Clinical Senate Update on Maternity, Children and Young People Dr Ryan Watkins

1. Clinical Senate Update on Maternity, Children and Young People Dr Ryan Watkins Joint Clinical Director Maternity Children and Young People Strategic Clinical Network 2nd July 2014

2. Obstetric led units Obstetric led unit with Co-located midwifery units Standalone midwifery units

3. Number of Babies Born in South East Coast 2010 – 2013 Source: NMC Local Supervising Authority 2012/13

4. Poor Maternity Outcomes • There are pockets of deprivation within the region (i.e. parts of Medway and Brighton) • Maternity Dashboard being developed to help identify unwarranted variation across South East Coast • There is no fetal medicine centre in South East Coast • All obstetric led units have achieved minimum birth rate size (2500) • Maternity may not be a prime driver for major service change, although neonatal services may be. • Reconfiguration of other acute services may precipitate the need for reconfiguration of maternity services due to changes in critical dependencies

5. Trends in stillbirth rates at >28 weeks gestation 1990-2008 Source: The Lancet 2011

6. Still birth rate per 1,000 total births, 2009/10 to 2011/12 Source: LSA Annual Report 2011/12

7. Teenage pregnancy rate cross the South East Coast 2008 - 2012 Teenage pregnancy rates across SEC, 2008/09 - 2011/12 Source SEC LSA report 2011/12

8. SUMMARY OF STRATEGIC VISION FOR MATERNITY SERVICES ACROSS SOUTH EAST COAST STRATEGIC CLINICAL NETWORK Interventions (transformation programmes) Service model characteristics System objectives • Transformation programmes: • Identify ‘best practice’ booking to inform triage into improved pathways • Improve pre term birth pathway • Improve stillbirth pathway • Improvementin database to describe outcomes controlling for confounders • Agree maternity commissioning standards in order to decrease unwarranted variation Decrease pre term birth across South East Coast SCN area • Delivering the following outcomes: • Decrease the number of pre term births and/or increase the mean gestational age of births below 34 weeks gestation • Decrease still birth rate • Reduce the number of vacant maternity ultrasound posts • Improved partnership working between maternity and mental health services Empowered service users at the heart of service design and decision making Decrease Stillbirth across South East Coast SCN area Effective partnership with Primary Care Improve resilience of maternity ultrasound provision Evidence based best practice for standardised pathways using lean principles Improved maternity dashboard with change delivered through these programmes: achieved by a service with these features: Review current model of antenatal care to improve outcomes and user experience Commissioning of new technologies to improve maternity outcomes Work with MHDN to improve perinatal mental health provision Improved focus of antenatal care to support transition from pregnancy into parenthood

9. CYP Update

10. 92,3864 CYP 0-19YRS across SEC In 2011 • Where are the Paediatric services across SEC? Links to London and Southampton Acute Pead Trusts Burns Community Trusts Mental Health Trusts

12. Past and Current Reconfigurations across SEC Advice to East Sussex CCG’S • 26/06/2014 • After careful consideration, all three CCG governing bodies agreed that option 6 was the best way to ensure safe and high quality services for local women and children in the long term. • This option results in the following configuration of services: • Birthing services retained at all three current sites • Consultant-led maternity services provided at the Conquest Hospital, Hastings • Two midwife-led birthing units provided - at Crowborough and Eastbourne • Short-stay paediatric assessment units provided at both Eastbourne and Hastings.  • In-patient (overnight) paediatrics, the special care baby unit and emergency gynaecology co-located at the same site as the consultant-led maternity service.  Advice to Surrey Downs CCG

13. SEC Variation • Public Health Outcomes & Indicators

14. Long-term conditions Recovery from illness Premature Death • SEC Variation • NHS Outcomes & Indicators Perinatal Congenital infant, acquired natural causes, injury, RTA, childhood cancers Reducing time spent in hospital LTC unplanned hospitalisation asthma, diabetes epilepsy Emergency admissions not requiring hospitalisation i.e. Lower Respiratory Tract infections Improving Children, YP and Family’s experience of healthcare (GP, OOHs, A&E, acute IP care, end of life care) Harm due to ‘failure to monitor’, delivering safe care to children in acute settings Medication errors, infections

15. Our Data NHS Outcomes Domain 3

16. Our Data NHS Outcomes Domain 2

17. Programmes of Work • SCN

18. Children and Young People’s Vision Required outcomes Service improvements Programmes Children, young people and family empowerment for self-care Reducing neonatal, infant and childhood mortality Primary care standards for children and young people Reducing unplanned hospital admissions for children and young people with diabetes, epilepsy and asthma Integration with public health, education and social care Integrated care pathways for acute illness Access and skills in primary care Community children’s nursing standards and recommended models Reducing emergency admissions for children with lower respiratory tract infection Comprehensive community children’s nursing teams Improving the experience of children, young people and families of healthcare Supporting CCGs with reconfiguration of hospital paediatrics Access and skills in hospital paediatrics Reducing incidence of harm due to failure to monitor Access and skills in children and young people’s mental health services Supporting specialised commissioners to define networks of care with specialised service providers Reducing harm due to drug errors Access and skills in specialised services Effective transition to adulthood Improving transition to adulthood Transition to adulthood standards and best practice pathways

19. Example of Map for Acute Conditions A and E Working Group

20. Example of Map for Asthma Focus Working Group

21. Further Questions