15 January 2018

Better Births – Implementing Community Hubs and considering models of care

By Logan Van Lessen, Consultant Midwife and Clinical Lead for North Central London (NCL) Community Hubs

We face an exciting year ahead for Better Births in 2018. We have made some significant progress in agreeing how we are going to implement community hubs and what models of care we can provide that will ensure continuity of care and carer wherever we can.

Discussions and meetings have been held with frontline managers and staff and we are now putting together standard operating documents (these spell out how we are going to function) for the Park Lane and Harmood Children’s Centre hubs.

Harmood Children’s Centre Hub

At this hub, which will be based in Camden, midwives from University College London Hospital (UCLH) and Royal Free London NHS Foundation Trust will be providing continuity of care antenatally and postnatally. This will be an improvement from current care provision, especially for women at UCLH, who receive their antenatal care at the hospital rather than the community and their postnatal care is fragmented due to postcode boundaries. There is an agreement now that women who have booked at either trust will continue to receive postnatal care across existing boundaries in the NW1 and NW5 area, from their known midwives. There will be a midwife available at Harmood Children’s Centre hub from Monday to Friday as midwives from both trusts will be located there on separate days of the week.

There are still operational issues and staffing levels to negotiate in order to care for 100 women (for the pilot). The project team is working hard to support and engage with the right people in ironing out these important issues.

Park Lane Children’s Centre Hub

At Park Lane Children’s Centre hub (in Haringey) we have agreed that we will be testing a caseload model of care for about 100 vulnerable women. These are women who will be in the moderate to low category of vulnerability. Midwives from the Whittington and North Middlesex will provide total care either in a team or as buddies. Women will be cared for throughout pregnancy, labour and postnatally by a midwife known to them. For this model, we are negotiating numbers of midwives required and also working out ‘on call’ arrangements that are more family friendly e.g. we are considering shifts patterns to cover the work 24/7. This model offers midwives an opportunity to manage their own caseload and exercise their autonomy as midwives.

What happens now?

This month we will be inviting midwives keen to be involved in these pilots for their expressions of interest. For those midwives who wish to develop their skills and broaden experiences as well as pioneering Better Births, this is a great opportunity. It is time limited and something midwives may wish to consider in the short term. Both pilots will be completed by the end of 2018 as we need to evaluate the impact of these models of care on women and the professionals caring for them. Midwives will be supported throughout the pilot by the project team with regular reviews, clinical supervision and with any ongoing issues to ensure both midwives and women feel secure.

Information

If you need to discuss in detail on any of these proposals or are interested in trying out the case loading model, please contact me at Logan.VanLessen@nhs.net or the project lead for NCL, Charlotte McClymont at UCLPartners Charlotte.McClymont@uclpartners.com.

A big thank you to midwifery colleagues, partners and women who have engaged and helped us so far in planning these proposed models or Better Births.

Update on our Choice and Personalisation workstream

By Gillian de La Motte, Personalisation and Choice Clinical Lead, NCL Early Adopter

What is Choice and Personalisation?

The Better Births (2016) report states “Personalised care, centred on the woman, her baby and her family, based around their needs and their decisions, where they have genuine choice, informed by unbiased information.

As Early Adopters of the Better Births principles, when the pilot period is completed, our aim is for women to say, when asked, that they were offered choice throughout their pregnancy, during the birth and in the postnatal period.

How will we offer Choice and Personalisation?

This will begin with the initial booking appointment and continue throughout pregnancy, birth and beyond.

Through dialogue with their midwife, every woman will have a personalised care plan developed that will be tailored to their individual needs, taking all medical and social needs in to account. This personalised care plan will be reviewed and amended as their pregnancy continues and the dialogue surrounding choice will continue as the pregnancy progresses.

Don’t we do this already?

Although we already do this we need to adapt what we do to empower women to be a greater part of decision making and care planning, through an informed discussion.

The Better Births report states that women resent being labelled high, medium or low risk and prefer to be seen as an individual rather than a risk factor.

Assessing risk

Risk assessment is a vital part of care planning. However, women feel too much emphasis is put on risk and clinical care and the individual needs are sometimes ignored. Women also need to see midwives throughout their pregnancy regardless of risk factors, to be able to discuss how they can best prepare themselves for birth and beyond.

What are we doing?

The two community hubs planned for the pilot will aim to address Choice and Personalisation challenges. In these hubs midwives will be providing continuity of care and carer. The women cared for by these teams will have a pioneering personalised care plan. Also, pilots amongst our existing caseloads of women will commence, inserting conversations surrounding personalisation and choice within the existing antenatal care framework. This will be audited later in 2018.

Get involved

In early 2018 I would like to facilitate a few focus groups to hear from midwives on the floor to help develop a tool to reflect these Personalisation and Choice principles.

If you are interested in taking part and sharing your experience and opinion, please contact me at g.delamotte@nhs.net

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