Agenda item

To receive a verbal report to outline the progress to date with the development of these services at Ysbyty Glan Clwyd and the impact on Denbighshire’s residents.

9.35 a.m – 10.15 a.m.

The Chair welcomed Betsi Cadwaladr University Health Board (BCUHB) representatives Alison Cowell, Assistant Area Director Central – Children’s Services, Fiona Giraud, Head of Midwifery and Women’s Directorate and Mandy Cook, Neonatal Services Manager to the meeting.  The representatives outlined to the Committee the progress to date with the development of the Maternity Services, Women’s Services and the Sub-Regional Neo-Natal Intensive Care (SuRNNIC) Unit.

In her introduction the Head of Midwifery and Women’s Directorate updated the Committee on the progress made to date by the Midwifery and Women’s Directorate with regards to the special measures improvement plan, particularly in relation to four specific areas:

·       Leadership:  midwifery and women’s services were now managed on a pan-North Wales basis in order to aid the monitoring of the services.  The three general hospitals had maternity units, with a clinical lead assigned to each unit.  The leadership structure now in place conformed to the requirements of the Royal College of Obstetricians and Gynaecologists (RCOG).  A Consultant Midwife had recently been appointed for the BCUHB Health Board Area, she was based at Ysbyty Glan Clwyd; 

·       Workforce:  there had been a nationwide staffing problem in maintaining middle-grade medical rotas.  BCUHB had successfully tested a new model which had led to it being able to recruit three consultant posts within the Directorate.  Governance arrangements in relation to workforce matters had also been strengthened recently;

·       Culture:  following a decision to remove third year midwifery training students from the Ysbyty Glan Clwyd site, a delivery plan had been compiled with a view to improving the learning environment at the site.  It would take up to 12 months to fully implement the plan, but already some Bangor University students had successfully returned to the site to continue their studies.  Two specific areas for improvement had been identified at the Ysbyty Glan Clwyd site, they were to increase the number of mothers who breastfed their children (this was not unique to Ysbyty Glan Clwyd) and reduce the number of caesarean section births at the hospital (historically Ysbyty Glan Clwyd performed more caesarean births than other comparable maternity units).  Officers were required to report performance against these improvement actions to the Chief Nursing Officer annually in November;

·       Compliance:  there had been a marked improvement in this area.  The Service was now monitored across North Wales on a four hourly basis.  Officials also met with Welsh Government (WG) on a fortnightly basis in relation to compliance matters.

Responding to members’ questions BCUHB representatives advised that:

·       Ysbyty Glan Clwyd had one dedicated Obstetrics theatre and in the case of emergency caesarean operations the target was 30 minutes, with each case kept under regular review and prioritised accordingly.  Work was currently underway to assess future resource requirements, including theatre provision and anaesthetic cover etc.;

·       Historically Ysbyty Glan Clwyd had the highest rates of caesarean births in North Wales.  Work was currently underway to promote natural births where appropriate and to reduce the number of unnecessary interventions.  This work would be led by the Consultant Midwife, based at the hospital;

·       Whilst no discernible link had been established between deprivation and caesarean rates, there was a link between obesity and caesareans.  Consequently as circa 25% of expectant mothers in North Wales had a Body Mass Index (BMI) of 35 or higher work was underway with a view to educating expectant mothers about maintaining healthy lifestyles;

·       Women’s services, including cancer services, were being developed on a pan North Wales basis with a view to complying with RCOG standards.  The development of the SuRNNIC Unit was based on the same principles with a view to delivering the best standards in the UK;

·       Current breastfeeding rates stood at 56%, with the target figure at 70%.  Rates at Ysbyty Glan Clwyd were on a par with a number of other maternity units across the county.  A recently published paediatric report had highlighted low breastfeeding rates as a nationwide problem and had called for the WG to introduce a Breastfeeding Strategy.  Public Health Wales’ (PHW) assistance would be sought to undertake a campaign to raise awareness of the benefits of breastfeeding;

·       92% of the Directorate’s budget was spent on staffing costs, the majority of whom were operational staff supported by a small team of administrative staff based across North Wales;

·       The Board conformed with national standards in respect of the number of nurses and midwives providing services across its area; and

·       33 new midwives were due to take up posts in September 2017, which conformed with the numbers requested by the Service

The SuRNNIC Manager then updated the Committee on the development of the new regional unit located at Ysbyty Glan Clwyd advising that:

·       The aim of the development was to have a centre of excellence for all sick neo-natal babies located in North Wales;

·       Once the babies were well enough they would be transferred to their nearest special care baby units at Bangor or Wrexham, with babies local to the Ysbyty Glan Clwyd area remaining on site;

·       The SuRNNIC unit would be staffed by a team of neo-natal specialists. The Unit and the other two special care baby units would work as a network to deliver specialist care services to mothers and babies following the same guidelines and practices;

·       The unit would include a 24 hour assessment unit to which patients could be admitted directly or transferred from another hospital;

·       Staff at SuRNNIC would work with voluntary organisations such as SANDS (Stillbirth and Neonatal Death Charity) in respect of bereavement services and support;

·       Construction work was currently underway on the ‘new’ build.  Once that was ready the staff and patients from the current Special Care Baby Unit would move in to enable the ‘old’ part to be refurbished prior to both structures being joined and opened as the new SuRNNIC unit;

·       There had been a keen interest in the recruitment exercise for staff for the Unit.  To date 5 neo-natologists had been recruited, with a sixth post due to be advertised in the near future.  In addition 5 neo-natal practitioners had been recruited and they were currently in the process of developing their skills in conjunction with Bangor University and would be equipped with the required skills by spring 2018, when the Unit was scheduled to open;

·       New equipment was on order, including a mobile intensive care unit which would be available for 12 hours a day.  For times when that unit was not available an agreement was in place between the Health Board and the Cheshire, Merseyside and Manchester Ambulance Services for them to provide out of hours cover.

Responding to members’ questions BCUHB officials:

·       Confirmed that a partnership approach was required between different public sector organisations with a view to addressing the obesity crisis and reducing the risks of Type 2 diabetes etc.  Children could be an effective tool to persuade parents for example to change their lifestyles, eating and exercise habits etc.;

·       Advised that foetal damage by drugs was not a problem, however foetal alcohol damage was a far bigger problem and midwives were trained to identify such problems when babies were born;

·       Confirmed that midwives did work with expectant mothers to alert and educate them with regards to the risks to the unborn child when drinking alcohol whilst pregnant;

·       Advised that the Health Board provided home births and promoted the availability of midwifery led maternity units which were available for mothers identified as ‘low risk’ of complications.  These were available at Denbigh, Pwllheli and Tywyn community hospitals at present.

At the conclusion of the presentation the Chair and Committee members thanked the Health Board representatives for attending and congratulated them on the improvements achieved to date in relation to Women’s Services across North Wales and wished them well with the development of the SuRNNIC Unit.