NHS GREATER GLASGOW & CLYDE CLYDE DIVISION LSA REPORT

NHS GREATER GLASGOW & CLYDE CLYDE DIVISION LSA REPORT AUGUST 2006

During the past year, significant changes have impacted on my role as LSA Midwifery Officer. An external review of Argyll & Clyde Health Board resulted in the Health Minister for Scotland instructing the dissolution of the Board and this took place on 31 st March 2006. The Health Board services were then divided between NHS Greater Glasgow and NHS Highland. On 1 st April 2006, the LSAMO for NHS Highland, Mrs Helen Bryers took ownership of the 5 rural maternity units in Argyll, now within her catchment area. These are: Lorne & Islands Maternity Unit. - Oban Mid Argyll Maternity Unit - Lochgilphead Campbeltown Maternity Unit - Campbeltown Rothesay Maternity Unit - Rothesay Dunoon Maternity Unit - Dunoon NHS Greater Glasgow became known as Greater Glasgow and Clyde, with Clyde being considered a separate division for an 18 month assimilation period. This being the case, after a period of discussion, it was agreed that I would retain the position of LSAMO for Clyde Division, working alongside Greater Glasgow s LSAMO, Ann Holmes, until the new regional LSAMO for the West of Scotland takes up post. Joy Payne took up this post on the 7 th August 2006.

1. Name of LSA NHS Greater Glasgow & Clyde Clyde Division Name of LSAMO (until 07.08.06) Betty Adair Community Maternity Unit Vale of Leven Hospital Alexandria Dunbartonshire G83 OUA Number of Supervisors of Midwives 16 Number of supervisors relinquishing role this year 2 Number of supervisors removed this year 0 2. Clyde Division Maternity Units Royal Alexandra Paisley The Royal Alexandra Maternity unit is a Consultant led service, offering a full range of maternity services with both neonatal and adult intensive care units on site. In 2005 it had 3,277 births. It employs 175 midwives Inverclyde Royal Greenock Inverclyde Royal closed as a Consultant led service in 2004 and opened as a Community Maternity Unit, offering both consultant led and midwife led ante natal services, midwife led intra natal and post natal services. In 2005 it had 116 births It employs 31 midwives

Vale of Leven Alexandria Vale of Leven closed as a Consultant led service in 2004 and opened as a Community Maternity Unit, offering both consultant led and midwife led ante natal services, midwife led intra natal and post natal services. In 2005 it had 61 births It employs 32 midwives

3. Royal Alexandra Paisley (No of Midwives 175) SOM s 12 SOM No. of Midwives G Burdge 15 J Crawford 15 E Dempsey 15 H Devlin 15 D Finlay 16 A Fulton 15 C Harkins 9 L Lang 15 M McGowan 15 L Manion 15 C Ramsay 15 A Wight 15 Awaiting appointment of 2 supervisors of midwives.

Inverclyde Royal Greenock (No. of Midwives 31) SOM s 2 SOM No. of Midwives J Scobie 16 L McCormick 15 Vale of Leven Alexandria (No. of Midwives 32) SOM s 2 SOM No. of Midwives M Cummings 16 M Ure 16

4. How midwives access a supervisor All midwives in NHS Argyll & Clyde are allocated a named supervisor of midwives. Midwives are advised how to contact their supervisor and have access to contact numbers for all supervisors in Clyde Division. Our integration with Glasgow will shortly allow for access to all Glasgow Supervisors of Midwives also. Clyde Division supervisors of midwives are currently establishing a local forum with Glasgow Supervisors of Midwives. 5. How midwifery practice is supervised Guidance for statutory supervision of midwives has recently been published. Written by the Scottish LSA Midwifery Forum, it is intended as a tool to guide supervisors of midwives and to demonstrate to midwives how they will benefit from supervision of midwifery. All midwives meet with their named supervisor of midwives annually to discuss professional development requirements. In each locality supervisors are involved in risk management, peer review and formulation and review of guidelines. Supervisors of midwives remain challenged by an expanding consultant led service and the ongoing development of the Community Maternity Units in their area. 6. Service users involvement in monitoring supervision of midwives and LSAMO annual audit. Dissolution of the Health Board has also meant dissolution of the Maternity Services Liason Committee, which was one of the main routes through which the LSAMO involved users. Work is ongoing to establish a committee which will serve this purpose and to integrate with Glasgow s Maternity Services Liason Committee.

7. Engagement with HEI s in relation to supervisory input to midwifery education One of the University of Paisley midwifery lecturers is currently an Clyde Division supervisor of midwives. She teaches on both undergraduate and post graduate programmes. At University of Paisley there are currently discrete sessions in relation to supervision of midwifery in all 3 years of the programme with supervision of midwives as a running theme throughout all modules in relation to management of care. This Supervisor of midwives also has responsibility for organising and delivering the Preparation of Supervisors of Midwives Programme. The LSAMO participates in the Clinical/Education group, with midwifery lecturers and clinicians meeting 3 monthly to ensure clinical placements meet standards for student midwives. Clyde division recently received a very favourable report from NHS Education for Scotland when its practice placements were audited. 8. Number of complaints regarding discharge of supervisory 0 function 9. Number of LSAMO investigations undertaken 0 10. Number of midwives suspended from practice 0

NHS Greater Glasgow and Clyde LSA Annual Report to NMC for Glasgow Division, September 2006 For the supervision period April 2005-March 2006 0. Designated Local Supervising Authority Midwifery Officer To 6 th August 2006 From 7 th August 2006 Mrs Ann Holmes, Consultant Midwife Mrs Joy Payne, LSAMO NHS Greater Glasgow and Clyde NHS Ayrshire and Arran Dalian House, 350 St Vincent Street Eglinton House, Ailsa Hospital Glasgow, G3 8YZ Dalmellington Road, Ayr Tel: 0141 201 4469 Tel: 01292 513611 ann.holmes@gghb.scot.nhs.uk joye.payne@aapct.scot.nhs.uk Chief Executive Mr Tom Divers NHS Greater Glasgow and Clyde NHS Board Dalian House, 350 St Vincent Street Glasgow, G3 8YZ Tel: 0141 201 4641/4642 email: tom.divers@gghb.scot.nhs.uk 1. How LSA makes report available to the public The report is available in hard copy format to the public from the Board under the freedom of information act. It is also tabled at the Maternity Services Liaison Committee (MSLC), which has robust user representation through the Maternity Services User Network (MATNET). From there, MATNET representatives can share it with the wider MATNET members as required. Feedback has been positive to date, with no key issues identified. Currently the organisation is undergoing major redesign, however there is potential to include the report on the Board s intranet site in future. 2. Numbers of supervisor of midwives (SOM) appointments, resignations, removals Current 2006 2005 2004 Number appointed in year 2 3 2 Number resigned in year 3 1 0 Number removed in year 0 0 0 Reasons for resignations: 2006 1 retired, 1 emigrated, 1 promoted to non midwifery post 2005 1 promoted to non midwifery post There are no worrying trends in relation to the above. 1

3. How midwives are provided with continuous access to a SOM Currently there are 3 maternity units in Glasgow with approximately 11000 deliveries in total per annum. All midwives notifying their intention to practice in Glasgow are allocated a SOM within the unit they work, where possible, to facilitate ease of access. Midwives can change their SOM as requested and a minority opt to do so. Twenty-four hour supervisory cover is provided in all Glasgow maternity units, through either an on call or duty rota. Midwives are contacted by the SOM on appointment by letter, including the SOM s contact details, general information about statutory supervision and local arrangements for contacting the on call/duty SOM 24 hours a day if required. Some units have a supervisory notice board where on call rotas, annual leave/sickness cover or other information is posted and others use email systems to disseminate this information. Questions around this are included in the LSAMO annual audit (report enclosed) and all midwives report knowing how to contact a SOM 24 hours a day and the majority receiving relevant information as above (70-87%). 4. How the practice of midwives is supervised Currently, Glasgow is in transition to a regional structure for full time LSAMO provision. Meantime, supervision is supported by 1 day a week of an LSAMO at Board level. Three Link Supervisors are identified, who have a co-ordinating role to facilitate communication and support supervision within the maternity units. The LSAMO meets with SOMs bimonthly to share information from key stakeholders related to practice, service, education and statute and discuss the following: local and national service, practice and education initiatives; developing guidelines for midwifery practice; peer review of supervisory scenarios; and have presentations from national speakers on key priority areas. Previously Glasgow wide guidelines for supervision were produced by the LSAMO alongside SOMs, which have recently been superseded by Scotland wide guidance issued in June 2006. This document emerged from the previous Glasgow guidance and was ratified by the NMC Midwifery Unit. These guidelines are shared with key stakeholders such as: the Board Chief Executive, Director of Nursing, Director and Head of Midwifery within the Women s and Children s Division, Professor of Midwifery and all SOMs. Annual audit of supervisory practice is conducted by the LSAMO, through a survey of midwives and supervisors experiences of supervision, alongside visits to the units by the LSAMO and user representatives (report enclosed). Excellent response rates have consistently been achieved for the survey, indicating that Glasgow midwives have a keen interest in the standard of statutory supervision. Results are shared with the above key stakeholders and action planned as required. Consistently the standard of supervision has been reported as highly satisfactory, but naturally with some areas for improvement identified. 2

SOMs are actively involved in key arenas across Glasgow, examples of which include: MSLC; clinical risk management and expert case review; service redesign projects; clinical governance committees; lead midwife and multidisciplinary service and practice groups; area nursing and midwifery committee; area perinatal effectiveness committee; undergraduate programme planning boards; NMC steering groups. SOMs also lead Glasgow wide initiatives on behalf of the LSA, such as: development of bedsharing guidance for midwives; multidisciplinary water birth protocols and guidance; and home birth service options, information and criteria. All of the above reassures the LSA that SOMs are abreast of key initiatives in statute, practice, service and education, and are actively engaged as appropriate. Updates on such initiatives are shared with the wider SOM group at the bimonthly meetings with the LSAMO. This facilitates SOMs being as up to date as possible to enable dissemination of information to their midwives Midwives are encouraged to meet with their SOM at least annually to discuss their professional development requirements. In this year s audit around 75% of midwives had opted to meet with their SOM; all found her approachable (63% highly approachable); and where they had sought support from their SOM, 92% were satisfied with the support at the time (36% highly satisfied). Currently there are no midwives undergoing supervised practice. This year s audit indicates that a minority of SOMs have been involved in investigating possible misconduct/alleged impaired fitness to practice cases, with none resulting in supervised practice programmes or referral to the LSA. 5. Service users involvement in monitoring supervision of midwives and LSAMO annual audit As part of this year s audit process, 2 members of MATNET (affiliated with the MSLC) accompanied the LSAMO in visiting the 3 maternity units. Visits were carried out following results from the audit survey, to facilitate exploration of any issues identified and covered the following themes: how SOMs contribute to woman centred care and advocacy, leadership and evidence based practice, and monitoring maternity services. This proved a valuable addition to the audit methodology and is recommended for further development in the future. 3

6. Engagement with HEIs in relation to supervisory input to midwifery education There are excellent links with the local HEI (Glasgow Caledonian University), as one of the lecturers is a SOM. SOMs are involved in the undergraduate programme board and undertake teaching sessions about statutory supervision on both the undergraduate and postgraduate programmes. Led by our lecturer SOM, SOMs have recently developed an enhanced programme to support students, including a series of taught university sessions about supervision and open days about supervision within each maternity unit. This will be implemented from the next university semester. All the practice development midwives and some other SOMs are research active and involved in research initiatives within their own unit, Glasgow wide and in partnership with the HEI. Examples of this include: a research programme around the citywide implementation of public health midwifery; views of young women; and intrapatum decision making (part of Scotland wide research). All of the above ensures that SOMs are abreast of key education and research initiatives and engaged as appropriate. Updates on any initiatives are shared with the wider SOM group at the bimonthly meetings with the LSAMO. This facilitates SOMs being as up to date as possible to enable dissemination of information to their midwives. 7. New policies related to the supervision of midwives The following have been developed since the last report: Statutory Supervision of Midwives in Scotland this guidance document was produced by the Scottish LSA Forum (Glasgow LSA Chair) in consultation with SOMs and the NMC Midwifery Unit. It was launched at the Scottish SOM Conferences this year in May/June attended by over 200 SOMs. The document provides an overview of supervision in Scotland as well as standards for SOMs and guidance on a variety of relevant issues. This will be the standard expected of SOMs across Glasgow. Policy for auditing records this was developed by SOMs alongside the LSAMO and taking a statutory and risk management perspective. It outlines the standard expected of SOMs for auditing midwifery records and includes the audit tools to be used. It incorporates a general record audit tool for auditing all midwifery practice within a given case record and an individualised audit tool, for use where the practice of an individual midwife has been highlighted of concern. The policy is being implemented this year and may require modification as a result once tested. Programme of supervisory support for students this is as described in section 6 and is being implemented from the next university semester. 4

8. Developing trends affecting midwifery practice NHS Greater Glasgow and Clyde has recently undergone major organisational change, resulting in the amalgamation of 2 NHS Boards and reorganisation of all operating divisions. As a result, a new Women s and Children s Division has been created, which includes all 3 maternity units and the children s hospital. Whilst it must be acknowledged that this is still bedding down, a single system approach and management structure for maternity services should facilitate: equity of access to services; consistency of clinical guidelines, standards and care programmes; and seamless decision making where issues are identified. Current priorities for the Division include: further developing normality for women; further implementing midwife managed care and services; and moving to a single model of midwifery pan Glasgow. An evidence-based approach is proposed throughout and all key stakeholders will be involved. This should result in enhanced services for women and increased professional opportunities for midwives. In addition, the Board has a strategy for modernising maternity services and there are plans to move to 2 maternity units for the city. In preparation for this all 3 units have undergone Birthrate Plus Manpower Planning, therefore impact of both of the above will be fed into the West of Scotland Maternity Services Planning Group, on which the LSAMO sits. There have been no independent or external reviews of maternity services during this reporting year and no worrying trends identified. Information on clinical activity follows. Maternal deaths PRM QMH SGH Number and cause if available 0 1 septicaemia due to prolonged premature rupture of membranes and preterm labour 1 intra-abdominal haemorrhage, secondary to uterine rupture, placenta praevia over previous caesarean section scar Perinatal deaths Rate per 1000 PRM 34 stillbirth, 6.3 per 1000; 6 early neonatal death, 1.1 per 1000 QMH 27 stillbirth, 7.7 per 1000 SGH 16 stillbirth, 5.5 per 1000 Serious untoward incidents PRM QMH SGH Brief description of event (s) 0 0 0 5

Supervised practice programmes Number of midwives on and reasons PRM 0 QMH 0 SGH 0 Reports to NMC Fitness to Practice PRM QMH SGH Number of midwives and reasons 0 0 0 6

8.1 Facilities report Princess Royal Maternity Available beds Intrapartum Services Pre labour 8 Labour Suite 9 Recovery/High dependency 6 Midwives Birthing Unit 2 Inpatient Services Antenatal Total 25 Average stay Postnatal 64 mixed 2.3 days postnatal WRHS 4.09 days Outpatient Services Clinic Day Care Assessment EPAS Neonatal Services Total 64 Total 13 couches 18 beds 1 couch 4 beds/1 couch 22 beds 15 couches ICU 10 Special Care 23 Total 33 Births Total no and % Annual total 5343 % SVD 3060 57.1% % Instrumental 615 11.5% % Caesarean 1559 29.1% % Multiple 103 1.9% % Breech 21 0.4% Total no and % Total no and % Forceps 370 6.9% Elective 577 10.8% Ventouse 245 4.6% Emergency 982 18.3% 7

8.2 Facilities report The Queen Mother s Hospital Available beds Intrapartum Services Pre labour 0 Labour Suite 9 Recovery/High dependency 3 Midwives Birthing Unit 4 Total 16 Inpatient Services Average stay Antenatal 16 Postnatal 50 2.8 days Total 66 Outpatient Services Clinic 8 couches Day Care Assessment 4 beds / 16 chairs EPAS 3 beds Total 31 Neonatal Services ICU 10 Special Care 18 Total 28 Births Total no and % Annual total 3493 % SVD 1945 55.7% % Instrumental 482 13.8% % Caesarean 1047 30% % Multiple 50 1.4% % Breech 14 0.4% Total no and % Total no and % Forceps 352 10.1% Elective 482 13.8% Ventouse 129 3.7% Emergency 565 16.2% 8

8.3 Facilities report Southern General Hospital Available beds Intrapartum Services Pre labour 0 Labour Suite 10 delivery Recovery/High dependency 5 assessment/ recovery Midwives Birthing Unit 0 Total 15 Inpatient Services Average stay Antenatal Postnatal 52 mixed beds 2.9 days postnatal Total 52 Outpatient Services Clinic 15 rooms Day Care Assessment 5 spaces EPAS 2 rooms Total 22 Neonatal Services ICU 4 Special Care 17 Total 21 Births Total no and % Annual total 2968 % SVD 1886 63.5% % Instrumental 338 11.5% % Caesarean 693 23.3% % Multiple 46 1.5% Total no and % Total no and % Forceps 200 6.7% Elective 264 6.8% Ventouse 138 4.6% Emergency 429 14.4% % Breech 89 2.9% 9

9. Number of complaints regarding discharge of the supervisory function 0 No complaints received in the reporting year. 10. Number of Number of LSAMO investigations undertaken 0 There have been no LSA investigations in the reporting year. 10