Finance, Activity, Outcomes Maternity Programme Board 20 th March - - PowerPoint PPT Presentation

Finance, Activity, Outcomes

Maternity Programme Board 20th March 2015

Maternity Tariff - Activity

69% 65% 71% 71% 31% 35% 29% 29% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HUH 2013 HUH 2014 National 2013 National 2014 Deliveries with complications and co- morbidities Deliveries without complications and co- morbidities 47% 47% 66% 66% 40% 40% 27% 27% 13% 13% 7% 7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HUH 2013 HUH 2014 National 2013 National 2014 Intensive Intermediate Standard

Table 1: Antenatal Tariff locally and nationally 2013 - 2014 Table 2: Birth Tariff locally and nationally 2013 - 2014

78.0% 78.0% 64.2% 64.2% 21.0% 22.0% 35.0% 35.0% 1.0% 0.0% 0.8% 0.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% HUH 2013 HUH 2014 National 2013 National 2014 Intensive Intermediate Standard

Table 3: Postnatal Tariff locally and nationally 2013 - 2014

Maternity Tariff - Spend

Table 4: 2013/14 Spend

Deliveries without CC £4,631,420 Deliveries with CC £3,175,957 AN Standard £2,521,368 AN Intermediate £3,298,187 AN Intensive £1,825,072 PN Standard £853,029 PN Intermediate £293,460 PN Intensive £23,631

Total £16,622,124

Table 5: 2014/15 Forecast

Deliveries without CC £4,197,179 Deliveries with CC £3,255,667 AN Standard £2,436,422 AN Intermediate £3,335,725 AN Intensive £1,837,583 PN Standard £835,883 PN Intermediate £291,840 PN Intensive £11,640

Total £16,201,939

* Additional revenue comes from other CCGs such as Waltham Forest

GP Ante/Postnatal Service

519 464 465 430 440 450 460 470 480 490 500 510 520 530 Antenatal activity Qtr 1 Qtr 2 Qtr 3 734 825 846 660 680 700 720 740 760 780 800 820 840 860 Postnatal activity Qtr 1 Qtr 2 Qtr 3 Table 7: GP Confederation Antenatal Activity Qtr 1, 2, 3 Actual spend Qtr 1, 2, 3 £57,920 Table 8: GP Confederation Postnatal Activity Qtr 1, 2 , 3 Actual Spend Qtr 1, 2, 3 £ £96,200 Table 6: Finance forecast for GP Confederation contract 2014/15

Non-Recurrent Funding 2014/15 Annual Budget (£000's) YTD Budget at Month 11 (£000's) YTD Actuals at Month 11 (£000's) Full-Year Forecast (£000's) Full-Year Forecast (Under)/Overspen d (£000's) Antenatal Local Enhanced Services 596 546 239 261 (335) Total Non-Recurrent Funding 596 546 239 261 (335)

Births & Deliveries 1

Table 9: City & Hackney deliveries at the Homerton 2012/13 to 2014/15

50 100 150 200 250 300 350 400 April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December 2012/13 2013/14 2014/15

Per annum: 2012/13 – 3281; 2013/14 – 3480; 2014/15 – 2543 to date

Births & Deliveries 2

Table 10: City and Hackney deliveries at other maternity units

43 35 47 29 46 30 34 38 40 29 37 42 29 40 49 33 38 39 37 35 40 43 32 42 43 43 47 46 44 41 56 48 41 13 13 17 17 21 17 23 17 27 20 18 26 15 17 20 16 21 20 19 28 22 24 22 13 18 20 24 28 8 9 12 15 17 5 7 8 6 4 9 6 10 4 3 11 9 9 10 6 5 4 9 6 8 9 4 15 7 7 8 6 10 7 6 3 10 7 9 2 6 7 6 2 7 11 8 7 10 4 7 5 5 4 8 10 7 9 11 11 12 6 10 11 7 4 13 8 10 10

2 1 1 2 1 3 3 2 1 1 2 1 1 2 2 2 2 3 1 2 2 1 3 1 1 10 20 30 40 50 60 70 80 90 100 January February March April May June July August September October November December January February March April May June July August September October November December April May June July August September October November December 2012/13 2013/14 2014/15

Percentage share

UCLH Whittington Barts Health Other Providers Royal Free

Births & Deliveries 3

Table 11: Trends in births at Homerton and other units

3281 3480 3391 855 892 952 500 1000 1500 2000 2500 3000 3500 4000 2012/13 2013/14 2014/15 (forecast) Homerton Other Units

Births Projections

Table 12: Birth Data & Projections

Births may increase in City and Hackney by as much as 650 over the next eight years.

2003 2008 2013 Annual Increase 2023 Projection Annual Increase 2023 Projection

City and Hackney 4,323 4,485 4,500

0.40% 4,683 0.07% 4,532 5,119 5,150

Newham 5,102 5,963 6,267

2.08% 7,700 1.00% 6,923 7,507 7,605

Tower Hamlets 3,940 4,230 4,608

1.58% 5,390 1.73% 5,470 5,536 6,077

Barking and Dagenham 2,594 3,619 3,796

3.88% 5,555 0.96% 4,177 4,318 4,251

Havering 2,366 2,787 3,004

2.42% 3,815 1.51% 3,490 3,427 3,478

Redbridge 3,376 4,013 4,591

3.12% 6,242 2.73% 6,010 5,151 4,947

Waltham Forest 3,770 4,582 4,721

2.27% 5,909 0.60% 5,012 5,102 4,869

Total NEL

25,471 29,679 32,264 2.39% 39,294 0.84% 35,614 36,160 36,377 Increase 7,030 3,350 3,896 4,113 Actual Last 10 Years Last 5 Years GLA Forecast (central + NPP) GLA Forecast (SHLAA plus NPP)

Public Health Outcomes

80.7% 81.3% 76.3% 73.0% 74.0% 75.0% 76.0% 77.0% 78.0% 79.0% 80.0% 81.0% 82.0% Quarter 1 2013/14 Quarter 2 2013/14 Quarter 3 2013/14

Table 14: Breastfeeding prevalence 6-8 weeks Table 13: Antenatal assessment by 12 weeks + 6 days Table 15: % women who were smokers at time of delivery

5.4 4.9 4.7 4.4 5.1 0.0 1.0 2.0 3.0 4.0 5.0 6.0 Qtr 1 2013/14 Qtr 2 2013/14 Qtr 3 2013/14 Qtr 4 2013/14 Qtr 1 2014/15

Table 16: Uptake of flu vaccine by pregnant women 2013/14

82.3% 82.4% 81.8% 83.5% 82.1% 80.5% 81.0% 81.5% 82.0% 82.5% 83.0% 83.5% 84.0% Qtr 1 2013/14 Qtr 2 2013/14 Qtr 3 2013/14 Qtr 4 2013/14 Qtr 1 2014/15 33.2% 35.9% 39.8% 28.0% 30.0% 32.0% 34.0% 36.0% 38.0% 40.0% 42.0% C&H Rate London Rate England Rate

Maternal/Neonatal Mortality

Maternal mortality

• 5 maternal deaths between July 2013 and February 2015

Table 17: Neonatal & infant mortality 2011-2014 Table 18: Neonatal morbidity – Sis Table 19: Rates of mortalities per 1000 births 2011-13

Neonatal mortality 2011 2012 2013 2014

Pre-term intrapartum deaths 7 <5 <5 6 Term intrapartum deaths <5 <5 Pre-term stillbirths 32 39 23 25 Term stillbirths 11 6

Totals 39 42 40 38

Unexpected admissions to NICU for term babies (SIs) 2012-13 16 2013-14 8 2014-15 11

5.8 8.8 5.7 5.5 7.6 3.9 4.9 7.1 4.1 1 2 3 4 5 6 7 8 9 10 Stillbirth rate Perinatal mortality Infant mortality City and Hackney London England

Patient Experience 1

Family & Friends Test Response rates

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% Oct-14 Nov-14 Dec-14 Jan-15 Response rate FFT-Antenatal Response rate FFT- Intrapartum Response rate FFT-Postnatal Hospital Response rate FFT-Postnatal Community 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

Table 20: FTT Response rate pre October 2014 (combined question results)

Table 21: Response rate % post October 2014 (Four questions asked)

Patient Experience 2

Maternity - November 2014 Response Rate % Recommend Response Rate % Recommend Response Rate % Recommend Response Rate % Recommend Antenatal Care

• 93.1%
• 100.0%
• 95.5%
• 93.9%

Birth 11.3% 95.1% 4.2% 100.0% 22.1% 96.8% 19.6% 94.4% Postnatal Community Provision

• 96.6%
• 0.0%
• 97.0%
• 97.2%

Postnatal Ward

• 86.4%
• 91.0%
• 93.0%
• 90.4%

BARTS HEALTH NHS TRUST HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST England London 97% 100% 96% 95% 92% 93% 94% 95% 96% 97% 98% 99% 100% FFT-Antenatal FFT-Birth FFT-Postnatal Hospital FFT-Postnatal Community

Table 22: Response rate by FFT questions

Table 23 : FTT recommendation scores Dec 2014 Table 24 : FTT comparison of recommendation rates locally, regionally and nationally

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% Response rate FFT-Antenatal Response rate FFT-Birth Response rate FFT-Postnatal Hospital Response rate FFT-Postnatal Community Oct-14 Nov-14 Dec-14 Jan-15

KPIs and CQUINS

Table 25: Update on GP Ante/post natal service process KPIs

Homerton Maternity CQUIN : 70% continuity for low risk women for antenatal care Reporting in 2014/15 quarter 4.

Each practice has a named GP lead for Maternity provision and a named Midwife In place Evidenced by practice list of names for lead GPs Each practice has an agreed protocol with their named midwife regarding: 1) regular practice meetings / review of current caseload 2) how urgent communication is managed, 3) clear documented clinic times / access information (for both practice and midwife staff) for patients In development Confederation to work with the Homerton Hospital to create a service level agreement that will outline these areas and ask the Federation to negotiate and implement these. In development – through Homerton / CCG / Confederation meetings

Maternity Dashboard

Please see separate excel spreadsheet

London Quality Standards 1

Core standard Assessment team review RAG status October 2014 All women receive one to one midwifery care in established labour Staff rotas for all Midwives were reviewed for random dates. Births data were also reviewed for random dates, in addition to the maternity dashboard. The reviews demonstrated that women were receiving one to one care in established labour more than 98% of the time. 24hours dedicated theatre (and access to a 2nd theatre) Staff rotas were reviewed for random dates. There is adequate cover for labour ward, and when necessary there is additional cover for a team to manage a second emergency in a second theatre. All neonatal care provision is provided as per national service specification and working toward British Association of Perinatal Medicine (BAPM) 2011 There is on- going recruitment within the neonatal nurse staffing. Supportive use of bank and agency Compliance to BAPM 2001 76% Qualified In Service 96% of team NMC registered In-house Professional development Expanded Community team Off rota roles: PDN, SC lead, Breast Feeding, medicine management, ROP, counselling, research secondments There is one consultant midwife for every expected 900 normal births Although the Trust self-assessed and rated compliance with this standard as RED, Homerton has 1 consultant midwife for promoting normality and 1 consultant midwife for Public Health. The Consultant Midwife for Public Health leads on public health interventions which impact on health outcomes and promotes healthy outcomes, which in turn also has an impact on increasing normality in the local population. On review of the births numbers and expected normal births, the Trust is RAG rated as GREEN for this standard. Previously red

London Quality Standards 2

Core standard Assessment team review RAG status October 2014

Midwifery staff vacancy rate below 10% consistently The dashboard demonstrates a vacancy rate of less than 5% all of this year. Supervisor of midwives (SoM) to midwife ratio of 1:15 The current ratio is 1:18.5. There is a Supervision rota 24 hour a day, evidence of this was

• reviewed. The Trust will meet the standard after commencement of the newly offered post

holder and the 2 yet to train, complete their training. Continues red Maternity staff turnover below 10% consistently Performance against this standard was reviewed from the maternity dashboard and vacancy rate which is below 5%. Minimum number of midwife to births ratio of 1:30 Although the Trust is meeting this standard, due to the complexity of cases being seen, the recent Birthrate plus assessment recommended the ratio of 1:26. The funded establishment consists of 201.5 WTE, making the ratio 1:30. Dedicated consultant

• bstetrician on labour ward at

minimum 98 hours with 24 hours internal cover over 7 days per week The hours currently covered by Consultant presence are Monday - Thursday 0800-2200, Friday - 0800-1800, Saturday and Sunday 0900-1600. From 1st February 2015 it will be 0800-2200 every day. The Trust informed the assessment team that they would take stock after February 2015 in view of any further increase in cover. No plans to increase cover beyond 98 hours per week were therefore shared. RCOG and Safer Childbirth (2007) recommend 168hours presence per week. Previously Amber 24hours dedicated maternity anaesthetist cover Staff rotas were reviewed and demonstrated availability 24 hours per day.

London Quality Standards 3

Core standard Assessment team review RAG status October 2014

24hours Obstetric Consultant Anaesthetist availability Staff rotas were reviewed and demonstrated availability 24 hours per day. The rotas included grades of staff. The rotas reviewed included main theatres staffing. 24hours dedicated neonatal resuscitation support and internal senior paediatric/neonatal cover The following staffing details are in place. Staff rotas for all grades were reviewed for a range of random dates. 3 consultants attending Mon-Fri 9-5 in NICU, NICU 2 and SCBU 24/7 neonatal consultant cover (resident 0800-1900) 1 consultant at weekends (resident 7 hours during day) 2 middle grade /senior ANNP on at night time, with 2 ST1-3 During the daytime 3-4 middle grades on and 5 ST1-3 doctors 2 middle grade on weekend daytime This is as per BAPM recommendations

Labour ward coordinator is supernumerary on each shift

The maternity dashboard was reviewed and indicated that the Trust performance against this standard this year has been RAG rated as Amber or Red. Between the months June to August 2014, performance has been rated as RED 38-55% of the time. There is always a Band 7 midwife on each shift, in addition there is a Band 7 maternity coordinator who is back up for the

• coordinator. However despite this, the standard is not being met. The Trust has recently

completed the Birthrate plus review which demonstrated increased acuity in the clinical activity and recommended a higher midwife to births ratio for the Trust. Continues Amber

Patient Safety Indicators - before and after North East London (NEL) Gateway Review

20 40 60 80 100 120 140 160 180 95 152 6.9 48 125 0.49 14 0.8 7.4 3.7 0.16 2.6 25 2.5 4.8 80 173 10.1 62 140 0.44 19 0.8 7.0 3.4 0.44 2.5 15 2.8 6.0

Patient Safety Indicators per 1000

per 1000 for 2011-2012 per 1000 for 2013-2014