WORKFORCE: A report from NHS London has outlined significant shortfalls in consultant presence in labour wards.

The review in June said only Epsom and St Helier, Lewisham, King George and North Middlesex hospitals met the requirements set out by the Royal college of Obstetricians and Gynaecologists.

The document was revealed to ther HSJ under the Freedom of Information Act.

The results were in response to a request from NHS London’s chief nurse Trish Morris Thompson.

The document said: “The chief nurse wrote to each Cluster CE in May 2011 seeking assurance that they have systems in place to identify specific concerns in maternity services and that actions plans are developed in response and that their performance regime is tracking progress against plan and that they are intervening when progress is slow.

“The chief nurse also sought assurance that the midwife to birth ratio is no lower than 1:30, that 1:1 care for women in established labour is achieved 100%of the time and that the recommended labour ward obstetric consultant presence is in place for each maternity service. Only 4 provider units have been able to achieve the RCOG recommendations for consultant presence on labour wards – this is a financial challenge for the commissioners of maternity services.”

 

What the report highlights at London trusts:

Imperial has received an outlier alert from the CQC in relation to the high Caesarean section rate.

West Middlesex has flagged as red on the Organisational Health Indicator for maternal deaths in the last two years and specific recommendations were made by the Pan London Maternal Death review in relation to one of these deaths. Reduction in midwifery staffing - Ratios are now at 1:39. Inadequate consultant presence on labour ward i.e. currently at 86 hours per week – requirements = 98 hours.

Ealing has one of the lowest home birth rate in London i.e. at 0.7%. Their caesarean section rate has increased significantly at 33%.The trust is also under their hours with labour ward consultant obstetrician presence i.e. at 56 hours. It should be at 60 hours and it is not clear if this is dedicated time. The maternity unit has been identified by the CQC as an outlier for postnatal re-admissions. The trust is currently reviewing the reasons for their re-admission rate. 

NWLH. North West London NHS Trust has been a concern in terms of the quality of their serious Incident reports and delays in reporting times. The unit has had to suspend services 3 times in the past 6 months due to no beds for an average of 14 hours on each occasion.  

North Middlesex The trust has recently commissioned an external review of the safety and quality of maternity services.

The Royal Free Hospital The trust has received an excellent CQC review recently.

Barnet & Chase Farm– Regular suspensions of services on both sites on a weekly basis due to either lack of beds or midwives.

Whittington: Opened a new Midwifery Led Unit in 2010 which is being well utilised. The unit has a gap of 20 hours for consultant presence on labour ward. Currently the presence is at 40 hours it should be 60. However, generally there are no concerns.

UCLH : Very little data on this unit submitted to the SHA.

Barking, Havering and Redbridge has received warning notices and a report highlighting a number of concerns from the CQC relating to quality and safety within the maternity unit. NHSL had asked the commissioners (Redbridge) to commission an external review prior to the CQC visits. The Trust has flagged as red on the Organisational Health Indicator for the number of maternal deaths (2 maternal deaths in the first 4 months of 2011). Both deaths had a significant number of service delivery and care contributory factors. NHSL has been working in closely with the trust in developing an action plan to address all of the concerns and ensuring that the objectives are measurable and sustainable. Consultant presence on labour ward is 98 hours on the Queen’s site – Requirement = 168hours.

Consultant presence on the King George site = 40 hours which is adequate.

Whipps Cross has flagged red on the Organisational Health Indicator for maternal deaths in the last two years. The trust has commissioned its own external review into maternal deaths and a further review into its Antenatal Services. Both reports have made significant recommendations.

There is inadequate consultant presence on labour ward i.e. 72 hours, requirements = 98. Midwifery staffing levels are 1:35, NHS London advises 1:30 as a minimum.

Newham has received an outlier alert from the CQC in relation to the unit’s high caesarean section rate. The CQC has asked the Trust to undertake further work around audit and assurance of their action plan. The Trust has also flagged as red on the Organisational Health Indicator for maternal deaths in the last 2 years. Consultant presence on labour ward = 60 – Requirements – 168 hours – well below the recommended hours.

Homerton: The Chief Nurse has written to Will Huxter, Director of Procurement, Contracting and Performance at NHS East London and the City in response to the reduction of funding for midwifery posts at the Homerton.

Barts & The London: Have demonstrated significant improvement in both the commissioning and provision of maternity services.

Consultant presence on labour ward = 60 hours – requirements = 98 hours.

South London Healthcare Trust The trust has made significant improvement in recruiting midwives particularly to the Queen Elizabeth site. However, there are concerns re: Inadequate presence on labour ward currently at 60 hours per site – requirements = 98 hours as both sites have a birth rate of >4,000pa.

Maternity support workers on Pincess Royal site have completed the foundation degree programme and have been exemplary.

Lewisham: Recent change in management structure within the maternity unit suggesting that there were concerns; however NHSL had not been informed of any concerns. Significant delays in submission of their SI reports. This has been raised with the trust.  Consultant presence on labour ward = 60 hours which is adequate.

Kings Due to capacity challenges there is on-going capping. Consultant presence on labour ward = 94 – requirements = 98.

Guy’s and St Thomas’ Capacity challenges – suspension of services on 5 occasions within the past 6 months. Consultant presence on Labour Ward = 62.5 hours. Requirement is 168 hours.

Croydon: The trust and the cluster has been working closely with NHSL in developing an action plan to address each of the concerns and a recent meeting with the CQC, NHSL and the cluster offered assurance that the trust are taking the necessary measures to improve both the commissioning and provision of maternity services. The HoM and the Clinical Director are being supported by two external consultants i.e. a midwife and obstetrician respectively. Consultant presence on labour ward = 72 hours – requirements = 98 hours.

Epsom and St Helier has received an outlier alert from the CQC in relation to the unit’s high caesarean section rate. They have submitted a response to the CQC and have not been asked to undertake any further action at present. The Trust has an effective strategy in-place re: Reductions in C/S. Rates have lowered since the issue of the CQC alert.  Adequate Consultant presence on labour ward: Epsom = 40 hours and St Helier = 60.

St Georges has flagged as red on the Organisational Health Indicator for the number of maternal deaths. The trust has been working closely with the maternity service advisor, the LSAMO and the NHSL’s patient safety manager in improving their investigations into their SIs and RCAs over the past 2 years.  

St Georges commenced capping in 2011 for all women with a Croydon postcode. This has been done in partnership with Croydon Health Services.

Consultant presence on labour ward = 82 hours. Requirements – 98.

Kingston Commissioned its own external review in 2010 of maternity services and a number of recommendations have been made particularly around the capacity and estate. There is a need to rebuild Kingston maternity unit – demand outstripping capacity as the unit was originally built to provide a service for 3,500 births p.a. and the demand now is almost at 6,000. Consultant presence on labour ward = 98 hours. Requirements are 168 hours per week.

 

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