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Over the last few years, Bradford City Clinical Commissioning Group (CCG) have been working with our partners to improve maternal and child health.

We welcome the increased focus on maternity services following the publication of the National Maternity ReviewThe National Maternity Review led to the Five Year Forward View for maternity care - Better births: Improving outcomes of maternity services in England (2016).

The report highlights that staff should be supported to deliver care that is centred around the woman. It also outlines a vision for maternity services to become; safer, more personalised, kinder, professional, and, more family friendly. 

Bradford City CCG is currently working with our maternity services providers and the Maternity Partnership to assess the current maternity services we commission.

The Five Year Forward View for maternity care sets out planning, design and safe delivery of services. How women, babies and families will be able to get the type of care they want, and how staff will be supported to deliver such care through the following recommendations:

How are we doing? 

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Smoking cessation

Our aim is to encourage pregnant women to stop smoking during pregnancy, ideally altogether.

Why measuring smoking cessation is important

Each year, in the UK, smoking during pregnancy is associated with up to 2,200 premature births, 5,000 miscarriages and 300 perinatal deaths. Smoking during pregnancy also increases the risk of babies developing a number of other conditions, including;

  • respiratory conditions,
  • attention and hyperactivity difficulties;
  • learning difficulties, and;
  • problems of the ear, nose and throat.

Therefore, making sure babies are protected from tobacco smoke means that children have a healthy start in life.

What are the smoking cessation rates in our CCG?

Smoking cessation is measured by the number of women smoking when first pregnant in comparison to the number of women smoking at time of delivery. 

We are working with partners across health and social care to help women who are planning to have a baby or are already pregnant to quit smoking as we recognise that there is a need for improvement. 

National average - 10.4%

In our CCG - 10.1%

What we are doing to work with expectant mothers to support and encourage them to stop smoking

Public health have funded a smoking cessation midwife and we have clear opt out referral process for pregnant women in to the smoking cessation service.

Neonatal mortality and stillbirths

Why measuring low birth weights is important

Preterm birth and being small for gestational age are the reasons for low birth weight. Preterm birth is also the most common direct cause of newborn mortality. Both are also important indirect causes of neonatal deaths.

Low birth weight is considered to be a factor in 60-80% of neonatal deaths. Therefore, by improving the care of mothers during pregnancy, during childbirth, for babies of low birth weight we can help reduce neonatal and infant mortality rates.

What we are doing to improve the health of mothers and maternity services in Bradford

We are working with Bradford Hospitals NHS Foundation Trust to continually improve maternity services. Locally, we have our Every Baby Matters Partnership Group who meet to address the ten recommendations outlined by the Infant Mortality Commission Report in 2006 when infant mortality rates were very high. We also have Better Start Bradford (a £49million research programme over 10 years) to provide evidence based projects for pregnant women and young children in the three most deprived wards in the district and share the learning across Bradford. We are also engaged in work at a Yorkshire and Humber level aimed at reducing stillbirth rates.

  • 9.7 neonatal mortality and stillbirths per 1,000 births

Experience of maternity services

Why measuring experience is important - the friends and family test (FFT)

Patient experience is measured through the Friends and Family Test (FFT). This is a survey given to all patients about the quality of the care received – asking if they would recommend the service to family and friends. The results of the FFT helps give services and commissioners a better understanding of patient needs. It is an enabler in helping to improve services. 

What are the friends and family test results in Bradford?

In November 2016, 13.1% of patients asked responded to the FFT. Of these 100% reported that they would recommend maternity services to friends or family.

Find out more about the friends and family test in the video below from NHS England.

 

Care Quality Commission (CQC)

The 2015 Care Quality Commission (CQC) National Maternity Services Survey assessed patient experience across the entire maternity pathway. This includes antenatal, intrapartum and post natal.

In 2015, women in our CCG, reported a score of 78.5. We recognise that this needs to be improved as it falls within the 2nd to lowest quartile in England.

Choice over maternity services

The Five Year Forward View promises to “make good on the NHS’ long standing promise to give patients choice over where and how they receive care” and is supported by the national maternity review “Better Births”, which outlines a vision for maternity services to offer personalised care, centred on the woman, her baby and her family and based around their needs and their decisions, where they have genuine informed choice.

  • reports of the composite score from the CQC maternity survey for our CCG is equal to 63.7% which indicates a need for improvement.

Note: Results from the latest survey of 2015 will be updated on a 2 yearly basis instead of 3 yearly, due to a review undertaken by the CQC regarding their patient survey programme

What we are doing to improve choices in maternity services to secure care that is personalised and centred on the woman, her baby and her family based on needs

We commission services which provide the four choice guarantees outlined in Maternity Matters:

  1. choice of how to access maternity care
  2. choice of type of antenatal care
  3. choice of place of birth (home birth, midwifery led care & obstetrician led care)
  4. choice of place of postnatal care

However, we recognise there is much to do to ensure all women are fully aware of the choices available to them and are enabled to make informed decisions around their care options.  In support of this and to achieve delivery of the additional requirements relating to choice and personalisation outlined in Better Births, the five year forward view for maternity services we have established a Maternity Programme Board which will link into the West Yorkshire & Harrogate Local Maternity System.

Caesarean section

Why measuring caesarean sections is important

A caesarean section is an operation to deliver a baby, it can be a planned or an unplanned operation:

  • planned (elective) – where a medical need for an operation become apparent during pregnancy or it is requested by the mother in advance.
  • unplanned (emergency) – when circumstances before or during labour mean that a ceasaran section must be performed.

Rates of cesarean section in our CCG

For quarter 2 2016/17:

Bradford Teaching Hospitals NHS Foundation Trust

  • total births - 1,556
  • planned caesarean - 8.6%
  • emergency caesarean - 13%
  • total caesarean - 21.6%

Airedale NHS Foundation Trust

  • total births - 559
  • planned caesarean - 10.7%
  • emergency caesarean - 14.3%
  • total caesarean - 25%

Breast feeding initiation by provider

Why measuring levels of breast feeding is important

Levels of breast feeding are measured at delivery and in the 6-8 weeks following birth. In the UK, 73% of mothers start breastfeeding. Breast feeding provides health benefits for both mother and baby and helps build a strong emotional bond. It also reduces the risk of: 

  • infections, with fewer visits to hospital
  • diarrhoea and vomiting, with fewer visits to hospital
  • sudden infant death syndrome (SIDS)
  • childhood leukemia
  • type 2 diabetes
  • obesity
  • cardiovascular disease in adulthood

What are the levels of breast feeding in Bradford?

In Bradford, breast feeding rates are assessed at delivery and at the postnatal checkup which happens in the 6-8 weeks after birth.

Bradford Teaching Hospital Foundation Trust - 74.1%

Airedale NHS Foundation Trust - 77.8%

What we are doing to improve the health of mothers and maternity services in Bradford

We are working with the Strategic Breastfeeding Group and Better Start Bradford to identify opportunities to increase breastfeeding rates. Providers continue to work to maintain Baby Friendly accreditation.

What you tell us about maternity services

We make sure that we are listening, engaging and involving patients in the planning and design of their local NHS. To do this, each programme of work has the infrastructure to engage and collect information from people through:

Maternity Service Scorecard

The insight and feedback you give us makes sure that we not only collect information but have the means and ability to use it to inform our commissioning activity and quality improvement. All this insight and feedback is pulled together in a system we call grass roots.

Grass Roots

Grass Roots pulls together information reported through NHS Choices, Patient Opinion, Healthwatch, complaints, local groups and direct patient, family and community feedback to help us understand your experience of local services. This information informs our CCG planning and decision making. 

The following represents feedback received in to grass roots regarding maternal and women’s health from September 2014 – end October 2015. The number of responses received relating specifically to maternity services was 26 (this relates to patient feedback from 253 patients or carers and 39 staff). 

What you report through grassroots

As well as this, for each of our programmes of work, we tailor engagement to ensure we are reaching people who use local services. Specifically for maternity services, the maternity partnership and the women’s health network dive in deeper to understand experiences. 

The Maternity Partnership

The Maternity Partnership covers Bradford District and Craven. It works with providers and commissioners of maternity services to make sure that services meet the needs of local women, parents and families.

Each year the Maternity Partnership conducts a series of focus discussion groups throughout the district to listen to the views and experiences of new mums and mums-to-be. The topics discussed are chosen by people who use the service. The aim of the focus groups is to gain insight into the views of women who are seldom heard and less likely to use other feedback mechanisms such as grass roots and the friends and family test amongst others.

Each focus group has a different theme, 2015/16 focused on personalised choice and 2014/15 focused on community midwifery, you can see the key themes from each of these groups below: 

2015/16 focus groups, personalised choice:

2014/15 focus groups, community midwifery:

Women's health network 

Bradford City CCG has supported the development of the Women's Health Network to enable key messages to be shared with women and develop a better understanding of health matters. Specifically, the network is helping us share messages relating to the importance of pre-conception care, diet and nutrition, accessing health services for children and preventative care (such as immunisations and screening) appropriately and in a timely manner.

The network has hosted a series of focus groups, workshops and events to build better understanding. Key themes include:

Patient stories 

 

What we have done in 2016/17

During the last year we have worked with providers of maternity services and our partners to improve maternal and child health outcomes. 

This work is split into three main areas;

  • developing maternity services
  • improving outcomes - through Better Start Bradford
  • research - through Born in Bradford.

 

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Developing maternity services - addressing perinatal mental health issues

We have continued to work with our partners develop a streamlined, easy to follow pathway which raises awareness of perinatal mental health issues. The pathway makes sure that women, and their partners, see the right person at the right time. We have also worked with our partners on the design and implementation of training for midwives, health visitors, and children’s centre staff.

Developing maternity services - BabyClear programme

We have worked with Public Health England to establish the BabyClear programme at Bradford Teaching Hospitals NHS Foundation Trust. This includes:

  • briefing sessions for midwifery staff and other relevant health professionals,
  • improved care pathways to reflect our evidence base,
  • advanced skills training to support stop smoking advisors to work effectively with pregnant women
  • finding ways to engage with pregnant smokers who do not use stop smoking services
  • awareness and engagement with all health professionals involved with pregnant smokers.

Developing maternity services - specialist midwives

We have worked with our colleagues in public health to recruit a dedicated smoking cessation midwife.

We also have a breast feeding support midwife who runs education and training and awareness raising to improve uptake and continuation of breast feeding.

Developing maternity services - maternity partnership focus groups

We have worked with our colleagues in public health to recruit a dedicated smoking cessation midwife.

We also have a breast feeding support midwife who runs education and training and awareness raising to improve uptake and continuation of breast feeding.

Developing maternity services - Every Baby Matters recommendations

We have continued to support the implemetation of the Every Baby Matters recommendations. These include;

  • early access to pre-conception, maternity and infant care
  • breastfeeding
  • health and nutrition of pregnant women and new mothers
  • cutting down on alcohol and/or non-prescribed drugs
  • cutting down on smoking
  • understanding about genetically inherited issues
  • Healthy Start vitamins
  • help with housing, training and finance.

Developing maternity services - Yorkshire and Humber maternity dashboard

We have worked with partners across Yorkshire and the Humber to introduce a maternity dashboard. The dashboard will be used as a comparison tool for commissioners and service providers to highlight any variations across locations. It will help use to plan a coordinated approach to identifying and tackling inequalities; share best practice and initiatives; provide a shared forum for discussion. In turn, it will allow us to put patients at the heart of decision making, help us seek the highest quality and reduce health inequalities for our population.

Developing maternity services - Yorkshire and Humber stillbirth recommendations

We have worked with our partners across Yorkshire and the Humber to develop and introduce the Yorkshire and the Humber stillbirth recommendations. The recommendations include reducing the risk of stillbirths and the provision of bereavment care for women and their families experiencing a still birth.

Developing maternity services - recurrent funding for the Bradford Doula project

We have secured recurrent funding for Action for the Community’s (ACL’s) innovative Bradford Doulas project. The Bradford Doula's train community volunteers to work with expectant mums from about two months before the birth to about six weeks after with the aim of improving the health and well-being of mother and baby

Improving outcomes - Better Start Bradford

We are continuing to support the Better Start Bradford programme. The programme received £49 million funding from the Big Lottery to improve maternal and child health outcomes. This programme is based in the Bowling and Barkerend, Bradford Moor and Little Horton areas of the city and will benefit 20,000 young children, aged between zero and three years, over 10 years.

In the past year, through Better Start Bradford, a number of projects have commenced including:

  • establishment of a caseloading midwifery pilot in support of the development of personalised midwifery care,
  • introduction of the Baby Buddy app across the district, 
  • roll out of the perinatal support service,  
  • roll out of talking together. 

Research - Born in Bradford

Born in Bradford (BiB) is a long term study of a cohort of 13,500 children who were born at Bradford Royal Infirmary between March 2007 and December 2010. The health of the 13,500 children are being tracked from pregnancy through childhood and into adult life.

Born in Bradford researches the many influences that shape our lives, including; our parents and wider family, our genes, the way we choose to live, the local environment, the services we access. It then looks at how these all come together to affect health and wellbeing.  

The information collected from the Born in Bradford study is being used to find the causes of common childhood illnesses as well as explore the mental and social development of the next generation. Findings from the study will be used to inform our future commissioning decisions.

What we are doing over the next two years 

Better births: improving outcomes of maternity services in England

We are currently working with the providers of maternity services and the Maternity Partnership to assess our current arrangements for commissioning and service delivery in line with the Better births: Improving outcomes of maternity services in England (2016) recommendations.

We will use the outcome of this assessment to look at our priority areas and deliver an action plan to the maternity network.

There are a number of other areas which have also been identified for action during 2016/17:

In response to the requirements of Better Births, improving outcomes of maternity services in England we have established a Maternity Programme Board to oversee the implementation of the recommendations of this five year forward view for maternity services. Led by a senior clinician we have developed an action plan and will engage with senior management from across the local health and care system to achieve delivery. We are also engaged in the developments being led by the Yorkshire and Humber Maternity Clinical Network and the learning from the Maternity Choice and Personalisation Pioneers and Early Adopter sites.

Our plans for the next five years 

Through the establishment of a programme to improve outcomes in maternity services we will build on the learning from our two maternity pilots which are currently in Airedale and in the Better Start Bradford locality.

Developing and building on our learning will help create personalised maternity care. We plan to meet the needs of all our communities, as set out in Better Births: improving outcomes for maternity services in England (the five year forward view for maternity care).

We will be working with the Maternity Partnership, the Women’s Health Network and other community based forums to ensure that services are developed which are accessible  to women from all communities and meet their needs and expectations of personalised care.

We will also develop our relationship with the Born In Bradford research project and Better Start Bradford, their findings help inform the evidence based for ongoing service development. 

We will continue to be active participants in the Yorkshire and Humber Maternity Clinical Network and use this forum as a vehicle for sharing good practice around key themes and developing toolkits to address shared priorities for action.

We see a bright future for maternity services in Bradford, which will include:

The future of maternity services