Transforming Maternity Services Together

Transforming Maternity Services Together

Key facts about the BANES, Swindon and Wiltshire proposal and how to have your say

Our proposal has been developed by all the NHS organisations that plan and buy health services as well as those that provide or manage maternity services across Bath and North East Somerset, Swindon and Wiltshire. Together they make up the Local Maternity System.

Over the last 18 months, these organisations have worked with over 2000 women and families, staff and partner organisations to look at ways we can improve the services we provide to mothers and families across the region.  We want to provide:

  • More equal access to the different birthing options available to women
  • Improved personalised care so we listen to and understand what women want
  • Continuity of care to improve the relationship between mother, family and midwife
  • Improved community support to provide targeted care close to home
  • Integrated and seamless care regardless of where and how women choose to give birth.

We can only deliver these improvements if we make some changes to how we currently do things.

Despite the financial pressures facing the NHS locally and nationally, we are not planning to reduce how much we spend on maternity services, nor are we proposing to reduce the amount of staff we have or close any buildings.  We want to make more efficient use of our existing budget, resources and our staff to provide more services, not less for women and families across our area.  Some of the changes we are proposing are because currently certain services are underused and we are often staffing empty buildings and beds.

The changing needs of our local population

There is increasing pressure on services at our Obstetrics Units at the Royal United Hospital, Great Western Hospital and Salisbury District Hospitals. This is because we are seeing more and more high risk pregnancies (for example because of high blood pressure or diabetes) that require support in a hospital setting with an expert medical team available to step in if required.

In addition, many women with a low risk pregnancy are also choosing to have their babies in an Obstetrics Unit because they like the option of a doctor to support them should they need it or they are worried about having to move, by ambulance, to another site during or after their labour if they need the help of a doctor. We need to offer these women a safe, convenient alternative so staff at our Obstetrics Units can focus on mothers who really need their care.

We have developed our proposal for change to ensure our services are efficient and sustainable to support future population growth, changes in housing policy, and the repatriation of military personnel to South Wiltshire from April 2019.

By using what we have available to us differently, we can make sure our maternity services meet the needs of women and their families now and in the future, and provide staff with a great place to work.

What people have already told us

Over the past 18 months, we have worked with over 2000 women and families, our staff and partner organisations from our Local Maternity System to develop our future plans for maternity services. Their feedback, along with national guidance, such as Better Births, has led to the development of a proposal for the future delivery of maternity services across our region.

Partner organisations that form part of the Local Maternity System include Great Western Hospitals NHS Foundation Trust (GWH), Salisbury NHS Foundation Trust (SFT), the Royal United Hospitals Bath NHS Foundation Trust (RUH) and Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Groups.

We are proposing to continue to support births in two, rather than four, of our community freestanding midwifery units (FMUs).  Women will be able to deliver their baby in Chippenham FMU and Frome FMU, and antenatal and postnatal clinics will continue to be provided in all four – at Chippenham, Frome, Paulton and Trowbridge as well as all other current locations e.g. GP practices.

We believe we have the right number and mix of staff but they’re not based in the right locations to deliver our future vision and ensure efficient use of our resources.  In our FMUs, particularly at night, staff are rostered to cover areas where there is no or very little birth activity. At the Royal United Hospital, staff often have to be moved around at short notice in order to provide a service 24/7 across four FMUs, an obstetric unit and to support home births.

We undertook a detailed analysis (which included looking at factors such as local demand for services and average travel times to the FMUs) to inform our proposal to continue support for births in two of the FMUs.

Some key facts: 

  • 85% of women currently give birth in one of our three obstetric units and less than 6% give birth across our four Freestanding Midwifery Units.
  • 92% of women of childbearing age currently live within 30 minutes of a place to give birth. Our proposal has limited impact on this travel time.
  • On average one baby is born in each Freestanding Midwifery Unit every two or three days.

We’re proposing to create two new alongside midwife-led units, one at Salisbury District Hospital and one at the Royal United Hospital Bath, which will provide more women with the opportunity to choose a midwife-led birth. These two units will be in addition to the White Horse midwife-led unit that already exists at the Great Western Hospital in Swindon.

We’re proposing to improve our range of antenatal and postnatal services for example by providing more breastfeeding support to women in their own homes.  We also want to support more women to give birth at home if this is their preferred choice. 

We’re proposing to improve and better promote our home birth service by creating more capacity for midwives to fully and confidently promote and support home births through our proposed changes.

We’re proposing to replace our 9 community postnatal beds (4 at Chippenham and 5 at Paulton Freestanding Midwifery Units) with support closer to or in women’s homes. Women who need to be admitted for medical treatment after giving birth would continue to be treated in their local Obstetric Unit at one of our acute hospitals in Bath, Salisbury and Swindon. 

The changes we are proposing will mean:

  • We can provide more choice for more women across our area about where and how they are supported before, during and after the birth of their child.
  • We can make better use of our resources and workforce so we can further improve our antenatal, postnatal and birthing services.

Members of the Health Overview and Scrutiny Committees of Bath and North East Somerset and Wiltshire Councils met together with commissioners on 12 November to approve the start of a public consultation. 

What happens next?

The Consultation will run for a period of 14 weeks from 12 November 2018 until 24 February 2019.

Once the public consultation has closed, the responses will be carefully and independently analysed and the results will be used to help the Governing Bodies of Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Groups to make their final decision by Spring 2019.

We will also make the consultation results available to the public and explain how everyone’s feedback has helped shape our plans.

The views and experiences of our staff have helped shape our proposal, they want to be able to provide safe, high quality care before, during and after birth, in the best environment for each woman.