Review of Maternity Services (S.R.9/2021): Response of the Minister for Health and Social Services.

Findings

Comments

1

It has been recognised by the majority of service-users and maternity staff that the current maternity facilities within the General Hospital are inadequate and highly  unacceptable.  The  Panel  is therefore  pleased  that  a  commitment has been made to upgrade the facilities imminently.

Accept.

2

Evidence suggests that there has been little  active  involvement  in  the refurbishment  plans  of  the  current maternity  unit  with  women  who  are recent  or  future  users  or  with  the midwives providing services.

Acknowledged. Please see recommendation 1.

3

Without  a  clear  strategy  for  the maternity services, the planned upgrade works appear to have been led by the need for improved estates rather than a chance to improve the model of care.

Acknowledged.

4

Standalone midwife led maternity units are a safe and cost-effective choice for women  experiencing  a  normal' pregnancy  and  upgrading  two  rooms within the current maternity unit does not necessarily equate to a midwife led facility.

Acknowledged.

Findings

Comments

5

The Panel has concerns regarding the plan to refurbish the current Maternity Unit in phases over a two-year period, whilst remaining fully operational, and the potential disruption this may cause to the service provided to women and their families and to the staff working in the Unit.

Accept.

Measures are in place to minimise disruption to women  and  staff,  whilst  vital  backlog  of maintenance work continues.

6

Whilst maternity services appear to be safe' when considered through the lens of major empirical measures such as perinatal  mortality  or  major  physical trauma, it is the emotional component of quality that appears to be lacking at times. A lack of emotional safety in the delivery  of  care  is  leaving  women feeling unsafe, unsupported and with negative opinions of the service.

Acknowledged.

We  are  transitioning  to  a  continuity  of  care midwifery  model  which  will  support  the development  of  the  professional  relationship between  all  mothers  and  midwives.  We  are working on public health messaging to inform mothers on their choice of place of birth and care.

7

Continuity  of  care  contributes  to improving  quality  and  safety  of maternity care. High quality evidence indicates that women who receive care in these models are more likely to have effective care, a better experience and improved clinical outcomes.

Acknowledged.

8

58 per cent of women who have birth in the last five years did not see or speak to the same midwife every time at their antenatal check-ups and 55 per cent did not see or speak to the same midwife when receiving postnatal care.

Acknowledged.  It  is  noted  that  these  statistics reflect only those that completed the Review of Maternity Services Survey, where 656 people out of the approximately 4,579 women who gave birth over the last five years responded. This is not a whole reflection of the Maternity Services activity for the last five years.

This  equates  to  8.3%  and  7.9%  of  Maternity Services activity, respectively.

9

Differing advice provided to women by maternity staff, usually following the birth of their baby, has led to confusion and increased levels of anxiety.

It is noted that consistent written information is provided to each woman following delivery and through  the  antenatal  period  in  the  form  of Antenatal  Wellbeing  Wallets  and  Postnatal Discharge Packs.

10

Continuity  of  care  in  the  antenatal, intrapartum  and  postnatal  periods  of pregnancy  would  improve  women's trust in their caregivers and help them

Acknowledged.

Findings

Comments

to build and maintain relationships and rapport.  Furthermore,  evidence suggests that continuity of care would also  improve  women's  emotional wellbeing and mental health during and after pregnancy.

11

Whilst there is a clear intent within the maternity  team  to  provide  greater continuity of care, it is evident from the concerns received that there is much more progress to be made.

Acknowledged.

12

The development of a women centred midwife led model of care would enable women to receive the majority of care in community settings with a focus on normality,  the  family  and  a  positive transition to becoming a mother.

Accept.

We  are  transitioning  to  a  continuity  of  care midwifery  model  which  will  support  the development  of  the  professional  relationship between  all  mothers  and  midwives.  We  are working on public health messaging to inform mothers on their choice of place of birth and care.

13

Kindness  and  compassionate  care  is something that every woman, baby and family deserve and should expect from all midwives, doctors and members of the maternity team.

Accept.

14

Whilst  the  majority  of  women  who engaged with the review felt listened to, supported and respected throughout the three stages of pregnancy, a significant percentage did not receive the level of compassion  and  kindness  that  you would  want,  or  indeed  expect,  when receiving maternity care.

Acknowledged.

15

Steps  are  currently  being  taken  by Maternity  Services  to  address communication  issues,  to  bring compassion back into the heart of the service and to embed a more cohesive culture.

Accept.

16

Currently,  there  is  no  system-wide agreement to a single maternity strategy which describes agreed outcomes and performance  goals  for  maternity services.

Acknowledged. Please see recommendation 5.

Findings

Comments

17

Whilst  a  maternity  strategy  is  being developed,  a  Task  and  Finish  Group should be established to drive forward the  necessary  transformation  to maternity services.

It is noted that there is a Task and Finish Group in situ which commenced in September 2020.

18

Critical indicators need to be identified and agreed to allow the maternity team to determine whether the service is of high quality.

A Maternity Services dashboard has been in use, since  September  2020,  following  the establishment  of  the  Task  and  Finish  Group. Please see recommendation 8.

19

Currently, there does not appear to be coherent  workforce  strategy  which underpins  maternity  services  or  that could  be  used  to  support  a  new maternity strategy. Such a strategy is vital  for  assessing  whether  the midwifery workforce is adequate for a new model of midwife led care.

Acknowledged. Please see recommendation 10.

A  Maternity  Workforce  Strategy  is  being developed  which  will  be  aligned  with  the Maternity Strategy and will be published in 2022.

20

Insufficient staffing resources may be compromising the effectiveness of the care provided to mothers, babies and their families.

Reject.

21

The inclusion of midwives who provide specialist  services,  such  as  perinatal mental  health,  safeguarding  and practice  development  is  essential  to providing high quality care.

Accept.

These roles are fundamental to our service and will be incorporated into our workforce strategy.

22

The current leadership structure is not appropriate for providing leadership to the  work  required  (particularly developing a maternity strategy) and for ensuring a consistent clinical model and a robust system of clinical governance in the maternity service. Furthermore, under the current leadership model, the voice of the midwives is not heard in the right fora and both the midwifery and the medical leadership must be for the entire maternity pathway not focused on the hospital component.

This  will  be  considered  in  line  with recommendation 11.

23

Maternity Services policies are open to interpretation  and  can  be  applied differently  according  to  the  specific

Acknowledged. As part of the continuous process, the policies are under review.

Findings

Comments

member  of  staff,  leading  to  a "discordance in care".

24

There is an opportunity to improve the governance process of ratifying policies and  standard  procedures,  as  well  as ensuring  these  are  shared  across  the entire  system  (for  example,  to  new midwives, junior doctors, GPs, Health Visitors,  Perinatal  Mental  Health specialists etc.)

Acknowledged.

25

In concurrence with a previous review undertaken  by  the  Royal  College  of Obstetrics  and  Gynaecology,  it  was found that more rapid progress needs to be made with ratifying policies as well as  communicating  and  monitoring adherence.

Acknowledged.

There is an enhanced governance structure which allow  for  timely  review  and  ratification  of policies.

26

There is currently no clear culture to uniformly encourage informed choice by the service, rather it appears to be largely driven by women themselves.

Acknowledged.

27

Once the refurbishment of the maternity unit is complete, women will have a choice of home birth care, traditional maternity care or birthing on the new midwife-led birth units.

Accept.

28

Whilst  the  majority  of  women  feel involved  in  the  decisions  about  their care,  some  reported  feeling unsupported  with  their  choices  or coerced into agreeing to the type of care received.

Accept. It is noted that information regarding the type  of  care  is  distributed  through  leaflets, signposting,  website  information  and communications. This forms part of the Public Health work.

29

Women  and  their  partners  are  not always given the opportunity to discuss or understand their options of care and are  not  routinely  given  access  to evidence and guidelines to help them make informed decisions.

Acknowledged.

We  are  transitioning  to  a  continuity  of  care midwifery  model  which  will  support  the development  of  the  professional  relationship between  all  mothers  and  midwives.  We  are working on public health messaging to inform mothers on their choice of place of birth and care.

Findings

Comments

30

Maternity  Services  and  the  Health Visiting  services  have  both  achieved Stage one accreditation of the UNICEF Baby Friendly Initiative programme.

Accept.

31

A  significant  number  of  women reported  receiving  either  inadequate breastfeeding  support,  or  a  lack  of compassion and respect about how they wished  to  feed  their  baby.  The promotion of breastfeeding has to be underpinned by women having ready access to highly trained professionals, in the hospital, the community and at home,  who  provide  easily  accessible and consistent support and advice.

Acknowledged.  It  is  noted  that  all  midwives receive training in infant feeding. Annual updates are provided to staff in line with the Baby Friendly Initiative recommendations.

32

In some cases a lack of breastfeeding support from maternity staff and health visitors post birth and a lack of respect for women's choices as to how they wished  to  feed  their  baby  had consequences for the mum's emotional well-being and mental health.

Acknowledged.

33

Staff and resource constraints have led to  breastfeeding  champions'  being unable to be released for work towards the Baby Friendly Initiative. As a result, it is unclear when the Maternity Unit may be ready to progress to Stage 2 accreditation.

Acknowledged. We are aiming to achieve Stage 2 accreditation by Spring 2022.

34

The Health and Community Services' intention is to recruit a breastfeeding midwife specialist who would help lead and  drive  training  beyond  the  Baby Friendly Initiative.

Accept.  The  Breastfeeding  Midwife  Specialist will be referred to as the Infant Feeding Specialist Midwife.

35

UNICEF  Baby  Friendly  Initiative strongly  supports  the  view  that pregnancy  is  the  right  time  for midwives to discuss infant feeding and that it should be on a one to one basis around 34 weeks of pregnancy. Despite this, 29% of respondents to the Panel's survey were not provided with relevant

Acknowledged.  It  is  noted  that  these  statistics reflect only those that completed the Review of Maternity Services Survey, where 656 people out of the approximately 4,579 women who gave birth over the last five years responded. This is not a whole reflection of the Maternity Services activity for the last five years.

Findings

Comments

information  about  feeding  their  baby during pregnancy.

This  equates  to  4.2%  of  Maternity  Services activity.

36

Despite  relevant  information  being available  online,  we  found  that  the majority of women that engaged with the Panel were not made aware of the maternity page on the Gov.je website during  their  pregnancy  and  did  not know it existed.

Acknowledged. Please see recommendation 19.

37

Despite being advised that women were routinely asked about their emotional well-being and mental health at their first contact with primary care or their booking visit with the midwife, 21% of respondents to our survey reported that neither  their  GP  or  midwife  had enquired about their mood or feelings during pregnancy.

It is noted that these statistics reflect only those that completed the Review of Maternity Services Survey,  where  656  people  out  of  the approximately 4,579 women who gave birth over the last five years responded. This is not a whole reflection of the Maternity Services activity for the last five years.

This  equates  to  3.0%  of  Maternity  Services activity.

38

A  new  pathway  for  perinatal  mental health  has  been  developed  with  the intention of making the referral route clearer  and  more  consistent  for expectant and new parents. The highest priority  within  the  pathway  is  an emphasis on the identification of needs at  the  earliest  point  and  early intervention.

Accept.

39

The Panel was pleased to learn that the Health  and  Community  Services Department has committed to recruiting a Perinatal Mental Health Midwife to better  support  staff  providing  and women  receiving  mental  health support.

Accept.

40

A lack of continuity in care during and after  pregnancy  could  impact  on  the ability  of  a  women  to  form  trusting relationships  with  their  midwives, leaving  them  feeling  uneasy  about discussing  personal  matters,  such  as their emotional wellbeing.

Acknowledged.

Findings

Comments

41

One in ten fathers/partners experience mental health issues during pregnancy and a year after birth. Despite this, the majority  of  women  (314)  who responded to the Panel's survey said that the baby's father/their partner was not  asked  about  their  emotional wellbeing following the birth of their baby.

Acknowledged. Please see recommendation 23.

42

The quality of bereavement care can have  a  considerable  effect  on  the wellbeing of parents and their families in the time immediately following the loss of a baby, as well as in the longer term.

Accept.

43

Whilst  midwives  and  neonatal  are offered training in respect of baby loss, it  is  unclear  as  to  whether  there  are currently  any  requirements  for members  of  staff  to  receive  such training on a regular basis.

Accept.

44

Delays  in  the  delivery  of  de-brief sessions following traumatic births can negatively  impact  parents'  mental health. However, we found that, in the majority  of  cases,  women  and  their partners are not offered the opportunity to ask questions about their labour.

Acknowledged. Please see recommendation 25.

45

There  are  undoubtedly  positive developments being made in the field of perinatal  mental  health  within maternity services. However, progress needs  to  be  made  quickly  and  the impact of the investment needs to be monitored.

Accept.

46

The  establishment  of  the  Maternity Services  Partnership  is  a  very welcomed  development  and  is  an excellent  vehicle  for  enhanced communication  between  maternity services  and  women  and  to  ensure continuous  involvement  of,  and

Accept.

Findings

Comments

feedback  from,  women  and  their families.

47

The Panel's own survey, with a high level of respondents, demonstrated that women wish to have their say on their experiences  of  maternity  care.  The development of a maternity survey that collected the views of the women on a regular  basis  would  be  extremely beneficial  for  collating  and  assessing service users' experiences.

Accept.

48

One of the immediate actions that was recommended  following  the  2020 Ockenden Review in the UK was that all Trusts must create an independent senior  advocate  role  to  ensure  that women and their families are listened to and their voices heard.

Acknowledged. It is noted that the Independent Senior  Advocate  role  is  fulfilled  by  a  Non- Executive Director within NHS Trusts. Greater consideration is required to understand how this role would translate into a different health care system in Jersey. Please see recommendation 29.

Recommendations

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1

The Minister for Health and Social Services must ensure that all Maternity Staff  are  given  the opportunity  to  be involved  at  some  point during the design stages of  the  Maternity  Unit refurbishment.  The Minister  must  also engage  with  the Maternity  Voices Partnership,  and  the public  in  general (including fathers/partners),  to ensure  that  recent  and future users of the service

Min HSS

Accept.

To ensure the opportunity to be involved has  been  formally  offered  during  the design stage, a meeting will be organised with:

• Maternity  Voices  Partnership (representing public, recent and future users of the service)

• Minister for Health and Social Services

• The  Refurbishment  Design Team

It is noted that the design plans have been  circulated  to  Maternity  Staff throughout their revisions, since 2017.

Complete d in July

2021.

Recommendations

To

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Comments

Target date of action/ completi

on

are  able  to  share  their views.

2

The Minister for Health and  Social  Services should  engage  an independent  estates expert  to  assess  the options  for  the  upgrade work,  including  a standalone midwifery-led unit,  to  the  Maternity Unit and provide a more rapid response.

Min HSS

Reject.

The refurbishment design commenced in  2017,  with  external  construction works commencing on 5th July 2021, and internal construction works due to commence on 16th August 2021.

To  allow  for  an  independent  estates expert at this time will lead to a delay in works commencing and will result in:

• Delay  in  construction  works

and completion date

• Dissatisfaction on the part of current  and  future  service users,  their  families  and Maternity Staff

• Increase in costs

Delay  to  the  implementation  of  new ways of working.

N/A

3

The Minister for Health and Social Services must ensure that a midwife-led model of care is defined which incorporates, at a minimum,  continuity  of care in the antenatal and postnatal period, with the ambition  of  extending this  to  the  intrapartum period.  The  main objective  of  the  model should be to ensure that care  is  delivered  in  the home, or as close to home as  possible,  to  reduce inconsistency of advice in both  the  antenatal  and postanal periods, and to increase  women's satisfaction  with  the service.

Min HSS

Accept.

Due  to  the  constraints  on  the  service during  the  pandemic,  work  that  was underway regarding continuity had to be changed  to  ensure  that  care  delivery could continue whilst meeting the public health guidance. This ensured access to midwives  was  maintained  throughout, without  compromising  care.  This  has had an impact on the continuity of care, which we are now addressing.

Community midwives currently have a caseload of women who are seen in GP Surgeries.  Wherever  possible,  these women are followed up post-natally by the same midwife.

Ongoing.

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4

The Minister for Health and Social Services must ensure  that  the  Local Committee,  developed following  the  initial Culture Summit, includes multi  professional  and across  sector representation  and  that the  Culture  Strategy  is published as an integrated part  of  the  Maternity Services  Strategy. Furthermore, the Culture Strategy  should  be  a statement  of  the overarching values of the maternity service and the behaviours  that  will underpin those values.

Min HSS

Accept.

The Culture Strategy is being developed, which  includes  the  behaviours framework, and is to be published by January 2022.

This  will  form  part  of  the  Maternity Strategy.

End of Q2 2022.

5

The Minister for Health and Social Services must ensure that a system-wide maternity  strategy  is developed without delay which  includes  cultural values,  the  proposed model of care (including choices of maternity care and continuity of carer), the  maternity  care pathway (community/parish  led maternity  service), expected  outcomes, performance measurement  framework with  KPIs/benchmarks and approach to oversee policy development

Min HSS

Accept.

The system-wide Maternity Strategy is under  development  and  is  due  to  be published during  2022.

End of Q2 2022.

6

The Minister for Health and Social Services must establish  a  system  wide

Min HSS

Partially accept.

A Maternity Services Task and Finish Group commenced in September 2020 with a specific focus on the maternity

To be establish ed by

Recommendations

To

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Target date of action/ completi

on

Maternity  Task  and Finish  Group  that  is accountable  to  the Independent JCM Board. This  should  include  a dedicated  project manager. The remit of the Group should be to drive forward the development of the Maternity Strategy and  to  undertake  the recommendations identified in the Panel's report.

service.  This  will  be  replaced  by  a system-wide  group  which  will  report into the HCS Board.

October 2021.

7

The Minister for Health and Social Services must establish  a comprehensive system of performance management,  including an  annual  service  user survey and staff survey, to  enable  benchmarking against other appropriate maternity services.

Min HSS

Accept.

Performance  Management  is  presently undertaken by:

• HCS Performance Management Standards (reportable monthly).

• This  will  imminently  include KLOEs (Key line of Enquiries CQC  (Care  Quality Commission) NHS).

Service  User  Survey  is  presently undertaken by:

• My Experience (service users)

• My  Experience  Champions (staff to support implementation of user feedback)

• PALS  (Patient  advice  and liaison service)

• Maternity Voices Partnership

Staff Survey is presently undertaken by:

• Be Heard. Currently held every two years. We acknowledge that a form of staff survey could be undertaken yearly.

N/A

Recommendations

To

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Benchmarking  is  presently  compared against:

• NHS  Digital  for  English national mean.

• National ONS Data.

• Mothers and Babies: Reducing Risk  through  Audits  and Confidential  Enquiries  across the UK (MBRRACE-UK).

• Patterns  in  maternity  care  in English Hospital Royal College of  Obstetricians  and Gynaecologists (RCOG).

• National maternity and perinatal audit.

• Pre-term birth national standard.

• Department  of  Health  for England,  working  towards  a Smoke Free Generation.

• Healthy Lives, Healthy People Strategy.

• NHS 5 Years Forward View.

• RCOG  2018  Alcohol  & Pregnancy standards.

• BFI 2020 standards.

Inter-island working with Guernsey & IoM

8

The Minister for Health and  Social  Services should  establish  a dashboard similar to the new  National  Maternity Dashboard to enable easy comparisons,  such  as Clinical  Quality Improvement  Metrics, with  other  maternity providers. The dashboard should be made publicly available.

Min HSS

Accept.

Maternity  Services  presently  use  a Maternity  Dashboard,  benchmarked against  the  National  Maternity Dashboard.  This  dashboard  is continuously reviewed and developed. It is  noted  that  Clinical  Quality Improvement Metrics are included.

The data within the dashboard is being validated, to allow for the dashboard to be made public from January 2022.

January 2022

Recommendations

To

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on

9

The Minister for Health and  Social  Services should engage the Jersey Care  Commission  to support  the  maternity system  to  establish  a robust  and  measurable quality  framework,  with suitable  resources allocated

Min HSS

Reject

The  responsibility  for  this  framework sits with HCS.

N/A

10

The Minister for Health and Social Services must develop  a  maternity workforce  strategy  to consider  future workforce  requirements, assess  different  roles  to support  all  aspects  of maternity  care  and explore options for staff rotations  with  partner organisations.

Min HSS

Accept

A Maternity Workforce Strategy is being developed which will be aligned with the Maternity Strategy and will be published in 2022.

End of Q2 2022.

11

The Minister for Health and  Social  Services should  develop  an appropriate  leadership team  for  maternity services,  including  the appointment of a Director of  Midwifery  and  an Associate  Medical Director,  who  is  also Lead Obstetrician.

Min HSS

Partially Accept

We  accept  the  Director  of  Midwifery recommendation. However, we will be appointing a Clinical Lead for Obstetrics rather than another Associate Medical Director. The job descriptions for these roles are currently being drafted.

Aim to be in post by year end 2021.

12

The Minister for Health and Social Services must endeavour to complete all actions  from  the  Royal College of Obstetrics and Gynaecology reviews of maternity  services  and have  a  complete  set  of key  organisational

Min HSS

Partially Accept

There has not been a review from the Royal  College  of  Obstetrics  and Gynaecology. However, an independent review was undertaken and all actions arising have been addressed through the Maternity Task and Finish group.

Maternity  Services  is  constantly reviewing and updating guidelines and

Complete year end 2021

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policies in  place  by  the end of 2021

will defer to national guidelines in the absence of local guidelines.

13

All birthing women and their  partners  should routinely  be  provided with  evidence  and information  concerning their options in respect of pain  relief  and  birth choices,  highlighting benefits  and  risks,  and given the opportunity to discuss  and  understand these prior to labour. All information  should  be delivered clearly and in a non-judgmental way.

Min HSS

Accept

All women are offered a discussion to clarify  birthplace  choice  and  options available for pain relief, as near to 36 weeks as possible.

The  Handheld  Records  contain information regarding pain relief options as well as signposting to websites for further information.

N/A

14

The Minister for Health and  Social  Services should  consider opportunities  to  better link  breastfeeding  and perinatal  mental  health support services together and  train  volunteers locally  to  provide  peer support services.

Min HSS

Accept.

Since  July  2021,  Mind  Jersey  is providing  peer  support  for  perinatal mental health. This service also includes partners.

Information  regarding  this  service  is being  disseminated  to  the  multi- disciplinary team.

Complete d.

Ongoing.

15

The Minister for Health and Social Services must ensure that breastfeeding champions  are  given protected  time  to undertake  the  work  and training  necessary  to fulfil their role.

Min HSS

Accept.

Will form part of the workforce review, to  ensure  they  are  provided  with protected time to undertake work and training as necessary.

Decembe r 2021.

16

The Minister for Health and Social Services must ensure  that  the  whole maternity  system, including  GPs, Midwifery, Neonatal and Health Visiting services,

Min HSS

Accept.

This  will  be  led  by  the  system-wide Maternity Task and Finish Group.

The Infant Feeding Specialist Midwife (Recommendation 31) would work with multi-disciplinary  team  to  ensure  the commitment  is  maintained  and

Spring 2023.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completi

on

demonstrates  a commitment to achieving Baby Friendly status and that the plan to achieve BFI full accreditation by Spring 2023 is owned by every service, adequately resourced  and  closely monitored.

developed across the health economies. This role is currently at advert for a six- month  secondment.  Continuation  is reliant on funding.

17

The Minister for Health and Social Services must ensure  that  the  utmost priority  is  given  to appointing  a  specialist breastfeeding  support midwife by the end of Q1 2022  to  champion  the UNICEF  standards  and mentor/upskill  staff whose  breastfeeding support  skills  require refinement

Min HSS

Accept.

End of Q1 2022.

18

The Minister for Health and  Social  Services should  ensure  that relevant  information about  infancy  feeding and, specifically, how to deal  with  breastfeeding issues,  is  provided  to women and their families routinely  during  their antenatal appointments.

Min HSS

Accept.

The appointment of an Infant Feeding Specialist  Midwife  would  ensure information and support is available to all women and their families.

Routine  information  provided  through antenatal  appointments  needs  to  be developed  in  conjunction  with  Health Visitors  who  are  provided  through Family  Nursing  and  Home  Care (FNHC).

End of Q1 2022.

19

The Minister for Health and  Social  Services should  ensure  that  the "Pregnancy  and  birth' page  on  the  Gov.je website  is  regularly updated and that women are  made  aware  of  the website  during  the  very

Min HSS

Accept.

The "Pregnancy and Birth" website page is currently being reviewed and will be updated by January 2022.

The website has been promoted via the maternity Hand-Held maternity records, latest edition.

Further to this, the opportunity is being explored  for  the  website  to  contain

January 2022.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completi

on

early  stages  of pregnancy.

embedded  live  links  to  ensure information is instantaneously updated from notable websites.

20

The Minister for Health and Social Services must ensure  that  every expectant  mother  is routinely asked about her feelings  and  mood  at every  antenatal appointment  to  ensure that  any  issues  are recognised  and  acted upon as early as possible.

Min HSS

Acknow ledged.

We  acknowledge  this  feedback  and recommendation;  work  is  ongoing  to ensure a consistent approach.

Ongoing.

21

The Minister for Health and Social Services must appoint  a  specialist perinatal  mental  health midwife by the end of Q1 2022.

Min HSS

Accept

In developing the Maternity Strategy, a Midwife Specialist for Perinatal Mental Health had been identified as crucial to the Perinatal Mental Health Pathway and for the care of women and their partners affected by mental health.

End of Q1 2022.

22

The Minister for Health and Social Services must ensure  that,  when recruited,  the  Perinatal Mental  Health  Midwife organises and encourages education and training of all midwives in perinatal mental  health  and  the delivery of care to make sure there is a consistent assessment  and  referral across all services.

Min HSS

Accept

End of Q1 2022.

23

The Minister for Health and Social Services must introduce guidance which ensures  that  all fathers/partners  are routinely  asked  about their mental health (either

Min HSS

Accept

This  will  be  addressed  with  the appointment  of  a  Perinatal  Mental Health Midwife Specialist and the roll out of the pathway.

N/A

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completi

on

directly  or  through  the mother)  during pregnancy and following the birth of the baby. The Minister  should  ensure that  as  part  of  the pathway,  access  to mental health support for fathers/partners should be expedited.

24

The Minister for Health and  Social  Services should  consider  the recruitment  of  a bereavement midwife, or the training of a current midwife  into  this position, in order to better support  families  going through baby loss.

Min HSS

Accept

End of Q1 2022

25

The Minister for Health and  Social  Services should ensure that the de- brief  service  following birth  is  universally offered  to  women  and adequately  resourced. Women and their families should be made aware of the  service  postnatally whilst both in hospital (if the women had a hospital birth) and at home. The Minister  should  ensure that  adequate  mental health  support  is available to diagnose and treat  women  with  birth- trauma-related  PTSD symptoms.

Min HSS

Accept

Maternity Services is developing a more universal offer of support.

Midwives will be trained and supported to offer debriefs to all women and to refer  to  a  Professional  Midwifery Advocate  (PMA)  or  Consultant  for further debriefing.

The PMA service is currently provided as  a  24/7  service.  Midwives  are undergoing  training  to  become  PMAs and it is anticipated that their training will be completed by April 2022.

N/A

26

The Minister for Health and  Social  Services

Min HSS

Accept

N/A

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completi

on

should provide quarterly updates  to  the  Panel  in respect  of  the  new perinatal  mental  health pathway  for  assurance that maternity and mental health staff are working collaboratively  and delivering consistent care to  women  and  their partners.

27

The Minister for Health and Social Services must ensure that the Maternity Voices  Partnership reports  to  the  maternity services leadership team on  an  annual  basis  to provide  feedback  from women and their families as to their experiences of the service

Min HSS

Accept.

The Maternity Voices Partnership was set up in early 2020 and unfortunately due to Covid-19 there was a delay in formalising  the reporting mechanisms. We  acknowledge  this  feedback  and recommendation.

Decembe r 2021.

28

The Minister for Health and  Social  Services should  request  feedback of  families  on  their experiences of maternity care.  This  could  be  an annual  or  a  bi-annual survey and/or during the six-week  and  two-year checks.

Min HSS

Accept

This recommendation will be actioned through the Maternity Task and Finish Group in conjunction with FNHC.

Ongoing.

29

The Minister for Health and  Social  Services should  create  an independent  senior advocate  role  within maternity services which reports to the Health and Community  Services Executive Team.

Min HSS

Accept.