An update on the temporary service changes at the Aveta Birthing Unit, (Cheltenham General Hospital), and at Stroud Maternity Unit. Following an extension of the arrangements in January 2023, the committee to consider the anticipated outcomes of a review of the changes, including: -
a) Cheltenham Birthing Unit (to remain closed to births for a further 6-month period (review date July 2023)
b) Stroud post-natal beds to remain closed for a further 6-month period (review date July 2023)
The committee to also receive an update on the actions being considered to progress midwifery recruitment and retention in Gloucestershire.
The committee received an update on the delivery of maternity services at Cheltenham General Hospital and Stroud Maternity Unit, including the actions taken to progress midwifery recruitment and retention.
Members recalled that at the committee meeting in May 2023, the committee had received information on Gloucestershire Hospitals NHS Foundation Trust’s maternity service staffing position and the actions associated with consideration of alternative staffing models to support the opening of the birth centre in Cheltenham and post-natal beds in Stroud.
Dr Simon Pirie, (Chief of Service: Women & Children) and Lisa Stephens, (Director of Midwifery), for NHS Gloucestershire joined the meeting via remote access to respond to questions.
Key points highlighted at the meeting included: -
An increase in the midwifery vacancy rate from 7.6% in January 2023 to 13.9% in May 2023, equating to 30 full time vacancies.
Despite the seasonal fluctuating annual picture, the position was looking more favourable in relation to the recruitment and retention of midwifes, with a possible re-opening of services at the Cheltenham Birthing Unit in January 2024.
Efforts were being taken to avoid the repeated opening and closure of maternity facilities in Gloucestershire when responding to workforce challenges.
Exploration of a long-term sustainable solution from which to address current staffing issues using a different maternity workforce model was ongoing.
A key priority was to provide one to one care to expectant parents.
The preferred model for Cheltenham proposed a designated Cheltenham Birth Centre and Home Birth Service, supplemented by on-calls. Midwives to work at the birth centre from 08:00-20:00. Outside of these hours, midwives would be redeployed to the Gloucester Birth Centre, returning to the Cheltenham Birth Centre if required during the night.
Community midwives working within the Cheltenham area will have a smaller caseload, but are likely to experience an increased number of calls to support homebirths in the Cheltenham and Gloucester areas. The remainder of community midwives to be enrolled on a dedicated on-call rota to respond to activity at the Cheltenham birth unit. Key to adopting this model, will require support and buy-in from other teams outside of the Cheltenham area, for which further consultation will be undertaken.
The Cheltenham model was not anticipated to impact on postnatal bed provision at Stroud Maternity Hospital.
The model for postnatal bed provision at the Stroud Hospital will require an assessment of the potential use of the non-midwifery registered workforce.
Having secured £2.7M of capital funding to provide a new Birthing Unit at Cheltenham General Hospital, the Hospitals Trust continue to work with the capital project team to finalise the design and construction timeline for the unit.
At the October HOSC meeting, members to be advised of:-
The preferred long-term midwifery workforce model and the impact on birth units in Gloucestershire;
The preferred long-term non-midwifery model for postnatal care provision and the impact on maternity services in Stroud;
The construction timeline for the new Cheltenham Birthing Unit, and
Indications of how the combined elements above will enable the re-opening of the Cheltenham and Stroud facilities to reopen.
Responding to concerns about the increased number of midwife vacancies in Gloucestershire, the Chief of Service and Director of Midwifery confirmed that the position in Gloucestershire reflected both the regional and the national position. The issue was being monitored, involving high level discussions with Southwest regional forums and with NHS England.
With responsibility for governance, care and safety, the Director for Midwifery informed members of her personal commitment to training and in ensuring graduate students were best placed in the most appropriate positions. It was noted that whilst every effort was being made to retain and manage key posts, in particular, clinical posts, September could prove to be a period of uncertainty, with no guarantees of graduate students accepting the posts offered to them. Later in the meeting, the Director outlined some of the work involved in encouraging nursing staff to pursue midwife positions. The criteria for trained nurses enrolling on a shorter ‘2–year’ training programme was that they had at least one year’s qualified nursing experience.
Cllr Gravells enquired about the latest position on the number of midwife vacancies in Gloucestershire, followed by a request for regular updates on the recruitment and take up of midwifes within the County. Updates to be included in the ICB Update reports to the committee. Action by NHS Gloucestershire
Reflecting on some of the factors impacting on the increased number of vacancies, including retirement and changes in service, it was confirmed that a regional and national workforce programme had been set up and was working closely with the Trust.
The Chief of Service was pleased to report positive feedback from new parents regarding their experiences of childbirth in Gloucestershire Hospitals and was hopeful the service was making significant improvements, (as indicated by the initial informal report following the latest Care Quality Commission inspection of maternity services).
Cllr David Drew, (County and District Councillor from the Stroud District), reiterated concerns about the future of Stroud Maternity Hospital and suggested that the current position had not improved since the previous year. Reflecting on earlier efforts by the Health Overview and Scrutiny Committee to prevent the closure of the Hospital, Cllr Drew expressed reservations about the viability of the maternity unit, which he suggested was being neglected.
Acknowledging, but discounting, suggestions of neglect, Professor Mark Pietroni assured members that the Gloucestershire Hospitals Trust remained committed to providing services at Stroud Maternity Hospital. He also stated that the provision of post-natal beds in Gloucestershire was not a requisite service offered by other hospitals in the UK. To provide some reassurance to Cllr Drew, Professor Pietroni suggested he meet with the Chair and Vice of the Committee after the meeting to clarify the position. Action by – Professor Mark Pietroni
In summarising the information, Chair, Cllr Andrew Gravells, recalled the decision at the last HOSC meeting for a small group of members to meet with the MP for Stroud and Health Ministers to consider how best to address local recruitment for the delivery of maternity services in Gloucestershire. It was confirmed that the MP for Stroud’s Office had responded to the committees request and had agreed to arrange a meeting on a mutually convenient date. Cllr Gravells. As Chair, to provide a verbal update from the outcomes of the meeting at the HOSC meeting on 10 October 2023 Action by – Democratic Services/Chair
Members noted the report and agreed more work was required, with a request that regular updates form part of the information reporting process to the committee at future meetings. Action by – NHS Gloucestershire
One member referred to an earlier work plan proposal and enquired if the broader topic of NHS staffing issues and the challenges experienced by NHS Gloucestershire could be incorporated into a cross party discussion with health ministers?
In response, Mary Hutton, Chief Executive of the NHS Gloucestershire Integrated Care Board (ICB), referred to the recent publication of the NHS England Long Term Workforce Plan, (published on 30 June 2023), and suggested that an item be added to the committee work plan to consider this, the ‘first comprehensive workforce plan for the NHS’.
Following the meeting, it was proposed that an ‘introductory’ paragraph on the plan be included in the ICB update report for noting at the October meeting, followed by a more in-depth report, (as a standalone information item), for discussion at the November meeting. For background details on the NHS England Long Term Workforce Plan, please refer to the link here. Action by - NHS Gloucestershire
Thanking Dr Simon Pirie and Lisa Stephens for their update, Cllr Gravells said he was pleased with the level of debate on the item, but that there was still more work to do.