being transferred after birth.

·       BHT want to continue to strengthen the midwifery ante and post-natal care at Wycombe and build on the continuity of carer model, mental health care, smoking cessation support and infant feeding support.

The following points were noted during the Committee’s discussion:

·       A Member raised concerns about the changes to maternity services provided in Wycombe, particularly in light of the high rates of caesarean sections (40%) and high-risk residents in the area. Ms Beddall assured the Committee that the changes aimed to improve services, not reduce them. The proposed improvements would prevent women from needing to visit multiple venues for different support services related to pregnancy and birth, as well as smoking cessation and healthy living.

·       Women also had an opportunity for home births, which offered the same care model as the Wycombe Birth Centre (two midwives and an option for ambulance transfer to Stoke Mandeville in case of emergencies). Despite the structural challenges Wycombe Hospital had faced, the decision to change maternity services was unrelated. Mr Macdonald emphasised the organisation's efforts to find the right balance in providing safe, sustainable, and value-for-taxpayer services. It was noted that the primary focus on the project was to improve care rather than following a financial incentive.

·       Members asked what engagement and consultation activities had been undertaken to include residents’ views about the proposed changes. Ms Beddall explained that regular engagement events had been held, including campaigns to increase the number of people electing to give birth there. An extensive survey with over 800 responses revealed that women preferred a midwife-led birthing centre attached to a labour ward. The Bucks Maternity Voice partnership had also gathered feedback through listening clinics, surveys, and attending groups with mothers and their partners and families. A ‘Mamas and Babas’ group, which particularly focused on Wycombe’s Pakistani population, had also been set up. Initially, residents raised concerns about the changes to the services, particularly at the start of the pandemic. However, in the most recent surveys, the feedback was increasingly positive. Continuity of care, as well as high quality ante- and postnatal care, had been identified as the most important factors for patients.

·       A Member raised concerns about aftercare of maternity patients and the increasing prevalence of mental health issues among young women during and after pregnancy. Ms Beddall acknowledged the importance of this issue as one in four women in the UK experienced a mental health issue during pregnancy or following childbirth. She noted that suicide was a leading cause of death for women during this period, particularly after childbirth. To address this issue, collaborative efforts were made with Health on the High Street to establish facilities in Chesham and Aylesbury in line with improvements made in High Wycombe. The goal was to provide perinatal mental health support to all women during their appointments. By locating perinatal mental health midwives and support workers in a centralised facility, women would have easier access to mental health support without the need for multiple appointments in different locations.

·       Concerns about the available staffing levels for maternity services in Buckinghamshire were also raised. Ms Beddall acknowledged the challenges in the midwifery workforce both nationally and in Buckinghamshire, with a shortage of at least 2,000 midwives in the country. However, efforts have been made to address this by increasing training places with university providers and recruiting existing midwives. The services collaborated closely with NHS England for recruitment, retention, and safety monitoring.

·       Recruiting to the Wycombe Birth Centre had been particularly challenging, partly due to the isolated nature of the birth centre, though recruitment for community midwifery roles had been more successful.

·       In response to a Member question about training for midwifery and medical teams, Ms Beddall assured the Committee that a training needs analysis had been conducted. The annual training programme aligned with the core competency framework set by NHS England. Every training session incorporated a focus on health inequalities, considering the significant disparities faced by women during childbirth in the UK.

·       A Member queried the high transfer rate from Wycombe Birth Centre to Stoke Mandeville and noted that the national transfer rate was outdated. Ms Beddall explained that no further national study had been undertaken, making it difficult to benchmark against current national transfer rates. She emphasised that all transfers from the WBC were necessary or based on patient choice.

·       A Member asked about the differences in cost associated with caesarean sections. Historically, caesarean sections were expensive, particularly due to longer hospital stays, though this has decreased over time. It was highlighted that the current proposal did not seek to change the rate of caesarean sections in Buckinghamshire, and that it was important to focus on the entire pregnancy pathway rather than just the birth itself.

·       A Member felt that there was a lack of information for men about the birthing process and expressed a need for more education. It was noted that access to information had improved over time, though more could be done in this area. Ms Beddall advised that she was currently in the process of securing funding for a project focusing on providing fathers and partners with more access to information. Maternity Voices Partnership also included engaging fathers in their work plan for the year.

·       A Member raised concerns about the medical-supported centre being located in Aylesbury, despite Wycombe being an area with greater deprivation. They also mentioned that the population had increased in both areas, which would support the need for centres in both areas. Ms Beddall explained that it was not just population size, but birth rate that needed to be considered. The birth rate had decreased across the county and was contrary to the overall trend of increasing demand in other health-related areas. The proposed model therefore focused on allocating more resources and personnel to the community of Wycombe.  Providing the same maternity services in both areas would not be economically feasible in terms of capital, space, and personnel.

·       Members expressed concerns about the changes particularly affecting women from deprived areas. Ms Beddall noted that the proposed changes would affect fewer than a hundred women, with only around 2.5% of deliveries taking place. The proposed improvements were aimed at enhancing access to expert care for women across Buckinghamshire and providing a centre of excellence at Wycombe Hospital for antenatal and postnatal care.

The Committee were asked to support BHT’s proposal to continue with the current model of are on a permanent basis, which consisted of the following.

·       A choice of birthing options – home birth, midwifery led birthing unit at the Aylesbury Birth Centre, within Stoke Mandeville Hospital and obstetric led labour ward births at Stoke Mandeville;

·       Midwifery led ante and postnatal outpatient care at Wycombe and Stoke Mandeville;

·       Community – home visits, including visiting mum and baby on the first day after birth.

The Chairman summarised the discussion and sought agreement from Committee Members to write to BHT after the meeting to seek further information and clarification.

The Chairman thanked the presenters.