Agenda and minutes

In accordance with the Council’s Constitution, Members are asked to declare any interest they may have in any matter which is to be considered at this meeting.

Manisha Modhavadia of the Barking and Dagenham HealthWatch had worked in the maternity care at Queen’s Hospital

Matthew Cole, Director of Public Health was a member of the Northeast London maternity system board.

As there were no decisions to be made at this meeting, the interests would be classed as non-pecuniary interests.

There were no other declarations of interest.

The minutes of the meeting held on 19 July 2023 were confirmed as correct.

Report to follow

Barking and Dagenham Healthwatch presented the report on the Barking & Dagenham Healthwatch Maternity Project and Workplan for year.

The report was commissioned by North-East London Local Maternity and Neonatal Service following the development of the Maternity Equity and Equality Action Plan 2022. The report reviewed whether women who had received maternity care were given the choices on where to receive their care. The report also covered the impact of disparity of care amongst the BAME community.

It was important for women to be given the choice on where to receive maternity care; however, this would depend on the capacity of the chosen hospitals maternity ward, therefore women would not necessarily have a full choice. Women that had received antenatal care would be able to request to attend a particular clinic, which could take parking and transport into consideration.

The BAME community had received a worse quality of care compared to those in white ethnic background. The Equity and Equality work delved deeper into the issues experienced by the BAME community upon receiving maternity care. Issues such as the referral process and experience while giving birth were highlighted in the Equity and Equality report.

Services across all hospitals was not adequate to meet the needs of all the demographic groups. Until the issues over access to healthcare had been addressed, healthcare services would continue to fail certain ethnic groups. The Equity and Equality Action plan recommended a helpline made available for pregnant women across North-East London with translating services being made available for non-English speaking patients.

An engagement project with local residents revealed concerns around the healthcare provisions which non-English speaking people received. Some residents believed that non-English speaking people would need to be encouraged to learn English otherwise the quality of healthcare they would receive would continue to be impacted. While other residents believed people had the right to receive the translation services. Residents voiced concerns over the risk non-English speaking patients faced in taking relatives to their appointments to act as translators. There could be a risk that the translation could be wrong or in the case of domestic abuse the wrong information my intentionally be given via translation.

There were particular pressures on midwives with the amount of time community midwives would spend with patients. It was reported that often procedures and instructions were not fully explained or made clear to the patient therefore the care provided was inadequate.

In response to a question regarding the referral process, the committee was advised that there were two routes for referrals. One route was through the GP and the other route was through self-referral. Self-referral could be done online, some websites would allow the user to change the language accordingly.

The report was noted.

The Chief Nursing Officer for North-East London ICB presented an updated report on the change of service provisions at Barking Community Birth Centre (BCBC).

Due to staffing related issues and operational pressures, the executive team at Newham Hospital had made the decision to suspend intrapartum care from 1 June 2023. Patients would still receive antenatal and post-natal appointments at BCBC.

Patients that planned to have their birth at BCBC had since been contacted and alternative arrangements had been made. Patients had been given the option to have a home birth or to attend the midwifery unit at Queens hospital. Patients who were classed as high risk would attend the main labour ward.

An action plan had been developed for the next steps for the maternity service and involved the recruitment of more midwives. There was a shortage of midwives and midwifery skills to provide care in a standalone birthing unit. Midwives were not getting enough experience in providing support which included emergency support to women in labour. Therefore, the Trust had identified the risk in the continuation of the intrapartum care service without fully trained staff which resulted in the suspension of the service. It was unclear of when the BCBC would reopen.

The difficulty that the trust faced was to openly promote BCBC without the staff to support it. There was a significant recruitment plan which included overseas recruitment and local recruitment. The Trust had also worked closely with the Academy and Universities to develop trained student midwifes who could be recruited as qualified midwives. Newly hired midwives would go through a program in which they would be supported by experienced midwives. There were currently 40 midwifery students who would be qualified midwives by October.

The Director of Strategy for Newham Hospital responded to a question regarding the opening of the BCBC. It was a statutory obligation for the trust to provide safe care and Newham Hospital was assisting with discussion over the BCBC. A review of the three birthing centers in London would contribute to the BCBC outcome. Newham hospital itself had struggled to reach substantial staffing levels with 60 vacancies in the midwifery team.

The Women and Children’s Health Divisional Director for Newham Hospital stated that midwives themselves raised concerns over risked imposed on intrapartum care in the BCBC.

A regular risk assessment was undertaken on for high-risk pregnancies to ensure both the baby and mother was well. There were specialist midwives who were working together to give pregnant women as much choice as possible on where to safely give birth.

In response to a question on whether the staffing issues would affect patients’ safety, the Chief Nursing Officer for North-East London ICB advised the committee that to date there was no risk to patient’s health; however, the midwives recognised that their competencies to manage risks if they should occur was inadequate.

The report was noted.

The Consultant in Public Health presented the report on the Corporate Plan Targets, Health Outcomes, and Inequality.

The Barking and Dagenham Joint Health and Wellbeing Strategy had been developed to focus local health priorities across the system. Work had been undertaken to develop a monitoring framework with a shared outcomes alongside the Place level to together with the Barking and Dagenham Joint Health and Wellbeing Strategy 2023-2028. The framework would replace the outdated outputs performance reporting.

The monitoring framework would reflect the following:

·  A core selection of outcomes which are being proposed for the London Borough of Barking and Dagenham’s Corporate Plan 2023-26 performance framework;

·  Outcomes aligned to NEL’s Joint forward plan; and

·  Local engagement with staff and partners.

The monitoring framework was discussed at the Committees in Common Development Session in July 2023. There was an intention to develop the framework through engagement and analysis over the autumn.

The resulting framework would be used as part of the framework for the Health Scrutiny Committee.

The report was noted.

The minutes of the last Health & Wellbeing Board and ICB Sub-Committee were noted.

The agenda reports pack and minutes of the last meeting of the Joint Health Overview and Scrutiny Committee can be accessed via: Browse meetings - Joint Health Overview & Scrutiny Committee | The London Borough Of Havering

The minutes of the last Joint Health Overview and Scrutiny Committee (JHOSC) were noted.

The work programme was noted.