1. Improving Maternity Care
Giuseppe Labriola
Deputy Head of Midwifery

2. Our vision
A safe high quality services
across 3 sites

3. One Maternity Service on Three Sites
• Cross site management team
• Cross site specialist teams
• Capacity managed across the 2 acute sites
• Staffing managed across the 3 sites
• One community service consisting of 13
community teams

4. Improving Safety in our service
Improved Fetal Surveillance
- GAP protocol
- Fetal monitoring master classes
- Fetal wellbeing and Surveillance Champions
- Competency testing
- Central monitoring
- Ability for the on-call Consultant to view Fetal heart
traces from home to improve decision making

5. Governance
Our aim is to reduce to zero the incidents where care/management
issues are identified to have contributed to harm
• UHL reported 16 SI’s
• QEH reported 22 SI’s
• Weekly conference calls (cross site) where all SI’s/Red incidents
are discussed
• Shared learning from incidents through cross site
meetings/guidelines
• 56 Maternity guidelines reviewed to standardise safe evidence
based care cross site

6. Staffing
• Recruitment continues to be a challenge
• A review of skill mix
• Establishment review carried out Dec-Feb (BR+)
• Reduction in Agency usage over the past months
London Maternity Quality Standard
24/7 consultant presence
LGT Consultant presence:
81 hrs at UHL
68 hrs at QEH

7. Standard 3
• One consultant midwife for every 900 expected
normal births.
LGT position:
– 2 Consultant midwives
– Need another 1.6 WTE consultant midwives

8. Normalising Birth
Reduction in overall caesarean section rate on both sites
• QEH = 24.9%
• UHL = 27.3%
• LGT = 25.9%
Reduction in elective section rate at UHL
12.7% 10.8% 11.6% 11.7% 7.3% 5.5% 7.8% 6.9% 9.0% 6.5% 7.2% 7.52% 10.5% 8.1% 11.5% 8.7%

9. Increasing out of Labour Ward Births
Lewisham Birth Centre has just celebrated its 5th
Birthday with 4065 births
Increase percentage of out of labour ward births
• Increased homebirths at UHL (2%)
• Opening of the Greenwich Birth Centre
• Increase choice for women
– Telemetry
– Pools for homebirths

10. Place of Birth Decision Tree

11. Access and Advice
• Self referral via phone (call or text) or online form
• Maternity helpline about to go live 15th June 2015
• Edie (e-midwife for non urgent enquiries)

12. Listening to what women tell us

13. Service user involvement
• Maternity Services Liaison Committee now up and
running in all 3 boroughs
• Whose Shoes workshop
• Reduction in formal complaints
• DVD’s of women’s stories (good and not so good for
training)
• Service user involvement in our transformation
programme

14. Early Pregnancy Evenings

15. Improved Friends and Family Test results
Return rate % that would not
recommend our service
At Merger
QEW 2% N/A
UHL 3.3% 33.33%
April 15
QEW 38.90% 3.52%
UHL 37.98% 1.56%

16. Next Steps
• To continue to build a culture within the workforce which
embraces our vision of one maternity service
• Increase births – ambitious target but there will be lots of
opportunities
• Clarify commissioning intentions regarding the London Quality
Standards
• Continue the 2nd year of the maternity transformation
programme
– Enhanced Recovery
– Outpatient induction of labour
– Reduction on length of stay