Agenda item

NHS London has carried out a review of maternity services across London including at North West London NHS Hospitals Trust. The chair of the Health Partnerships Overview and Scrutiny Committee has asked that this report is presented to the committee so that members are able to see how the service is viewed by NHS London.

Trixie McAree (North West London Hospitals Trust) introduced the item and advised that the Trust Maternity Services had reviewed three reports, these being the Centre for Maternal and Child Enquiries (CMACE) 'saving mothers' lives' 2011, the CMACE 2011 'a review of maternal deaths in London January 2009 to June 2010 and the CMACE London maternal death review Trust specific feedback report January 2009 to June 2010.  The reports outlined 19 recommendations and the Trust had benchmarked a positive achievement of 79% compliance.  Two areas of non-compliance included provision of pre-pregnancy counselling and consultant obstetricians and clinical leadership.  There had also been three areas of partial compliance, these being women with potentially serious medical conditions requiring immediate and appropriate multidisciplinary specialist care, training in recognition and management of the sick and/or deteriorating woman and interpretation services.  Members noted the on-going actions to improve compliance with the recommendations.

During discussion, Councillor Daly sought details with regard to midwifery staffing levels and she emphasised the need for tertiary action in respect of pregnant patients who had pre-existing conditions and to have a joined-up approach.  Further information was sought on what action was being taken in respect of recommendation four of the CMACE report with regard to women with potentially serious medical conditions requiring immediate and appropriate multidisciplinary specialist care.  Councillor Hunter asked what steps were being taken to increase availability of pre-pregnancy counselling and stated that diagnostic services for patients who are 12 weeks pregnant were very important.

The Chair commented that it would be beneficial if chemist shops had a private room available to provide contraceptives and sexual health advice.  She sought information regarding the measures taken to ensure that agency staff received the appropriate training and what services were available for anaemic patients.

In reply to the issues raised, Trixie McAree confirmed that pre-pregnancy counselling was directed at those who had medical conditions which potentially could complicate matters should a patient become pregnant.  Managing treatment of patients commenced as soon as it was known that they were pregnant.  A team of specialist midwives served both Brent and Harrow and whilst use of agency staff was low, any appointed received the necessary training, including an explanation of the relevant guidelines and an orientation process undertaken.  All patients were monitored throughout their pregnancy and this would include checking for anaemia and patients were encouraged to ensure that their vitamin D intake was sufficient.  It was noted that chemists offer free contraceptives.   

Jo Ohlson acknowledged that more could be done to signpost patients to the relevant services with regard to pre-pregnancy counselling.  Prakash Chatham added that a protocol was in place regarding patient planning during their pregnancy and included monitoring of various matter in blood levels, such as folic acid, and dietary concerns.

RESOLVED:-

(i)         that the benchmarked position for Maternity Services in August 2011 against national and pan London reports which demonstrates high levels of compliance overall at 79% be noted; and

(ii)        that the ongoing actions to improve compliance with the recommendations be noted.