Trust Board Febuary 2010 - Sandwell & West Birmingham Hospitals

SWBTB (2/10) 045 (a)
These efforts have produced good results with clear improvements in the Trust’s maternity services but
there remain continuing concerns about medium term sustainability, particularly in respect of the
Consultant led component of the service. It is these concerns along with the need to plan a transition to
the new service model outlined for the new Acute Hospital under the Right Care Right Here Programme
that led to the medium term review.
As one of the first steps in the Medium Term Review of Maternity Services a report was produced in
June 2009 that set out the clinical case for change. This report identified a number of drivers for change
to the intra-partum and acute consultant led elements of the Trust’s maternity services. In summary
these included:
• New and increasingly challenging national standards.
• The need to ensure that the actions which have been taken to improve quality and safety are
sustainable in the medium term.
• Given national staffing shortages, the need to attract and retain high calibre staff (obstetric and
midwifery).
• The increasing complexity of the population the Trust serves, with a rising birth rate.
• The need to move towards the long term plan for the Trust’s maternity services.
The clinical case for change concluded that from a clinical perspective a further change in the
configuration of services is required in order to enable the continued promotion of normality for women
with low risk factors and also the strengthening and further development of acute services for high risk
women in line with the drivers for change. The consolidation of obstetric-led, high risk deliveries and
associated acute care on one site would facilitate further improvements more rapidly (e.g. extended
consultant cover for labour ward) than trying to achieve this on two sites and would also more robustly
ensure the improvements would be sustained in the medium term particularly in relation to clinical
leadership and presence. In addition such consolidation would ensure integration of staff from the two
sites into one team working to the same clinical policies and processes ahead of the opening of the new
Acute Hospital. This clinical case for change was approved by the Chief Executives of the Trust,
Sandwell PCT and Heart of Birmingham teaching PCT.
In accordance with national guidance, as set out in Changing for the Better (DoH 2008), the focus of the
review has been on improving the quality of services. The Department of Health also requires that all
new reconfiguration proposals (since 1st April 2008) are subject to initial clinical assurance provided by
the National Clinical Advisory Team (NCAT). The purpose of the NCAT is to provide a pool of clinical
experts to support, advise and guide the local NHS on local service reconfiguration proposals to ensure
safe, effective and accessible services for patients.
In line with this requirement a visit by NCAT took place in July to review the clinical case for change for
the medium term service review of maternity services. The conclusion from this visit was support for the
clinical case for change with the following recommendations:
• Plan to transfer all high risk maternity services to one consultant unit at the City Hospital.
• Set up job swaps to break down barriers and encourage consistency of approach.
• Develop MLU at City Hospital.
• Consider developing MLU within Sandwell if and when sufficient midwifery staff have been
trained and/or recruited.
• In the interim introduce a community midwifery team in Sandwell to test acceptability with users
and build up midwifery capacity.
• Consider retaining some consultant ante natal care in Sandwell to minimise the need for women
to travel.
• Consider re alignment and reconfiguration of gynaecological services between Sandwell and
City to maximise on efficient delivery of care being cognisant of on call requirements and
training issues.
• Develop strategic plan centred on Community communication for proposed plans to enable
community and political support for these moves.
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