Www.hee.nhs.uk Personalised Maternity Care & Perinatal Services Barbara Kuypers NHS England & Health...

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PersonalisedMaternity Care

& Perinatal Services

Barbara Kuypers

NHS England & Health Education England


Scope of Project• What are our ambitions for Maternity Services

for 2022 and what changes to Maternity Provision might we envisage.

• Which key areas of service provision require development and what implications will this have for training and preparation of the workforce.

• How will Trusts meet the NHS Mandate for Choice and Personalised Maternity Care and 1-1 care through out. What Models of care might be required.

• What should commissioners be seeking when negotiating Service Level Agreements and CQUINs


Background – NHS Mandate

1. Offers women choice of providers.

2. Reduces the incident and impact of post natal depression through earlier diagnosis, and better intervention and support.

3. That every women has a Named Midwife who is responsible for ensuring she has personalised, one to one care through out pregnancy, childbirth and during the postnatal period, including additional support for those who have a maternal health concerns.

• The Mandate for Maternity supports improvements to the care and experience of women and families during pregnancy and in the early years for their children and asks NHS England to ensure that the NHS:


HEE Mandate

• As part of this ambition, HEE should work with the NHS England and others to ensure that sufficient midwife and other maternity staff are trained and available to provide every woman with personalised, one to one care throughout pregnancy, childbirth and during the post natal period.

• (HEE Mandate 2012-15 (2.3.3.).


Workforce Requirements

• Work is already underway with the Centre for Workforce Intelligence looking at the multi-disciplinary workforce requirements for various key pathways of maternity care.

• The project concentrates on the delivery of a wider workforce able to deliver the care and choices set out within the ambitions of the Mandate by putting in place the necessary actions and levers to ensure that there is an appropriate workforce in place to deliver the capacity and capability required by maternity services in 2022.

• The project will therefore be included in the Mandate to Health Education England.

• CfWI just published the Guidelines for Maternity Workforce Planning Pathway Toolkit


Future Workforce


WHO MAY BE OUR FUTURE EMPLOYERS?Acute

providers Integrated

Care Public Health Private

hospitals Universities Self-employed Social

Enterprise Local

Authorities

Private Industry and sponsors for future health provision

Non-government organisations

Private, social & charitable enterprise

Schools and Educational departments

Social Services Prison Services


1982-84: Maternity Care in Action Chapters 1, 2 &3

1993:Changing Childbirth Report

2004:National Service Framework for Children Young People and Maternity

2007:Maternity Matters

2014Ambitions for Personalised Maternity Services towards 2022


Key Values for Women

• Choice• Continuity• Control


1990:Acute and

Community Services with Home Births.

Main Employer NHS

2000:Concept of Choice, Continuity of Care

and Named Midwife as philosophy of Maternity Care

2010:Increased number of

Alongside and Freestanding

Midwifery Led Units

2020: Increased case loading models

provided by NHS and Social

Enterprise Groups


Personalised Maternity Care


Mental Health Support Needs

mentalhealthtoday.co.uk


Midwifery Managed Pathways

• For every Trust Maternity Unit to have an alongside Midwifery Led Facility that is modern and homely as part of their portfolio of services.

• For all professionals to understand and apply the findings of relevant research, i.e. the Birth Place Study and positively and actively invite well women to birth in Midwifery Led facilities.

• For every Trust Maternity Unit to have a total midwifery managed route and pathway from booking to discharge and to include, ultrasound services to neonatal examination and discharge. That the commissioners especially reward or bonus this pathway.


1st Welcome Appointment with Midwife

All Investigations and Scans carried out by

midwife at local Clinic

Health Promotion and A/N Appointments

either at home or at local clinic

Labour and Birth at Home or Midwifery Unit

Neonatal Examination at bedside or at Home

Post natal care with infant feeding guidance at home

or local clinic

Introduction to onward Health

Visiting Team and Family Planning

Team


Integrated Pathways of Care

• To encourage models of care that enable integrated working and reflects a group practice philosophy in which midwives have ‘control’ of their time management.

• This might reflect an ‘independent’ social enterprise model for particular categories of women such as those that require additional mental health support (Hull) or for those that are reluctant to access traditional maternity routes of care (Sheffield).

• To target particular groups of women who have social challenges and who require extra support throughout their pregnancy by multi-faceted teams (a little like the sure start model) which may include midwives and HVs (and social workers) working together longer into the PN period.


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and

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Unive

rsity

livi

ng fo

r the

first

tim

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ay fr

om h

ome.

Prec

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ar.

Also

go

t mar

ried.

Ca

se-lo

adin

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odel

and

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king

flex

ibly.

Part

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e w

orki

ng in

Acu

te

Serv

ices w

hilst

hav

ing

fam

ily. A

ppoi

nted

as

Supe

rviso

r of M

idw

ives.

Wor

king

par

t tim

e in

Team

Pra

ctice

for

Vuln

erab

le W

omen

.

Child

ren

now

at s

choo

l. Ca

se-lo

adin

g w

ith S

ocia

l

Ente

rpris

e M

odel

wor

king

flexib

ly o

n an

nual

ised

hour

s con

tract

.W

orki

ng a

s Clin

ical

Acad

emic

with

Trus

t and

Univ

ersit

y te

achi

ng p

re

and

post

reg

stud

ents

.Re

tired

with

occ

asio

nal

bank

hou

rs.


Acute Obstetric and Midwifery Provision

Midwifery Case-loading Teams in partnership with obstetric and physician support.

Community Midwifery Provision with Free Standing and Alongside Midwifery Facilities

Home Birth Case-loading Team

Specialist Partnership with Local Authority for women with Mental Health Support Needs.

Specialist Integrated Teams for women with Social Support Needs

(Safeguarding)

Specialist Integrated Team for women requiring support to access services.

New Dimensions Team


The emotional rollercoaster of pregnancy(from DH Parents' views on the maternity journey and early parenthood, 2011)


Childbirth & Mental Health

• Exacerbates pre-existing mental health disorders up to 50%

• Poorly understood• Lack of training• Emphasis on ‘wellness’• Screening often ineffective• Medication advice poor• Stigma, labelling, shame & embarrassment• Fear of not being a ‘good enough’ mother• Fear from the ‘authorities’• Great deal at stake• Midwives often first point of contact


Obstetrician

Physician

Anaesthetist

Neonatologist and Neonatal Home Support Team

Named Midwife

General Practitioner and

Primary Care Support


Integrated Multidisciplinary

Mental Health Team with access to

Mother & Baby Unit

Social Services for adult and

child Safeguarding

Support

Local Authority for Housing and

DWP Support.







Health Education England & Thames Valley

Influences the curriculae planning of all under and post graduate education and Perinatal Mental Health (PMH) is included in all Programmes.

Discussing with HEI’s about the need to develop PMH Training for existing workforce.

Supporting a project to develop mindfulness training for midwives and workshops for women.

HETV has supported post doctorate and intern opportunities.

Working to implement the ambitions of Personalised Maternity Care.


Today and 2022

• Students.salford.co.uk

• Named Midwife• Caseloading Models of

Care• 1-1 Care in Labour• Kings Fund Report and

dissolution of Supervision of Midwives

• Future Review of routes for Midwifery Training

• Kirkup Inquiry and Duty of Candour

• Workforce Toolkits• NHS England Review of

Maternity Services


Total Midwifery Managed Pathways

Every Contacts Counts & No decision about me without me


Thank you

Date post:	19-Dec-2015
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