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A report out today which looks at maternity services at Milton Keynes Hospital is calling for more permanent midwives and more beds.
The Care Quality Commission carried out the report, which follows on from one done in 2008 by the Healthcare Commission. Both reviews were carried out following the death of a baby.
Today's report says there have been improvements since the 2008 review, but more still needs to be done.
More midwives and beds
The main reccommendation within today's report is for the recruitment of more permanent midwives and for more beds on the maternity ward in Milton Keynes.
According to NHS MK the maternity unit at the hospital currently has the capacity to deliver around 3,700 babies a year. Last year it saw a record number of 4,000 babies being born there.
The Care Quality Commission says temporary measures are in place to make sure there are enough midwives to provide safe and effective care, but more needs to be done to find permanent solutions.
At the moment there are 30 permanent beds, with a further 12 that can be used when needed. However these additional beds cannot be used full time because of the lack of staff.
Roxy Boyce, the CQC's Regional Director in the South East, told Heart: "With one of the highest birth-rates in the country, it is vital that the trust can deal with added pressure on maternity services at any time. They have made suitable arrangements to effectively manage demand in the short term, but they haven't yet done sufficient planning for added demand on the services that the future is going to bring them."
Milton Keynes NHS Foundation Trust estimates it will need about 150 midwives by 2013/14 to cope with the rising demand.
From July to September 2009 there were 17 vacancies out of 108 funded posts. That's compared to 21.7 vacancies at the time of the Healthcare Commission's report in 2008. Midwife numbers are expected to go down further in 2010 because of retirements.
Plans which have been put in place to ensure there are enough midwives on a temporary basis include:
Community midwives spending more time working in the hospital
Better use of bank midwives
Asking local GPs to offer mothers the option of giving birth in other nearby maternity units
Working with the Oxford Radcliffe Maternity Unit to implement a shared rota of midwives from July
Milton Keynes Hospital says it is also:
Supporting the integration of EU midwives in to the workforce
Encouraging qualified midwives to return to midwifery in the NHS
Training and supporting the maximum possible number of student midwives
Supporting Maternity Care Assistants to train as midwives.
Today's report also says the Milton Keynes NHS Trust Foundation must plan better for emergency situations, like complicated births or staff shortages.
But Ms Boyce, from the Care Quality Commission, told Heart there have been significant improvements in this area:
"They now have a very good escalation policy which means they can bring in additional community midwives if they need to and they have 24 hour access to a dedicated obstetric theatre and to an anaesthetist. The staff themselves are now better informed on how to respond where there is a situation where there is insufficient staffing."
Other improvements include:
The strategic health authority has appointed more supervisors or midwives
Key posts of risk midwife, trust risk manager, head of midwifery and director of nursing have been filled. There are also plans to recruit a consultant midwife.
Policies and guidelines for maternity services are now regularly updated and cascaded to relevant staff.
Milton Keynes NHS Trust says that since the initial report in 2008 improvements have been made.
Dr Sandro Lanzon-Miller, Medical Director at Milton Keynes Hospital, said: “We took action immediately following the visit made by the Healthcare Commission, the previous healthcare regulator, in 2008, and instigated a series of actions in response to their feedback. We are pleased that the CQC acknowledge the improvements that we have made in the provision of maternity services, which include implementing the systems required to consistently deliver safe, high quality care.”
“We put temporary measures in place to ensure that we always have enough midwives to deliver safe and effective care to local mothers while we work to recruit more permanent midwives and open more beds permanently. To increase staffing levels we are encouraging midwives to return to practice, recruiting more students and linking with other hospitals to share their staff. We are steadily appointing additional midwives to our team and our recruitment drive continues.”
“We are fully committed to consistently delivering the highest standard of care, and we are working hard to drive forward further improvements. The Trust continues to work with NHS Milton Keynes to implement plans to meet the needs of local women by increasing capacity in the hospital.”
“Strenuous efforts continue to be made by the Trust to recruit additional midwives. To ensure the delivery of high quality care we have increased staffing levels on wards with bank and agency midwives.”
Milton Keynes Hospital is working in partnership with NHS Milton Keynes to agree capacity plans to keep pace with the projected increase in demand.
Elizabeth Hunter, Head of Midwifery at Milton Keynes Hospital, added: “The delivery of safe, high quality care is our top priority and our aim is to deliver one-to-one care to all women in established labour as we continue our efforts to meet the required number of midwives for the increasing birth rate in the city. We are developing services and moving towards more flexible, midwife-led maternity services, based around the needs of women.”
NHS Milton Keynes - which is responsible for the commissioning of maternity services in Milton Keynes - says:
"NHS Milton Keynes has worked closely with Milton Keynes Hospital in recent years to encourage high standards of maternity care, appropriate levels of staffing and capacity. NHS Milton Keynes has provided an increase in investment of £550,000 to help achieve these aims. Milton Keynes Hospital is now the second-highest funded maternity service per birth in the South Central region."
You can read the full report into maternity services at Milton Keynes Hospital here