Download MatCarePerinatal20150311 - Thames Valley Strategic Clinical

Personalised
Maternity Care
& Perinatal Services
Barbara Kuypers
NHS England & Health Education
England
www.hee.nhs.uk
www.hee.nhs.uk
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
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Background – NHS Mandate
• 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:
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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.
HEE Mandate
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•
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
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Future Workforce
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WHO MAY BE OUR FUTURE EMPLOYERS?
 Acute







providers
Integrated
Care
Public Health
Private
hospitals
Universities
Self-employed
Social
Enterprise
Local
Authorities
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 Private
Industry and
sponsors for
future health
provision
 Nongovernment
organisations
 Private, social
& charitable
enterprise
 Schools and
Educational
departments
 Social Services
 Prison Services
2014
2007:
Maternity Matters
2004:
1993:
Changing
Childbirth Report
1982-84:
Maternity Care
in Action
Chapters 1, 2
&3
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National Service
Framework for
Children Young
People and
Maternity
Ambitions for
Personalised
Maternity Services
towards 2022
Key Values for Women
• Choice
• Continuity
• Control
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1990:
2010:
Acute and
Community Services
with Home Births.
Increased number
of Alongside and
Freestanding
Midwifery Led Units
Main Employer NHS
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2000:
2020:
Concept of Choice,
Continuity of Care
and Named Midwife
as philosophy of
Maternity Care
Increased case
loading models
provided by NHS
and Social
Enterprise Groups
Personalised Maternity Care
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Mental Health Support Needs
mentalhealthtoday.co.uk
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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.
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1st Welcome
Appointment
with Midwife
Introduction to
onward Health
Visiting Team and
Family Planning
Team
Post natal care with infant
feeding guidance at home
or local clinic
Neonatal Examination at
bedside or at Home
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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
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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Specialist Partnership with Local
Authority for women with Mental
Health Support Needs.
Home Birth Case-loading Team
Acute Obstetric and Midwifery
Provision
Community Midwifery Provision with
Free Standing and Alongside
Midwifery Facilities
Midwifery Case-loading Teams in
partnership with obstetric and
physician support.
Specialist Integrated Teams for
women with Social Support Needs
(Safeguarding)
Specialist Integrated Team for
women requiring support to access
services.
New Dimensions Team
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The emotional rollercoaster of pregnancy
(from DH Parents' views on the maternity journey and early parenthood, 2011)
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Childbirth & Mental
Health
•
•
•
•
•
•
•
•
•
•
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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
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Obstetrician
General
Practitioner and
Primary Care
Support
Physician
Named Midwife
Anaesthetist
Neonatologist and
Neonatal Home
Support Team
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Local
Authority for
Housing and
DWP
Support.
Social Services
for adult and
child
Safeguarding
Support
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Integrated
Multidisciplinary
Mental Health Team
with access to
Mother & Baby Unit
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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.
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Today and 2022
• Students.salford.co.uk
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• 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
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Thank you
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