APPENDIX 15
Memorandum by Guy's and St Thomas' NHS
Hospital Trust (MS 21)
INTRODUCTION
The information below has been collated on behalf
of Guy's and St Thomas' Hospital NHS Trust (GSTT) Women's Health
Directorate by Elizabeth Hunter, Acting Midwifery Manager and
Belinda Ackerman, Consultant Midwife.
1. Collection of data from maternity units
1.1 The collection of data for the maternity
services at Guy's and St Thomas' Hospital NHS Trust is generated
with the completion of an electronic patient record. The majority
of antenatal data are completed retrospectively as computer access
is not yet available in the community setting. Ongoing statistical
reports are also provided via the info-browser facility. The data
collected is also submitted for inclusion to the DOH maternity
data tail.
2. The Staffing Structure of Maternity Care
Teams
2.1 There are currently 156.4 whole time
equivalent (WTE) midwives in post. The unit has recently completed
the Birthrate Plus workforce projection tool (Ball & Washbrook
2002) that is awaiting final analysis and review. This will match
midwifery staffing levels to the appropriate requirements of care
needed for women and their babies throughout pregnancy, labour,
birth and the post-natal period. The preliminary findings would
indicate that there may be a mismatch between current levels and
those indicated by the birthrate plus tool. The directorate is
currently undertaking some detailed workforce planning to establish
whether funding for additional posts may be required. (See Appendix
1 for diagram of Women's Health Directorate Structure.)
2.2 The majority of antenatal care is provided
in the community setting at 38 clinics co-ordinated by 15 midwifery
group practices of which five are `integrated' and 10 are `traditional'.
In addition a high-risk midwifery team is based in the hospital.
2.3 Integrated midwifery group practices
each consist of six midwives carrying a group caseload of 240
women and babies per annum in a specific geographic location.
Continuity of care is carried out for each woman and baby from
early pregnancy until 28 days post-partum. This takes place in
the home, at community antenatal clinics or in hospital as determined
by women's needs.
2.4 Traditional midwifery group practices
only provide antenatal and postnatal care in the community setting.
It is planned to roll out these practices to the integrated model
in the near future.
2.5 Core midwifery staff provide care in
the hospital ward areas. These staff will provide antenatal, intrapartum
and postnatal care to the women and babies of the traditional
midwifery group practices and women with high-risk maternity conditions.
2.6 Guy's and St Thomas' Women's Health
Directorate recently moved to a new location on the St Thomas'
site catering for 5,000 births per annum, with an potential 20%
increase to 6,000 births per annum. The directorate is planning
this increase incrementally and will initially increase to 5,500
births per annum.The profile of facilities offered is as follows:
2.7 The hospital-based facilities include
a Hospital Birth Centre with nine birthing rooms, two bereavement
rooms, four "elective" rooms and a birthing room especially
equipped for disabled women.
2.8 The Home from Home Birth Centre has
eleven birthing rooms and two poolrooms. The antenatal facilities
include a 19 bedded ward, five bedded Day Assessment Unit, and
a regional fetal medicine unit, in addition to a high-risk hospital
antenatal clinic.
2.9 The postnatal facilities include 14
beds for transitional care, 14 beds for high risk and 10 beds
for low risk mothers and babies. There is also a six bedded private
wing.
2.10 Specialist midwifery services provided
include: Bereavement, Sexual Health, Teenage Pregnancies, Female
Genital Mutilation and Mental Health.
2.11 Recent bids for Sure Start midwives
have been successful to meet the social needs of the local population.
3. Caesarean Section Rates
3.1 Caesarean section percentages for Guy's
and St Thomas' for the current year and three previous years are
shown below:
| 2000 | 2001
| 2002 | 2003 |
| Breech birth | 1.20% | 1.40%
| 1.30% | 0.80% |
| Elective LSCS | 7.20% | 7.40%
| 7.30% | 0.90% |
| Emergency LSCS | 16.80% |
17.80% | 19.50% | 18.00%
|
| Forceps | 3.20% | 3.40%
| 2.80% | 3.50% |
| SVD | 59.70% | 60.00%
| 59.50% | 59.70% |
| Ventouse | 11.80% | 10.00%
| 9.60% | 7.90% |
| No data | 0.00% | 0.00%
| 0.00% | 2.30% |
| Total | 100.00% | 100.00%
| 100.00% | 100.00% |
4. The Provision of Training for Health Professionals
who advise pregnant women and new mothers
4.1 There is a comprehensive in-house continuing education
programme run by the Professional Development and Consultant midwives.
GSTT also contracts with education facilities at King's College,
London. (Please see Appendix 2 for GSTT Women's Health Directorate
Continuing Education Programme.)
4.2 All sessions are provided to multi-professional staff
in the unit and to all bank and agency staff.
4.3 Multi-professional meetings, ad hoc teaching sessions
and demonstrations are carried out in the clinical areas on a
regular basis.
4.4 Staff are supported in personal development plans
and study leave by GSTT.
4.5 Referenced Maternity Guidelines are available in
all areas and reviewed annually by a multi disciplinary team.
A full set of guidelines is given to every new member of staff
on arrival in the Trust. They are also available through the Trust
Intranet and maternity application.
5. Recommendations
5.1 Collection of data in maternity units should be standardised
and computerised nationally in order to ensure that a comprehensive
audit and research tool is provided within the maternity services.
5.2 In order to facilitate the accuracy and completeness
of clinical data, consider evaluating the need for clinical data
input clerks.
5.3 Birth Rate Plus should be agreed as the "Gold
Standard" for workforce development and planning for all
maternity areas. This should ensure adequate staffing levels and
in particular, one to one midwifery care for all women in labour
(RCOG & RCM 1999). In addition, attention should be given
to recruitment and retention of midwifery staff in U.K. inner
city areas.
5.4 Review bridging the gap between supply and demand
and exploring skill mix and configuration of the services.
5.5 Continuity of care/carer provided by midwifery group
practices should be seen as the "Gold Standard" as suggested
by the Expert Maternity Group in 1993.
5.6 Support should be provided to NHS staff for personal
development and study leave. This is an important ingredient to
the retention of staff.
5.7 Support the provision of specialist midwives in meeting
the needs of groups of women requiring specialist support and
care, ie bereavement and Sure Start Midwives.
References:
Ball JA Washbrook M 2002 Report of the Birthrate Plus Project—Contribution
to demand led midwifery staffing model RCM. London
Department of Health 1993 Changing Childbirth Part 1. Report
of the Expert Maternity Group HMSO London
RCOG & RCM 1999 Towards Safer Childbirth. Minimum Standards
for the Organisation of Labour Wards. RCOG. London.
Appendix 2
GUY'S & ST THOMAS' NHS TRUST
WOMEN'S HEALTH DIRECTORATE
CONTINUING EDUCATION PROGRAMME—ISSUE 2
| Subject | Dates
| Facilitators | Times
| Venue |
| | |
| |
Multidisciplinary compulsory sessions must be attended annually
and are denoted by an asterix*
| *Maternal & | Wed 12 Nov 2002
| BA, JK | 9.00-4.00 pm |
Antenatal |
| Neonatal | Thur 18 Dec 2002
| FO, LM, CN & RO | 9.00-4.00 pm
| Education Room |
| Resuscitation | Wed 15 Jan 2003
| BA, KM, CN & RO | 9.00-4.00 pm
| 8th Floor |
| Workshops | Wed 19 Feb 2003
| BA, JK, CN & RO | 9.00-4.00 pm
| |
| Wed 19 March 2003 | KM, CN, RO, LM
| 9.00-4.00 pm | |
| Wed 23 April 2003 | BA, JK, CN & RO
| 9.00-4.00 pm | |
| Wed 28 May 2003 | BA, FO, CN & RO
| 9.00-4.00 pm | |
| Wed 18 June 2003 | BA, KM, CN & RO
| 9.00-4.00 pm | |
| Wed 16 July 2003 | JK, CN, RO, LM
| 9.00-4.00 pm | |
| Wed 27 Aug 2003 | BA, FO, CN & RO
| 9.00-4.00 pm | |
| Wed 17 Sept 2003 | BA, EJ, CN & RO
| 9.00-4.00 pm | |
| Wed 22 Oct 2003 | JDB, JK, CN & RO
| 9.00-4.00 pm | |
| Wed 19 Nov 2003 | BA, FO, CN & RO
| 9.00-4.00 pm | |
| Wed 17 Dec 2003 | EJ, CN, RO, LM
| 9.00-4.00 pm | |
| *Drills & Skills | All sessions
| Antenatal | |
|
| Shoulder dystocia | Thur 13 March 2003
| JDB, BA, KM | 9.00-4.00 pm
| 8th Floor |
| PPH | Tue 8 April 2003 |
BA, FO, AA | | (A/educ8th floor)
|
| Emergency breech | Thur 15 May 2003
| JDB, JK, SH | |
|
| CTG interpretation | Tue 24 June 2003
| BA, KM | |
|
| Wed 9 July 2003 | BA, KM
| | |
| Thur 7 Aug 2003 | JDB, BA, SH
| | |
| Wed 24 Sept 2003 | FO, EJ, KL, KM
| | |
| Tue 28 Oct 2003 | BA, JK, SH
| | |
| Thur 13 Nov 2003 | JDB, BA, SH
| | |
| Wed 3 Dec 2003 | BA, FO, KM
| | |
*CTG interpretation and Labour Management updates must be attended
6 monthly. This can be done through Drills & Skills Workshop,
KCL CTG study day, courses with CTG component eg ALSO or attending
perinatal mortality meeting
| *Customer Care | Wed 26 March 2003
| JDB, HF, MR | 1.00-4.00 pm
| P/N Ward Staff Room |
| Wed 7 May 2003 | JDB, HF, MR
| 1.00-4.00 pm | P/N Ward Staff Room
|
| Wed 23 July 2003 | JDB, HF, MR
| 9.00-12.00 pm | A/educ 8th Floor
|
| Thur 11 Sept 2003 | JDB, HF, Mr
| 1.00-4.00 pm | A/educ 8th Floor
|
| Thur 27 Nov 2003 | JDB, HF, MR
| 1.00-4.00 pm | A/educ 8th Floor
|
| Tue 9 Dec 2003 | JDB, HF, MR
| 1.00-4.00 pm | A/educ 8th Floor
|
| *Health care assistants Key Skills Workshops
| Wed 5 Feb 2003 | | 9.00-4.00 pm
| 10th Floor seminar Room |
| See separate | Wed 5 March 2003
| 9.00-4.00 pm | TBA |
|
| programme for content | Wed 9 April 2003
| JK | 9.00-4.00 pm | 10th Floor Seminar Room
|
| Tue 6 May 2003 |
| 9.00-4.00 pm | 10th Floor Seminar Room
|
| Mon 16 June 2003 |
| 9.00-4.00 pm | TBA |
| *Safer blood transfusion and IV | Wed 26 Feb 2003
| FO | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Cannulation | Tue 8 July 2003
| FO | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Tue 19 Aug 2003 | FO
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Tue 14 Oct 2003 | FO
| 9.00-12.00 pm | A/Education Room 8th Floor
|
*Mental Health Aspects of Maternity Care. For separate programme
contact Mary Davie on extn 5805 or email for information
*Fire/Manual handling
Please see separate programme
*Infection Control
Please see separate programme
| Antenatal Sreening | Tue 28 Jan 2003
| JK | A/Education Room 8th Floor
| |
| Thur 6 Nov 2003 | JK
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Normal Birth | Thur 6 March 2003
| BA | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Wed 4 June 2003 | BA
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Wed 10 Sep 2003 | BA
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Epidural Management | Thur 6 March 2003
| FO | 1.00-4.00 pm | A/Education Room 8th Floor
|
| Tue 13 May 2003 | FO
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Home Birth Workshop | Tue 15 April 2003
| FO | 9.00-4.00 pm | A/Education Room 8th Floor
|
| Wed 11 June 2003 | FO
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Thur 9 Oct 2003 | FO
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 3 Nov 2003 | FO
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Water Birth Workshop | Wed 12 Mar 2003
| KM & FO | 9.30-12.30 pm
| 10th Floor Seminar Room |
| Wed 5 Nov 2003 | KM & FO
| 9.00-12.00 pm | 10th Floor Seminar Room
|
| Female Catheterisation | Thur 1 May 2003
| FO | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Tue 19 Aug 2003 | FO
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Breastfeeding workshop for staff | Mon 3 Feb 2003
| FO | 9.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 7 April 2003 | JK
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 9 June 2003 | KM
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 4 Aug 2003 | FO
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 6 Oct 2003 | JK
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 1 Dec 2003 | EJ
| 9.00-4.00 pm | A/Education Room 8th Floor
|
| Antenatal Education | Thur 30 Jan 2003
| JDB | 9.00-12.00 pm | 10th Floor Seminar Room
|
| Workshop | Tue 13 May 2003 |
JDB | 1.00-4.00 pm | A/Education Room 8th Floor
|
| Transitional care | |
| | |
| of the newborn | Tue 11 Feb 2003
| SS | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Thur 2 Oct 2003 | SS
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Immediate care of the newborn | Wed 4 June 2003
| SS | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Wed 23 July 2003 | SS
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Tue 9 Dec 2003 | SS
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Neonatal Intravenous | Tue 4 March 2003
| SS | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Training | Thur 3 July 2003
| SS | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Tue 11 Nov 2003 | SS
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Neonatal Hypoglycaemia | Tue 20 May 2003
| SS | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Tue 17 June 2003 | SS
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Tue 22 July 2003 | SS
| 9.00-12.00 pm | 10th Floor Seminar Room
|
| Neonatal—Thermoregulation | Thur 3 April 2003
| SS | 1.00-4.00 pm | 10th Floor Seminar Room
|
| Thur 30 Oct 2003 | SS
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Neonatal Jaundice | Tue 11 Feb 2003
| SS | 1.00-4.00 pm | A/Education Room 8th Floor
|
| Tue 22 July 2003 | SS
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 22 Sept 2003 | SS
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Addiction and the Neonate | Wed 26 March 2003
| SS | 9.30-12.30 pm | Seminar Room 10th Floor
|
| Thur 2 Oct 2003 | SS
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Bereavement Workshops | Thur 27 Feb 2003
| MM | 1.30-4.30 pm | 10th Floor Seminar Room
|
| Mon 28 April 2003 | MM
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Thur 26 June 2003 | MM
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Mon 1 Sept 2003 | MM
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Bereavement Conference | Thur 8 May 2003 see M Mulkerrins for details
| | | |
| Portfolio development/record | Tue 28 Jan 2003
| CL | 1.00-4.00 pm | 10th Floor Library
|
| of achievement | Tue 18 March 2003
| CL | 9.00-12.00 pm | 10th Floor Library
|
| prep/CME | Tue 1 April 2003
| CL | 1.00-4.00 pm | 10th Floor Library
|
| Tue 14 Oct 2003 | CL
| 1.00-4.00 pm | 10th Floor Library
|
| Thur 11 Dec 2003 | CL
| 9.00-12.00 pm | AN Education Room 8th Floor
|
| Child Protection | Mon 14 April 2003
| FO | 1.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 11 Aug 2003 | FO
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Risk Management & Clinical | Mon 30 June 2003
| DB & KD | 1.00-4.00 pm
| A/Education Room 8th Floor |
| Governance | Mon 28 July 2003
| DB | 1.00-4.00 pm | A/Education Room 8th Floor
|
| Thur 4 Sept 2003 | KH
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Female Genital Mutilation | Thur 11 Sept 2003
| CM | 9.00-12.00 pm | A/Education Room 8th Floor
|
| Wed 15 Oct 2003 | CM
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Decision Making Workshop | Wed 26 Feb 2003
| JK | 1.00-4.00 pm | A/Education Room 8th Floor
|
| Mon 17 Nov 2003 | JK
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Permeal integrity (exercise & repair) |
Thur 26 Aug 2003 | JDB | 9.00-12.00 pm
| A/Education Room 8th Floor |
| Thur 27 Nov 2003 | JDB
| 9.00-12.00 pm | A/Education Room 8th Floor
|
| Thur 11 Dec 2003 | JDB
| 1.00-4.00 pm | A/Education Room 8th Floor
|
| Training the Trainer/ | Thur 24 July 2003
| DHF | 9.00-4.00 pm | Seminar Room 10th Floor
|
| Presentation Skills | Tue 25 Nov 2003
| DHF | 9.00-4.00 pm | A/Education Room 8th Floor
|
HOW TO
BOOK A
PLACE ON
THE WORKSHOP
— Confirm study leave with your Manager and book
your place with the Practice Development Midwives on ext 1794.
Key
BA=Belinda Ackerman, FO=Faith Oduegwu, LM=Lynda Mulhair,
JK=Jane Kennedy, DB=Jackie Dunkley-Bent, EJ=Evelyn Jackson, MR=Margaret
Richardson, SS=Sathya Singh, CL=Carmel LLoyd, MM=Mary Mulkerrins,
YE=Yvonne Evans, DB=Dawn Burford, Kd=Kathryn Druery, CM=Comfort
Momoh, DHF=Dianne Hamilton-Fairley, CN=Consultant Neonatalogist,
RO=Resuscitation Officer.
Also see separate Trust Programmes eg Child Protection.
|
