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Scrutiny Panel review of Maternity Services.
Sarah Keating
Baby Friendly Project Lead May 2021
1. Background
Family Nursing & Home Care (FNHC) is a Jersey charity committed to providing high quality, integrated nursing and home care in the community from prebirth to end of life. Our services touch the lives of more islanders than any other charitable organisation, helping children, their families, the sick, the elderly and the dying. We have teams of experienced and highly qualified nurses operating a range of services including, Health Visitors, School and Children's Nursing, District and Specialist Nursing as well as Home Care
2 Family Nursing & Home Care's Response to the panel questions :
This question is specifically in respect of the Breastfeeding support currently available to women antenatally and postnatally in Jersey.
Breastfeeding rates have remained statistically similar for the last 5 years in Jersey as reported in the annual Birth and Breastfeeding profile.
Work towards accreditation with the UNICEF Baby Friendly Initiative programme began in autumn 2018 across both Maternity and Health visiting services. Both services have five identified champions' who received training directly from UNICEF BFI team which covered all of the standards, train the trainer, and audit. The champion role is to support best practice, support the BFI lead with training delivery, assessment of staff practical skills and audit; and also to contribute to the BFI Operational group. The champions should be a resource for staff prior to referring on to the BFI lead for more complex cases; the champion role is undertaken within current established roles of HV's or Midwives. There are three stages to the accreditation process with completion of stage 3 constituting full accreditation andthestatusofBabyFriendly.
Service | Type | Award |
JerseyGeneralHospital | Maternity | Stage1accreditationJanuary 2021 |
Family Nursing and Home care | Health Visiting | Stage 1 accreditation October 2019 |
The Health Visiting service achieved stage 1 accreditation in October 2019, this means that policies and guidelines are in place to support evidence based practice, and that there is a planned education programme in place to support staff to work within the Baby Friendly Initiative standards. Staff Audits have taken place throughout the pandemic and these show an ongoing improvement in staff knowledge of breastfeeding support mapped against the UNICEF BFI standards. More than 90% staff had received training in the standards prior to the pandemic, and coupled with audit results I am confident that the HV service can apply for stage 2 accreditation by September 2021. This is in line with UNICEFtimeframeswhichallowsfortwoyearsbetweenstage1and stage 2.
Stage 2 involves the training of staff and subsequent auditing of staff practical skills and knowledge, alongside parental auditsto allow comparisons between staff knowledge and parental experience. Much of the work for stages 1 and 2 happens in tandem, so for example much of the training delivery had been completed prior to the formal stage 1 assessment, and at that point for the Health Visiting service, 25 staff members had received the BFI training delivered by the BFI lead, this included Health Visitors, Nursery Nurses and Baby steps facilitators.
UNICEF will complete staff interviews to see if the standards are met and upon successful completion of these stage 2 will be awarded.
UNICEF allow a further 12 months for completion of Stage 3 assessment at which point Baby Friendly service is awarded. We will know we are ready forstage 3 assessment when parental audits indicate that the standards are embedded in practice with parents receivinginformationinlinewiththesame.
COVID19 forced a rapid adjustment to the breastfeeding support offered during lockdown'. The BFI lead was able to support Health Visitors to deliver Breastfeeding support over Virtual platforms such as Zoom and FaceTime, and equip them with resources which could be shared with parents electronically.
The complex Breastfeeding support pathway remained in place throughout the restrictions with the BFI lead undertaking more than 80 virtual or face to face contacts andsupporting35breastfeedingfamilieswithadditionalsupportneedssuchasmultiple births and slow weight gain during that time. Amongst these numbers were families who were supported to continue to breastfeed where their baby had been diagnosed with a tongue tie but surgical correction wasnot an option due to temporaryservicesuspension. COVID19 has prompted us to consider how we can exploit social media and virtual technologies to support both families and professionals. Likewise, we are working on support for parents that can be accessed with ease, again through virtual platforms or social media channels. This would include videos, reading material, case studies and troubleshooting advice. BF Buddies took place virtually from autumn 2020 until Face to Face group restarted in April 2021 in line with COVID guidance.
We are using lessons learnt over lockdown to add an additional tier of help and guidance to our Offer.
The impact of COVID on Breastfeeding rates is not yet known. The Breastfeeding profile for2020hasnotyetbeenpublished.
FNHC was committed to the commencement of a complex breastfeeding clinic in Autumn 2020 as part of specialist support requirement within the UNICEF BFI standards. This is run by the BFI lead and although we anticipated that midwifery colleagues may also be involved with this, this has not been possible due to resource/staffing levels. The BFI lead is in the process of developing a business case for a member of the HV team to undertake additional breastfeeding training, and to take on within the current role, support of the specialist Breastfeeding support service.
Maternity services achieved Stage 1 accreditation in January 2021. Requirements for stage 2 are partially met for educating staff with >90% attending training totalling 90 staff including Midwives, HCA's maternity assistants and staff nurses; it is worth noting that a number of staff have left Jersey and their vacant posts once filled will need to access the training dependent upon the accreditation level of the facility in which they previously worked.
Champion engagement has been a challenge due to staff resource and subsequent inability to allow the champion's time to take this role forward. This continues to impact upon progress towards achieving Baby Friendly as a baseline staff knowledge audit was not completed until Autumn 2020 following staff interviews. This baseline audit shows that at that time, staff knowledge did not meet the UNICEF standards. This is not unusual at this stage following stage 1, but the tandem nature of work towardsstage1andstage
2 I hoped would have shown a greater level of staff knowledge in line with the UNICE standards. This may be attributed to the pandemic and a reduced opportunity for staff to practice these skills at a time when services were largely restricted.
No further staff interviews were completed in Q1 to allow the BFI lead to audit these against the standards. These are essential to allow us to identify areas for development and to target additional training/ resource sharing for these areas. There is therefore at this time insufficient data to suggest when Maternity unit including SCBU may be ready for stage 2 assessment. UNICEF guidance requires that stage 2 is completed by January 2023, with stage 3 taking place by January 2024.
Parental audits will be conducted alongside the planned audit schedule within the Health Visiting service as advised by UNICEF, these will give a fuller picture of whether staff knowledge is being translated into improved care delivery.
Reflecting upon the model of Champions supporting the BFI lead, particularly in Maternity services has been challenging. Staff and resource restraints have led to champions being unable to be released for work towards BFI, and indeed the championing in the unit and support to staff less confident also appears to have been impacted by staffing levels, and perhapsmorerecentlybyCOVID.
The frequent change in Heads of Midwifery has also slowed progress towards the BFI standards, with the most recent Head of Midwifery being the first to prioritise champion release to complete the work required on the unit for stage 1 accreditation. Staff sickness has impacted upon this ongoing releaseofstafftocontinuethe work towards stage 2. For this reason, I would support the need for a staff member on maternity and SCBU who is responsible for championing the UNICEF standards and mentoring/upskilling staff whose breastfeeding support skills need to be refined. This could be in the form of a specialist post, or within a current role with protected time and a contingency for sickness or absence cover. There is an ongoing offer for maternity staff to shadow the BFI lead at BreastfeedingBuddiesandthecomplexfeedingclinicwherestaff release allows.