Examination of Witnesses (Questions 600-619)
TUESDAY 1 APRIL 2003
MRS DONNA
OCKENDEN, MR
CHRISTOPHER GUYER,
MS SUE
CREEGAN, MS
PEGGY HAND,
MS MARGARET
WHEATCROFT AND
MRS MANDY
GRANT
600. Do we have the data from Portsmouth?
(Mrs Ockenden) We started measuring breast feeding
figures in 1995 when we were achieving about 56% breast feeding
following birth. Our rates vary now. In the main unit we are up
to about 73% at birth but in the peripheries, of which there are
four where 23% of our births take place, it is just over 80%.
So we have shown a steady and on-going increase in breast feeding
figures.
601. Would you agree the issue is about time?
(Mrs Ockenden) Yes, and midwifery expertise. We have
two infant feeding advisers and lactation consultants as well
who spend a lot of their time supporting mothers and midwives
working in these areas in the skill of breast feeding.
Mr Hinchliffe
602. You mentioned that the figure is higher
in your peripheral units. Is that because it is a more relaxed,
less clinical setting?
(Mrs Ockenden) Yes. I think midwifery staffing levels
are better in the periphery units. We have one midwife and one
health care support worker available 24 hours a day in the periphery
units. There may only be two women in a periphery unit at any
one time so effectively there is better continuity of care than
in the main units.
Dr Taylor
603. Going back to staffing and taking midwifery
first, how are you placed for staff across your central unit and
in your periphery units?
(Mrs Ockenden) We are awaiting the results of the
birth rate plus study. We have had the draft report but not the
final report, and we think the final report is going to indicate
that we are about right for midwifery staffing but we need to
look at our skill mix and at placing midwives according to where
the work is. For example, we were aware that on our labour ward
we do not currently provide one-to-one care in labour. If a woman
chooses to have a baby in the periphery unit she is almost guaranteed
one-to-one care in labour but in the main unit that is not the
case. So we need to look at encouraging women to have their babies
in periphery units and perhaps then taking some of the workload
away from the main unit where we know that there are cases where
one midwife may be looking after two women in labour, which is
not a good standard.
604. And recruitment and retention is reasonable?
(Mrs Ockenden) Two years ago in Portsmouth the turnover
rate was 22%. We are now down to just under 7%, so we have changed
a lot in the last two years. We currently do not have any midwifery
vacancies which I think is a record for Portsmouth and we are
delighted with that. I have only been the head of midwifery there
since 1 November and in the last six months, every month, there
has been an improvement in stability. This is probably because
the midwives feel they now have someone who listens to them; we
are working hard at professional development opportunities; and
I think the work force is happier than it was six months ago.
605. Do you recruit separately for the peripheral
units?
(Mrs Ockenden) No. Basically vacancy rates in the
periphery units are very low. Overall, if we looked at two separate
sets of figures, rates for peripheral units would be lower.
606. So if you work in a peripheral unit you
do not work in Portsmouth?
(Mrs Ockenden) That is right.
607. And you are saying it is easier to recruit
to those units?
(Mrs Ockenden) At the moment it is not difficult to
recruit to either, which I am delighted about. In the past it
has been difficult to recruit to the main unit. 22% turnover rate
was not one we were pleased with two years ago.
608. Is that a combination of pressure of work
in the centre as against perhaps a more relaxed, midwife led,
more positive atmosphere?
(Mrs Ockenden) That might be part of it. It is nationally
known that Portsmouth had a number of problems two years ago and
there was an external review into maternity services, and 22%
was the worst we hit.
609. Quickly, would rotation of staff between
the peripheral units and the centre be good?
(Mrs Ockenden) We are looking at all kinds of care
patterns at the moment. There are midwives who have indicated
an interest in case loading in Portsmouth and an interest in wanting
to rotate between the main and peripheral units, and we are open-minded
about it.
610. Presumably neither of you have to rely
on agency midwives?
(Mrs Ockenden) We have in the past.
611. But not now?
(Mrs Ockenden) No.
(Ms Wheatcroft) No. We have a number of midwives who
work on our own bank, but we do link up with Poole hospitals and
our midwives do rotate. Likewise their midwives come to us and
we are establishing that on a more structured basis.
612. And moving to the medical staff, are there
problems with the European Working Time Directive?
(Mr Guyer) I do not suppose our problems are any different
to anyone else's but yes, we do have problems and they mainly
centre around the New Deal hours and the approach to the European
Working Time Directive. Currently for our registrars we run a
hybrid system of on-call for gynaecology and a shift system for
obstetrics, but as of August of this year that will be illegal.
At the moment they are already being paid around three for their
hours. We have fortunately been given the go-ahead from the Trust
to appoint three more on to the middle grade rota so we can employ
them on a full shift system, which will become New Deal compliant.
It does not quite reach the European Working Time Directive but
it does give us a little bit of breathing space. Our concerns
are that given the paucity of people out in the work force at
the moment to fill those posts, we may not be able to recruit
to them. Clearly this means that there may have to be some sort
of backfill by consultants into what would have been registrar
work and again, with the current numbers of consultants we have
within our service, some of the service commitment would have
to go if consultants are going to fulfil some of the registrar
work.
613. Do you get the feeling from your SPRs that,
as other people have said and we are seeing more and more in the
medical press, they are very dissatisfied with the amount of training
they get because of the reduction in hours?
(Mr Guyer) Yes. I would support that. I have to say
that we are very pleased that Portsmouth seems to get very good
reports from the trainees about the training they are getting,
but I think across the board the Wessex trainees do find the reduction
in hours, particularly for surgical training and skills training,
means they are not getting the same level of experience than they
would have before.
614. Do you have people who do only obstetrics
or are you all obstetricians and gynaecologists?
(Mr Guyer) We have one consultant who just does obstetrics
and three who do sub specialties in gynaecology and therefore
no obstetrics, but the rest of us, nine, will do both.
615. And you do have some junior staff at the
moment?
(Ms Wheatcroft) Yes, because they are obviously going
to the gynaecology service.
616. And they rotate to Poole?
(Ms Wheatcroft) Yes, the juniors do. At the moment
we are New Deal compliant but there will be problems with the
Working Time Directive.
617. But when you become a birthing centre?
(Ms Wheatcroft) That is right.
Chairman
618. Is there, for you, a minimum number of
births that there should be in any peripheral unit for it to be
sensible, or viable? Do you have views on that?
(Mrs Ockenden) I think the view we have is that we
have four peripheral units with big variations in the number of
births.
619. What would be the smallest?
(Mrs Ockenden) The Grange at 85 births a year. Blackbrook
has 83.
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