Report of Saint Mary’s Managed Clinical Service (MCS), Manchester University NHS Foundation Trust

Dame Donna Ockenden was appointed to conduct an independent review of maternity services at Shrewsbury and Telford NHS Trust. A report highlighting the initial findings was published in December 2020 , with the second and final report being published in March 2022 . A report detailing Saint Mary’s MCS progress against delivering the immediate and essential actions to both reports was presented at the Health Scrutiny Committee on 22 June 22. This report provides a further update on our progress against the remaining actions.

In addition, as requested by the Health Scrutiny Committee in June 2022, Saint Mary’s MCS have provided actions being taken to address inequalities for our most vulnerable women from Black and Minority Ethnic (BAME) backgrounds.

This report also provides a summary of actions taken by the Saint Mary’s MCS in response to a 29A warning notice issued by the CQC, and outlines improvements made in key metrics.

The Committee considered the report of the Saint Mary’s Managed Clinical Service, Manchester University NHS Foundation Trust that described that Dame Donna Ockenden had been appointed to conduct an independent review of maternity services at Shrewsbury and Telford NHS Trust. A report highlighting the initial findings was published in December 2020, with the second and final report being published in March 2022.

A report detailing Saint Mary’s Managed Clinical Service progress against delivering the immediate and essential actions to both reports was presented at the Health Scrutiny Committee on 22 June 2022. This report provides a further update on our progress against the remaining actions.

Key points and themes in the report included:

·         Providing an introduction and background;

·         Discussion of the Manchester Foundation Trust response to emerging findings from the first Ockenden report;

·         Discussion of the Manchester Foundation Trust response to findings from the final Ockenden report;

·         Information on the support for the maternal health of women and families from Black African, Asian and other ethnic minority groups;

·         Information on the response to the Care Quality Commission s29A warning letter, noting that a s29A warning notice stated the reasons why the CQC considered that a trust needed to make significant improvements; and

·         Progress on success measures.

Some of the key points that arose from the Committee’s discussions were:

·         Welcoming the use of appropriate language and terminology throughout the report;

·         What research, if any had been undertaken to understand the psychological impact the findings of the Ockenden Report and the increased awareness of the issues identified had on women and families from Black African, Asian and other ethnic minority groups;

·         Noting that written information booklets were provided in 11 languages, what provision was made for speakers of other languages;

·         What provision was made to provide maternity services for refugee women and disabled women;

·         Noting comments regarding staff recruitment and retention;

·         What were the barriers to implementing the recommendation that ‘The transitional care model offered at the Wythenshawe site should be replicated across the three sites without delay’; and

·         Noting the reported work analysing a large data set of birth outcomes that found differences in the rates of fetal growth restriction in certain geographical areas with high ethnic diversity and enquiring what were the geographical areas.  

The Head of Midwifery, North Manchester, Manchester University NHS Foundation Trust made reference to the Maternity Voice Partnership that had been established across all three hospital sites. She advised this forum captured and articulated the voice of service users. She stated this feedback from women and their families, including those from different ethnicities was important to inform services and responses. She stated that she was not aware of any specific research into the psychological impact the findings of the Ockenden and increased awareness of the issues identified had on women and families from Black African, Asian and other ethnic minority groups. In response to a specific question the Committee was advised that further information on the 12 Black and Asian maternity equity standards that was referred to in the report would be circulated following the meeting for information.

The Consultant in Fetal and Maternal Medicine and Medical Director of Saint Mary’s Managed Clinical Service made reference to the initiatives to engage and support women and families from Black African, Asian and other ethnic minority groups, noting that consideration was also given to wider health inequalities, such as socio and economic deprivation. She made reference to the advice work undertaken across a range of health-related topics such as Vitamin D and vaccinations. She commented that this engagement with women helped understand the needs, concerns and risks experienced by women. She also stated that raising awareness of health inequalities amongst staff was also important to support this activity and address health inequalities. She further made reference to the intention to increase the number of staff across the workforce that reflected the women that were cared for.

The Consultant in Fetal and Maternal Medicine and Medical Director of Saint Mary’s Managed Clinical Service commented that it was important to recruit and train the staff so they were equipped with the required skillset to safely complete the transition of the care model offered at the Wythenshawe site across the other sites.

The Chief Nurse, Manchester University NHS Foundation Trust stated that translation services, either face to face or via telephone was utilised for speakers of other languages. She added that they would not use a family member as a translator.  She said that if it became evident that there was a need to publish a booklet in another language this could be arranged. The Head of Midwifery, North Manchester, Manchester University NHS Foundation Trust advised that there were specialist staff who worked with asylum seekers, adding that these staff had established community links and worked closely with the VCSE sector. She stated that a Specialist Midwifery Advocate would support a disabled person and devise specialist individual care plans, including those in the home setting.

The Consultant in Fetal and Maternal Medicine and Medical Director of Saint Mary’s Managed Clinical Service advised that the geographical areas referred to in the research into the rates of fetal growth restriction were Longsight, Levenshulme and Fallowfield. She added that this research would inform targeted intervention work to improve health outcomes. The Chair stated any future update reports should include this, and any other relevant data sets, and where possible this should be provided at a ward level.  

Decision

To note the report.