Interim review complete on transformation of acute maternity services

An interim review of the transformation of acute maternity services in the Northern Health and Social Care Trust (NHSCT) has been completed.

It follows a recommendation by the Board of the Northern Trust, approved by the Permanent Secretary Peter May in June, that all hospital births should take place at Antrim Area Hospital.

A 14-week public consultation around the transformation was carried out between November 2022 and March 2023, after clinicians advised that the provision of maternity services at Causeway Hospital was unsustainable due to falling birth rates, workforce challenges, and the absence of a neonatal unit.

The new model came into effect on July 17 2023.

In response to ongoing concerns from some elected representatives, campaign groups and service users, Northern Trust Chief Executive Jennifer Welsh offered to carry out an interim two-month review of the service change.

The review looked at the period from July 17 to September 18 2023.

“The reconfiguration of our maternity services came into effect in July, and represented a significant milestone in transformation of our health and social care system at a regional level,” said NHSCT Chief Executive, Jennifer Welsh.

“Change is not always easy, and we recognise this was a very emotive issue, not just for our service users and community, but for our staff too. While it is still early days, I am really pleased at how our teams have adapted and embraced the new model. I’m also encouraged by the feedback from women in our care which has been largely very positive.

“Providing the highest standard of care to women and babies has been, and remains, our priority, and this review demonstrates that the transition to moving all hospital births to Antrim has been done safely and effectively.”

Work to provide additional capacity at Antrim’s maternity unit is complete. The service has been further enhanced to provide a day obstetric unit for scheduled appointments, and an emergency obstetric unit for unscheduled attendances 24/7.

Theatre sessions for elective Caesarean sections have also been increased and a midwifery coordinator role has been created to ensure efficient flow of activity across the service.

All 321 women who had their babies at Antrim Area Hospital in August were invited to provide feedback via a survey. To date, 52 responses have been received.

There have been no formal complaints from service users since the new model became operational.

Ms Welsh said: “While we recognise that this is a relatively small sample survey, we are reassured by the overwhelmingly positive response from those women who have shared their feedback with us.

“77% of women who responded were very satisfied or satisfied with the care they received, while less than 10% were dissatisfied or very dissatisfied.

“We have considered all the feedback in detail and, where women have not felt satisfied with the care they received, we have listened, and their experience is already helping to shape our actions around quality improvement.”

The survey asked for detailed feedback on how the service could be improved with four key themes emerging: perception of maternity ward being “very busy” or “short-staffed”, concern around delays to planned induction of labour to manage activity during busy periods and efficiency of outpatient clinics.

More support for first-time mothers was also included.

Ms Welsh added: “We are committed to providing a safe and positive experience for all women in our care, their babies and their families, so having women’s feedback is vital as it provides us with meaningful insights on areas for improvement and learning.

“I would encourage anyone who is accessing our maternity services to please consider sharing your experience – good or bad – with us, via our Care Opinion platform.”

A six month review of the transition of acute maternity services will be carried out in the new year, focusing on the period since the new model becoming operational in July until mid-January 2024.

The SOS Causeway Hospital campaign group have welcomed the Interim Report but have highlighted the need for transparency and transformation of staff expenditure.

Gemma Brolly, Chairperson of the group, said they are currently awaiting responses to Freedom of Information requests, which she claims are now outstanding by 54 working days.

“Our campaign group comprises of local residents and professionals, advocating to secure a safe, high quality standard of health care in Causeway Coast and Glens. While we were heartened by the arrangement of a ‘Two Month Review’ which was secured at our recent meeting with the Permanent secretary of Health, Peter May and Chief Executive of the Northern Trust, Jennifer Welsh we were also made aware that concerns which were raised on a regular basis to our campaign group were not recognised by the Trust. This interim paper follows that same line, unfortunately,” stated Ms Brolly.

“In order to obtain a realistic picture of what is happening, having spoken to many service users and professionals alike, we had of course put forward requests for information, we are extremely concerned these requests have simply been ignored, one must wonder why? Of alarming concern also, and not mentioned at all within this report or elsewhere publicly is the effect the continuing closure of the midwifery-led unit in Altnagelvin. To what extent will this impact admissions to the labour ward in Antrim Area Hospital? One of the main reasons for the transformation of Acute Maternity Services transferring births from Causeway to Antrim, was issues with recruitment. This was also stated recently as a main reason for the continuing closure of the midwifery-led unit in Altnagelvin, yet in figures revealed to us, we find that outside of the Belfast Trust, the Northern Trust have the highest expenditure on both agency staff and bank staff from March 2019 until June 2023, with a shocking £104,453,000 spent on Agency staff and £63,294,000 spent on bank staff totalling £167,747,000. Surely transformation of expenditure in such a way, investing in recruitment and training as cited by staff themselves within the 14 week consultation would be a much more long-term solution. Our staff are our key resource, fair pay and improved working conditions would go a long way in inviting more prospective nursing/midwifery staff.”

Ms Brolly concluded: “The Two Month Review Report quotes an increase of only two birthing beds and six maternity ward beds, it states there have been 76 delayed inductions in two months, yet it claims “activity was managed safely and effectively via the prospective assessment of capacity and demand, smoothing activities and effective multi-disciplinary working. Recent statements from the Northern Trust would indicate issues of concern which have been highlighted to SOS Causeway Hospital are not of any significant concern within the Trust. We will however, continue to communicate with the Trust in the hope of securing transparent feedback which informs decision-making and secures the highest standard of health care. We will of course continue to advocate and engage with the public, encouraging them as the Trust have done, in sharing their experiences – good or bad – via the Care Opinion platform”(careopinion.org.uk).”