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September 2011 Quarterly Meeting notes

Quarterly Meeting Notes

28^th September 2011

Venue: Abbey Community Centre, 34 Great Smith Street, Westminster, London, SW1P 3BU

Theme:

Maternity Services

Mingzi Shi (Chinese National Healthy Centre) welcomed all to the meeting and introduced the first Item.

Item 1:

Domestic Violence: Health & Maternity Project

Jessica Donnellan, Standing Together

There are two main aims:

1. To look at violence against women during pregnancy.

2. To consult, train and build capacity with BME community organisations.

What is domestic violence?

Any incidence of physical or non-physical threatening behaviour in intimate (partner or family) contexts.

Who is affected?

1 in 4 women in their lifetime.

1 in 10 over the last year.

1 in 6 pregnant women.

The impacts of domestic violence are massive.

Health impacts – miscarriage/ foetal injury or death/ maternal injury or death.

We want there to be better opportunities to help –

Women experiencing abuse in A&E
Women presenting themselves to their GP with stress and depression
Mothers being called into school because of children’s behaviour.

We want there to be a better understanding in services of what the signs of domestic violence are so we recognise the cases.

We know –

Firstly that women are most likely to tell family and friends.

And secondly women will approach someone in their community.

This is why it is crucial for us to talk to community organisations. We want to raise awareness. We want to support organisations to enable disclosure. The main tactic that perpetrators use is to isolate victims. It is often dangerous for victims to disclose and especially at the point of separation if that is actually achieved. This is a highly dangerous time as many homicides happen at this time.

We want to work with organisations to create good information leaflets/ posters. Simple resources in different languages to subtly show women what help is available if they may be at risk.

Training – we will be providing free training in awareness skills, knowing how to respond, knowing what services are available and making sure the right messages are being given about what support can be given.

Aims of the first steps – to consult BME groups; to build capacity in BME organisations; to train volunteers and generalist workers; to provide basic information to BME organisations.

Q&A

Question: Can you tell us a little about the project you are doing with Imperial?

Answer: We are trying to train up midwives to be able to recognise and address domestic violence if they come up. Midwives are still part of a statutory organisation (large system) so disclosure may be more limited. It is likely that disclosure would rather happen in a community setting in their own language etc. However it is still important as the more opportunities we can create to address these issues the better.

Question: What kind of training will you be offering community organisations?

Answer: At the moment it is really open. We are trying to identify needs and will consult with organisations and identify individual needs of each organisation. Also NO organisation is too small.

Question: What is the timescale for this project and how far are you into it?

Answer: We are 9 months into a 5 year project. The consultation period will go on until the end of the year.

Question: What boroughs will you be working with?

Answer: All West London boroughs: Ealing, Brent and K&C, Hammersmith and Fulham, Westminster.

Question: Domestic violence can be intrinsic and hard to pin point. A part of the training will you also be taking into account diverse cultural backgrounds to address the different issues that can come up?

Answer: Training is not fixed at this point. Part of the consultation is exactly to find out what is needed. We are also hoping to reach the much smaller voluntary/ community groups. There is also the possibility that women can be trained to become trainers in their community.

Item 2:

Vision for Midwifery Services at Imperial

Pippa Nightingale, Head of Midwifery, Imperial

Imperial is the biggest provider of Maternity services in the borough.

We are doing a big project to do with changing the way we deliver care.

In 2007 there was the Confidential enquiry of Maternity and Child health (CEMACH) This reviewed maternal deaths in the UK and makes recommendations to improve care.

BME groups were pin pointed as 7 times more likely to die than white ethnic groups.

How can we change this statistic?

Access into Care:

Women were not coming to services early enough (seeing very few women before 12 weeks) and do not have good enough health records.

How can we make the service more accessible?

What we changed?

There are 4 different ways women access maternity services:

Maternity helpline – midwife answers enquiries.
Drop in Midwifery clinic
Online – electronic
GP – biggest proportion come from GP

However we need to make sure there are other options.

A significant number of women who died were Health tourists who had other complications.

We are missing the opportunity to reach women who are not being reached.

Language barrier

This is a real barrier. In the new system you can now get leaflets translated into your language.

Often in domestic violence cases the women used their partners to translate so how can you then identify the problems?

Another asylum seeker woman used her child.

A significant number who died had little or no English.

So how is it best to communicate?

This is a big challenge. Language line is used but for every woman during her first booking appointment, a face to face interpreter is always used.

It is stressed that women should never use a family member, particularly a child for translating.

FGM was also highlighted in the report as not being identified at the booking appointment – Now, at Imperial we have an FGM Midwifery clinic.

Every 3 years we have a report that looks at numbers of women accessing services before 12 weeks 6 days into their pregnancy. The latest report is just being put together but it shows that now 96% of women are accessing services before the 12 weeks, 6 days as opposed to before where were looking at 50% - 60% accessing services before this time.

This has made a big difference to ante-natal screening but there is still a high number of women missing ante-natal appointments.

Plan at Imperial

We’re going to move ante-natal care from the hospital setting to children’s centres. Women are more likely to go to an appointment near where they live. Women will also see the same midwife.

This will roll out in November: Ante-natal care and post-natal care accessed from Children’s centres.

Vitamin D supplementation

NICE guidelines state that women from BME groups are at a high risk of vitamin D deficiency. Now ALL women will be advised to take vitamin D. It will cost £1 for a 3 months supply or free if you are receiving benefits.

Work with Maternity Services Liaison Committee (MSLC)

This is how users of our service can help design the future of the service. We want representation from all communities. People who have used or are using the services. We want everyone’s ideas inputted.

Q&A

Question: Regarding FGM – are all your midwives specifically trained in FGM?

Answer:Yes – and we are the only service that is midwifery led. At Imperial all the midwives are trained to identify FGM and to then to refer them to the FGM midwives led clinic.

Question: Is there a pathway into Mental Health services and a link with criminal services regarding FGM?

Answer: Yes – a risk assessment is made at 32 weeks. Clear channels are made through to Mental Health services and also to Domestic Violence services. However we are somewhat cautious as we don’t want women to feel threatened and scared and to end up alienating women from using the service.

Question: The BME Health Forum have done some research on the need for increased use of interpreters. What’s happening regarding this issue in your services?

Answer: This is still an issue that we have to work around. The problem is that it is very expensive.

Question: Does translation have to be verbal? Can we not use technology a bit more?

Answer: Yes – but its still mainly a financial issue. We need to work on commissioning.

Question: When identifying domestic violence cases – how are you helping these women?

Answer: We work on building relationships and trust with midwives and working with Domestic violence organisations like Standing Together.

Question: With the use of interpreters, especially with women from African countries, there is the problem of not translating to them in their first language. There is also a time issue – a lot of these women will need more time than is allocated.

Answer: We are now looking at splitting their hour appointment into 2 shorter, easier absorbable appointments.

We also hope that it will be an easier, nicer setting when we move booking appointments to Children’s centres.

Item 3:

Feedback form BME Maternity Service Users

Nafsika Thalassis, BME Health Forum Manager

[to download the presentation lcick on this link]

This project is looking at BME women’s experiences of using Maternity services at St Mary’s hospital in Paddington and Queen Charlotte’s hospital in Hammersmith.

The aim is to empower BME women, enable them to join the MSLC and champion the findings of the report and feedback to the community.

Before continuing Nafsika stressed that despite some of the information that follows there is no doubt that having your baby at either of these hospitals is safe.

Initial Findings:

Some positive feedback –

1 woman who doesn’t speak English and had hepatitis had a very good experience. When her condition was identified an interpreter was booked and she received a lot of information. She was very happy with this service.

Some less positive feedback –

‘Are you happy to be pregnant?’

If pregnancy is not planned it is not appropriate to congratulate the woman – it can be insensitive.

Even thought there are 4 options for booking your 1^st appointment it is not known to all professionals. The Gynaecological department at St Mary’s referred one woman back to her GP even though it was already quite late.
History Taking

There are discrepancies between what has actually been discussed and what is noted down. Also the misspelling of one woman’s name led to her having to have to have all the information resubmitted.

Customer care

Lack of adequate communication, records being lost and women not always being treated politely and being told off.

Other concerns

Ramadan – one woman was fasting when she was 8 ½ months pregnant. Midwives could be made aware that some women could be choosing to fast and relevant advice should be on hand.

Interpreting services

Where as this worked very well when there a specific problem was identified early on, once one of the women was in the hospital due to complications after giving birth she was often alone and when the doctor came round to her no interpreter was offered and language line was not used.

Recruitment

We are still looking for BME women who are in the early stages of pregnancy to take part in the project.

Q&A

Question: This is a good study with very up to date information. Will Imperial take into account the findings and make the relevant changes?

Answer: An important part of the work is listening to people who use the service. This is why we sit on the Steering group of this project .

Question: With many of the issues that have come up I wonder if you have tried to make links with PALS to address some of them.

Answer: We are trying to steer clear of retrospective questioning. A lot of women have forgotten the details. There is more impact in recording issues as they come up.

Question: How long is the project?

Answer: It is 18 months and we are already 6 months in.

Question: Regarding pre-natal sessions, what do we do about women who are more isolated and perhaps having their first baby?

Answer: We are hoping that with moving services to Children’s centres we can have a closer connection with communities.

Comment: Also could you maybe link in with BME employers?

Answer: Yes absolutely, there are some specially commissioned programmes and outreach projects – first mum partnerships - working with young families encouraging people to access services. We also have a one to one service for women who are identified as vulnerable.

Question: What are tests done at the first appointment?

Answer: They are all fairly standard tests and then some are on demand such as HIV or Thallasemia.

Item 4:

Commissioning Maternity Services

Julia Mason, Senior Children’s Commissioning Manager, INWL

What is Commissioning?

Purchasing or procurement of services is just one element of commissioning. Commissioning is a cyclical planning and review process designed to achieve the best possible outcome for patients.

Procurement is the process of obtaining a contract to provide a service for an agreed price. Designing the service is done in conjunction with everyone who is involved.

Evaluation looks at what the impact of services are.

How are services funded?

Payment is by result – per patient that comes through.

For Maternity services there is a set price per care e.g Ante-natal, post-natal. Also for use of specialist services such as caesarean births.

There is also Maternity Matters money that is allocated in trying to reduce caesareans, reduce foetal deaths and fund additional midwives + additional short term grant funding for extra beds and improving hospital conditions.

How are maternity services commissioned?

With the radical changes being made to theNHS, new ways of NHS commissioning are being developed.

GP consortia will be in charge of commissioning much of services currently being commissioned by PCTs and Public Health is moving to the Local Authority.

All GPs will have to belong to Clinical Commissioning Groups (CCGs). Maternity services will then be commissioned by CCGs as PCTs and Health authorities will be abolished.

There will be Commissioning Support organisations in place and Local Authorities will have a duty to set up Health and Wellbeing boards.

Q&A

Question: Will the relevant CCG taking over the commissioning of services from Imperial support all the initiatives that are currently taking place regarding Maternity services? There might also be a conflict of interest because GPs offer some ante-natal and post-natal care.

Answer: It is our responsibility and we are working closely with them but there is still a lot of work to do.

Question: What is the size of these CCGs? How is it going to work if you have lots of smaller groups approaching big trusts?

Answer: In INWL we have 5 CCGs and one is actually very small and will clearly have trouble actually commissioning services. However they are already talking of joining together as a Consortium.

Question: Will current targets around health inequalities remain in place?

Answer: Yes – there are still key performance targets which are good thing particularly in relation to health inequalities.

Question: Regarding Health and Wellbeing boards – will there be one per cluster?

Answer: There will be one per borough.

Item 5:

The Imperial Maternity Services Liaison Committee & Feedback from Service Users

Jane Suppiah, Chair of Imperial Maternity Services Liaison Committee

[to download the presentation lcick on this link]

Jane is the lay co chair. She is not a health professional. It is a completely voluntary role. She has a great interest that women have a good experience.

The MSLC covers both Queen Charlotte’s and St Mary’s hospitals and has done since the 5 hospitals joined to form Imperial. It has been quite a challenge to bring the MSLC together as the two hospitals are quite different.

The existence of the MSLC is not a statutory requirement but there is a guidance that hospitals support their existence.

It runs because of the enthusiasm and support of parents.

We have a simple vision: to improve women’s experience.

We are made up of parent members, Commissioners, service user representatives, those who have used the service but also have a professional involvement e.g breast feeding specialists, supervisors of midwives, midwives.

What we do?

We gather feedback and present them at committee meetings. We raise issues that are of concern to women and discuss and agree on what action can be taken.

Challenge

We often have very specific individual cases presented to us and its very difficult to take these to the table. We try to look at more over all changes that can be made to make sure the overall experience is better.

Our committee today

We have about 20 involved. We have contributed to projects run by the hospital and we have seen practical changes taking place.

We’ve been working on:

How we bring issues to the MSLC
Service user involvement – breadth and diversity – we need to be more diverse in our representation.
How we capture wide range of service user views

We have got in touch with an organisation called Brain Juice who set up a free 5 minute online survey covering 4 simple questions.

The survey has given more weight to what was brought to the MSLC.

Next steps

Getting more women involved. We are taking part in the BME Health Forum’s project and hope to gather women from the project to the committee.

Walking the patch – get more service users involved in this task.

Raising awareness about what to expect from maternity services. We are considering creating a video around this.