Download Safety of Birth

A Commissioner’s
Perspective
Annette Williamson
Programme Lead - Reducing Infant Mortality
Birmingham
The Commissioners’ Role
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Assess health need
Consider the evidence base
Involve the public and clinicians
Design service specifications
Procure the right services
Stimulate the development of providers
Performance manage, review services
Commissioning Cycle
Considerations
• The commissioners are PCTs and Local Authorities
• There are national targets around infant mortality
• Determinants of risk are both medical and social
• Partnership working with wide range of
stakeholders is essential for effective
commissioning
• Practice based commissioning input
World Class Commissioning
• The NHS Plan 2000: a plan for investment, a plan for reform.
• Commissioning a Patient-Led NHS 2005: Shift in focus from spending to
investing in health and well-being outcomes.
• NHS Next Stage Review – Emphasis on Quality.
• A Step Further
• Raising Ambitions – New Form of Commissioning
• Effective World Class Commissioning - 11 Organisational Competencies
• understand the needs of their local population.
• steer the local health agenda
• main focus – better outcomes – adding life to years and years to life.
Determining the Quality of
Maternity Services
• Development of ‘Clinical Dashboards’ to support
clinical teams
• Commissioners involve clinician groups in strategic
planning and service development to drive
improvements in health outcomes
• Use of tools and toolkits to measure the quality of care
• Use information from tools to inform commissioning
CQUIN is one of several mechanisms for
improving quality
The Commissioning for Quality and
Innovation (CQUIN) framework is part of a
package of measures for improving quality
set out in the Next Stage Review
CQUIN is one of several mechanisms for
improving quality
• The NSR built upon existing structures to introduce some powerful
new ways to improve quality. These include:
• Getting the basics right eg Care Quality Commission enforcement
powers, Never Events, improving measurement
• Strengthening leadership eg National Quality Board, SHA Boards and
Medical Directors
• Improving accountability eg Quality Accounts, and developing
independent quality standards
• Supplementing support tools eg NHS Evidence service, Quality
Observatories
• CQUIN will operate alongside and reinforce these initiatives.
• CQUIN will also allow commissioners to demonstrate their World
Class Commissioning competencies
CQUIN will act as a vehicle to reinforce the Quality
Framework, encouraging all NHS organisations to give a
higher regard to quality.
New national choice
guarantees by Dec 2009
• Choice of how to access maternity care
• Choice of type of antenatal care
• Choice of place of birth
– Home
– Midwifery unit; freestanding or alongside maternity
unit
– Maternity team care in maternity unit
• Choice of postnatal care
• Also said women should have a midwife they know
and trust throughout pregnancy & in postnatal period
Number of Live Births In England & Wales Over the Past 20 Years
800,000
700,000
500,000
Total Number of Live Births (England & Wales
400,000
Live Births Born to Mothers Born in the UK"
300,000
Live Births Born to Mothers Born Overseas
200,000
100,000
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Births
600,000
Year
Birmingham
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20791 births in 2006/07
2 Foundation and 1 NHS Trust
3 Coordinating Commissioning PCTs
2 Associate PCTs
1 Local Authority
High rates of infant mortality & deprivation
Very diverse population
Variable quality of maternity services
• 2x less well performing Trusts
• 1x fair performing Trust
What have we done?
• Perinatal Institute - data collection and needs
assessment
• City wide commissioning group
• Develop common specification for maternity
services
• Develop social risk assessment tool
• Develop pathways of care for social risk
More of what we’ve done
• Birmingham Health and Wellbeing Partnership
• Smoking, breast feeding
• Pregnancy Outreach Workers and other interventions
for the very deprived, excluded, teenagers etc
• Workforce plan to
• Address rise in birth rate
• Deliver maternity matters choice guarantee
• Reduce caseload for community midwives in deprived
areas
West Midland-wide KPIs
• Quality framework for hospital trust contracts including
KPIs NICE and other guidance
• Booking before 12 weeks (80%)
• Antenatal detection of IUGR (60%)
• Smoking during pregnancy (below 15%)
• Breast feeding at 6-8 weeks (2% pa ^)
• Continuity of carer (75% named midwife)
Other challenges
• Alignment and co-production - previously
fragmented effort
• Commissioners and providers working together to
deliver better safer care
• Increasing the availability of obstetricians on labour
ward
• Meeting antenatal screening standards
• Offering choice and improving safety
Gaps
• Absence of a nationally agreed risk assessment
tool for social risk
• Absence of any evidence based intervention for
obesity in pregnancy
• Need to develop cohesive care pathways for
social risk across the city
• Weak evidence base for reducing infant mortality
Thank you
Any questions?