Report to: Board of Directors Agenda item: 7 Date of Meeting: 28 February 2018

Report to: Board of Directors Agenda item: 7 Date of Meeting: 28 February 2018 Title of Report: National Maternity Survey results 2017 Status: For information Board Sponsor: Helen Blanchard, Director of Nursing and Midwifery Author: Sharon Manhi, Lead for Patient and Carer Experience Sarah Merritt, Head of Nursing and Midwifery Appendices Appendix A: CQC benchmark survey 1. Executive Summary of the Report This report provides a summary of the Trust results of the Care Quality Commission (CQC) Maternity Survey 2017. The survey involved 130 NHS trusts in England that provide maternity services. Women were eligible for the survey if they had a live birth in February (and in some cases, January) 2017 and were aged 16 years or over at the time of giving birth. The 2017 survey of women's experiences of maternity services involved 133 NHS acute trusts in England. 322 patients from the RUH were eligible for the survey and 165 returned a completed questionnaire, giving a response rate of 51.2%. The CQC survey showed that the Trust scored: Better on 7 questions Worse on 1 question About the same for the remaining questions Compared to 2015, the Trust scored: Better on 3 questions Worse on 4 questions About the same for the remaining questions Areas where the Trust scores better than average have been identified together with areas where the Trust needs to improve its score. 2. Recommendations (Note, Approve, Discuss) The Board of Directors is requested to note the improvements identified in the report and accept the areas identified for improvement. Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 14 th February 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: 1 Agenda Item: 7 Page 1 of 9

3. Legal / Regulatory Implications The Trust is legally required to meet the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Trust is currently registered with the CQC with no conditions applied. Care Quality Commission (CQC) Registration 2014/15 NHLSA Standard 2: Learning from Experience 4. Risk (Threats or opportunities, link to a risk on the Risk Register, Board Assurance Framework etc) A failure to demonstrate systematic quality improvement in the delivery of patient care could risk the Trust s registration with the CQC. 5. Resources Implications (Financial / staffing) A failure to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009 could result in financial penalties. 6. Equality and Diversity Ensures compliance with the Equality Delivery System (EDS). 7. References to previous reports Maternity Survey results report to Management Board and the Board of Directors January 2016. 8. Freedom of Information This report is not exempt from publication. Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 2 of 9

Care Quality Commission (CQC) Maternity Survey 2017 1. Background The Care Quality Commission (CQC) Maternity Survey 2017 results were published on the CQC website on 30 th January 2018. This information only refers to the responses that women gave to the labour and birth section as that refers to care received from our hospital. It is recognised in some areas that women may receive their antenatal and postnatal care through other providers, and therefore this information has not been included on the CQC website. The CQC survey 2017 results are based on the responses of 165 mothers who gave birth at the Trust in February 2017. 322 mothers were eligible for the survey giving a response rate of 51.2% national average 35.8%). Of the 165 mothers who responded: o 38% were aged 16-29; 57% were aged 30-39 and 5% were aged 40+ o For 58% of respondents it was not their first pregnancy o 68% of respondents had a vaginal birth and 32% had a caesarean o 15% were left alone by midwives/doctors at a time when it worried them The survey results are divided into 3 sections labour and birth, antenatal care and postnatal care and there is a section score for each of these areas. Scores are benchmarked with other Trusts to determine whether a hospital scores are better, worse or about the same. The CQC provide a benchmarking report (attached as Appendix A) which is a national overview comparing Trusts to one another and identifying the Trusts that are scoring outside the expected range. The RUH commissioned Picker to administer the survey and the Picker results are included in this report. Picker was commissioned by 68 other Trust s to undertake the survey. The Maternity Survey is currently completed every other year however it is planned from 2018 that the Maternity Survey will run annually. This follows a recommendation from the National Maternity Transformation Programme at NHS England with the aim being to make maternity services safer and more personal by 2021. Four new questions were added to the 2017 survey: C13 Had any of the midwives who cared for you been involved in your antenatal care? D3 On the day you left hospital, was your discharge delayed for any reason? D4 What was the main reason for the delay? F1 Were you given a choice about where your postnatal care would take place? Two questions from 2015 were removed from the 2017 survey: B8 Which of the following health professionals did you see for your antenatal checkups? D8 Thinking about your stay in hospital, how clean were the toilets and bathrooms you used? Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 3 of 9

2. Picker Survey results comparison to 2015 and benchmarking against the Picker average. 2.1 Have we improved since the 2015 survey? A total of 52 questions were used in both the 2015 and 2017 surveys. Compared to the 2015 survey, your Trust is: Significantly BETTER on 2 questions Significantly WORSE on 1 questions The scores show no significant difference on 49 questions How do we compare to other trusts? The survey showed that your Trust is: Significantly BETTER on 10 questions Significantly WORSE on 5 questions The scores were average on 39 questions The Trust has improved significantly on the following questions: Lower scores are better 2015 2017 C1+. Labour and Birth: Did not get appropriate advice and support from midwife or hospital 15 % 6 % F2. Postnatal Care: Did not have contact number for a midwife or midwifery team 4 % 0 % The Trust has worsened significantly on the following questions: Lower scores are better 2015 2017 E5+. Feeding: Did not receive consistent advice 40 % 52 % Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 4 of 9

Your results were significantly better than the Picker Average for the following questions: Lower scores are better Trust Average B4+. Antenatal Care: Not given a choice of where to have baby 8 % 12 % B13. During Pregnancy: Did not have midwife telephone number 1 % 3 % B14+. During Pregnancy: Midwife did not always give the help needed 18 % 26 % C1+. Labour and Birth: Did not get appropriate advice and support from midwife or hospital 6 % 13 % C11+. Labour and Birth: Partner not involved enough 1 % 4 % C14. Labour and Birth: Worried when left alone by midwives or doctors 15 % 22 % C16+. Labour and birth: Not always able to get help by a member of staff within a reasonable time 12 % 21 % C19. Labour and Birth: Not always treated with respect and dignity 7 % 11 % D8+. Postnatal Hospital Care: patient not having anyone close to able to stay as long as they wanted 8 % 28 % F2. Postnatal Care: Did not have contact number for a midwife or midwifery team 0 % 4 % Your results were significantly worse than the Picker Average for the following questions: Lower scores are better Trust Average B9. Antenatal Check-ups: Midwives not always aware of the medical history 63 % 50 % E5+. Feeding: Did not receive consistent advice 52 % 44 % F5+. Postnatal Care: Did not see the same midwife each time 37 % 25 % F10+. Postnatal Care: Personal circumstances not taken into account 34 % 24 % F13+. Postnatal Care: Mother not given enough information about own recovery after the birth 53 % 44 % 3. CQC benchmarked results The CQC benchmarked results are attached at Appendix A. The responses to the 51 questions are compared to the scores out of 10 from 2015 and show the following: 7 questions where the Trust scored better than the national average 1 question where the Trust scored worse than the national average 43 questions where the Trust scored about the same as other Trust s Of the 51 questions, there were 35 question responses where the Trust score had improved from the score in 2015; 10 questions where the response was lower than in 2015; 4 questions where the score had stayed the same; 2 questions that were new to this year s survey. There were 4 questions where the response score had decreased by > 0.5, these were: During your labour, were you able to move around and choose the position that made you the most comfortable? Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 5 of 9

Did you feel that midwives and other health professionals gave you consistent advice about feeding your baby? Did you feel that midwives and other health professionals gave you active support and encouragement about feeding your baby? Were you given enough information about your own physical recovery after the birth? An action plan has been developed and will be focussing on the above areas together with areas in antenatal and postnatal care identified by the Picker survey on page 5 of this report. 4. Question comments Women were invited to provide additional comments on their maternity care and these have been analysed and detailed in the graph below. 105 comments were received and analysed. Many of the comments included positive and negative feedback and were categorised into the 8 areas shown in the table below. 70 60 50 40 30 20 10 0 National Maternity Survey Comment Theme Totals Negative Neutral Positive 79 of the positive comments from parents referred to their care and treatment and the attitude and behaviour of staff. I feel I had the best care Bath RUH midwifery team could possibly provide. I experienced bleeding after birth and feel all health professionals calmed me. Within a few minutes of buzzing for assistance, they were beside my bed. I cannot fault our NHS system. Both pregnancies were difficult and both times I felt safe. Thank you. I'd like to say how pleased my husband and I were with the staff at Bath Maternity Unit. The surgeon & team were professional & reassured me throughout when I was very nervous. They were all happy & nothing was too much for them even though they were very busy (midwives). I felt very cared for & well looked after. Thank you for such a great experience. Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 6 of 9

As a pregnant lady with a pre-existing condition, the care and attentive given by the community midwives was first rate. They were knowledgeable and supportive. As someone who experienced further complications, which required hospitalisation both pre and post labour, the care at RUH from consultants, Doctors and midwives was excellent. They were informative and always supportive. It was great to see the attention given even though they were understaffed. We have an excellent team of professionals and they need to be supported further. There were 24 negative comments about communication and 13 negative comments about timeliness. The only negative issue I had was lack of communication between The Mary Ward and NICU. My baby was in NICU for 5 days, I was asked to leave after 3 days. Fortunately the ladies in NICU managed to arrange usage of a NICU flat so that I could continue to express breast milk to feed my baby and to continue to trying to breastfeed. NICU staff were wonderful!! I was diagnosed with gestational diabetes so had more pre-natal care than usual. All departments were extremely helpful and professional. I felt very well cared for and involved in my decision making throughout. Postnatally I feel constant messages and advice from staff regarding breastfeeding would have benefitted me. I spoke/was referred to a number of different support services all with contradicting or alternating advice. I felt it reduced my confidence and made me slightly more anxious to make sure I was 'getting it right'. The breastfeeding support I received in hospital was very inconsistent. Each person I saw seemed to give different advice which was very confusing. I did not feel my decision to breastfeed was very well supported by some of the midwives but I think that was just because they were so busy it would've been easier for them if I was formula feeding. I had a forceps delivery and don't feel I was given sufficient advice about how to care for my stitches, exercises to do and my recovery or what to expect in terms of incontinence and pain. More support looking after the baby in the first day or 2 would also have been useful (swaddling, washing baby, nappy changing). Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 7 of 9

5. Areas for improvement action plan 5.1 Did not receive consistent feeding advice Team of key workers in each clinical area (Sally Tedstone, Infant Feeding Nurse Specialist) Completed Training to ensure standards maintained Consistent information is provided 5.2 Midwives not always aware of the medical history during antenatal period Booking appointment time increased by 15 minutes to support taking medical history (Di Butler, Midwife) Completed GP s supply community midwives with medical history 5.3 Did not see the same midwife each time during post-natal consultations Combined community clinics (antenatal and postnatal) introduced (Di Butler, Midwife) Completed Women now book repeat appointments with same midwife enabling continuity Appointments extended from 20 to 30 minutes Increased knowledge of medical and obstetric history 5.4 Personal circumstances not taken into account (postnatal) New notes have information pages both on general recovery and when to contact a midwife (Amanda Gell, Clinical Midwifery Manager) Completed 5.5 Mother not given enough information about recovery Discussion takes place with all women prior to discharge from hospital or birth centre covering general recovery after birth (Di Dorrington, Midwife) Completed 6.0 Other service improvement actions completed a) Labour and birth Increased selection of birthing equipment (Amanda Gell, Clinical Midwifery Manager) Completed Birth rooms have a home from home feel with decoration, low lighting, birthing couches and balls b) Staffing shortages More robust reporting of staff shortages using red flag indication. Standardised action is taken at the time to protect safety and quality and is included on Datix, the Trust s incident reporting system. (Amanda Gell, Clinical Midwifery Manager) Completed Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 8 of 9

c) Care in hospital after birth Introduction of a graffiti board on Mary Ward (Di Dorrington, Midwife) Completed Increased the number of sleeper chairs and a dedicated shower for partners who stay overnight. (Di Dorrington, Midwife) Completed d) Feeding your baby Continual promotion of skin to skin in theatre and babies remaining with their parents after birth if mum need to go to theatre. (Di Dorrington, Midwife) Completed Tongue tie training planned for 2 more practitioners. (Sally Tedstone, Infant Feeding Nurse Specialist and Amanda Gell, Clinical Midwifery Manager) June 2018 e) Care at home after birth Introduction of day 5 screening team (Louise Ward, Midwife) Completed All blood spot and hearing tests are completed by this team Planned increased to the establishment for Midwives and Midwifery Assistants in some community areas which will support postnatal care. (Di Butler, Midwife) Completed Established Bluebell team for vulnerable women with protected time for midwifery staff. (Di Butler, Midwife) Completed 6.1 In addition to the above actions there has been an increase in the number of hours identified to support improved cleaning in the Bath Birthing Centre. Amanda Gell, Clinical Midwifery Manager will be setting up a Patient Information Group with lay representation in June 2018. The above actions will be monitored by the Women and Children s Divisional Board. Recommendations The Board of Directors are requested to note the areas of good practice highlighted in the report and agree the areas recommended for improvement. Author : Sharon Manhi, Lead for Patient and Carer Experience Date: 1 st March 2018 Document Approved by: Helen Blanchard, Director of Nursing and Midwifery Version: Final Agenda Item: 7 Page 9 of 9

Royal United Hospitals Bath NHS Foundation Trust RD1 Royal United Hospitals Bath NHS Foundation Trust Survey question number Survey question Number of respondents (2017) 2015 score Change from 2015 to 2017 2017 score 2017 banding Section B Care while you were pregnant (antenatal care) B4 B6 B7 B9 B10 B11 B12 B13 B14 B15 B16 Were you offered any of the following choices about where to have your baby? (Cross ALL that apply) Did you get enough information from either a midwife or doctor to help you decide where to have your baby? During your pregnancy were you given a choice about where your antenatal check-ups would take place? During your antenatal check-ups, did the midwives appear to be aware of your medical history? During your antenatal check-ups, were you given enough time to ask questions or discuss your pregnancy? During your antenatal check-ups, did the midwives listen to you? During your antenatal check-ups, did a midwife ask you how you were feeling emotionally? During your pregnancy, did you have a telephone number for a midwife or midwifery team that you could contact? During your pregnancy, if you contacted a midwife, were you given the help you needed? Thinking about your antenatal care, were you spoken to in a way you could understand? Thinking about your antenatal care, were you involved enough in decisions about your care? 139 4.5 4.6 113 7.9 7.9 132 2.4 3.0 134 5.2 5.7 Worse 140 7.9 8.9 140 8.4 9.0 139 6.3 7.6 140 9.9 9.8 128 8.3 9.2 Better 140 9.3 9.5 139 8.8 9.1 Section C Your labour and the birth of your baby C1 C3 C10 C11 C12 C14 C15 C16 C17 C18 At the very start of your labour, did you feel that you were given appropriate advice and support when you contacted a midwife or the hospital? During your labour, were you able to move around and choose the position that made you most comfortable? Did you have skin to skin contact (baby naked, directly on your chest or tummy) with your baby shortly after the birth? If your partner or someone else close to you was involved in your care during labour and birth, were they able to be involved as much as they wanted? Did the staff treating and examining you introduce themselves? Were you (and/or your partner or a companion) left alone by midwives or doctors at a time when it worried you? (Cross ALL that apply) If you raised a concern during labour and birth, did you feel that it was taken seriously? If you needed attention during labour and birth, were you able to get a member of staff to help you within a reasonable time? Thinking about your care during labour and birth, were you spoken to in a way you could understand? Thinking about your care during labour and birth, were you involved enough in decisions about your care? 127 8.3 9.4 Better 109 8.6 8.1 149 9.5 9.4 161 9.7 9.9 Better 158 9.2 9.5 159 8.3 8.5 94 8.1 8.8 138 9.1 9.2 161 9.5 9.6 157 8.7 8.7

Survey question number Survey question Number of respondents (2017) 2015 score Change from 2015 to 2017 2017 score 2017 banding C19 C20 Section D D2 D3 D5 D6 Thinking about your care during labour and birth, were you treated with respect and dignity? Did you have confidence and trust in the staff caring for you during your labour and birth? Care in hospital after the birth (postnatal care) Looking back, do you feel that the length of your stay in hospital after the birth was On the day you left hospital, was your discharge delayed for any reason? If you needed attention while you were in hospital after the birth, were you able to get a member of staff to help you within a reasonable time? Thinking about the care you received in hospital after the birth of your baby, were you given the information or explanations you needed? 161 9.6 9.7 Better 162 9.4 9.2 154 7.1 7.0 161 5.6 142 7.4 7.7 160 8.0 8.2 D7 D8 D9 Section E E1 E4 E5 E6 Section F F1 F2 F3 Thinking about the care you received in hospital after the birth of your baby, were you treated with kindness and understanding? Thinking about your stay in hospital, if your partner or someone else close to you was involved in your care, were they able to stay with you as much as you wanted? (Cross ALL that apply) Thinking about your stay in hospital, how clean was the hospital room or ward you were in? Feeding your baby During your pregnancy did midwives provide relevant information about feeding your baby? Were your decisions about how you wanted to feed your baby respected by midwives? Did you feel that midwives and other health professionals gave you consistent advice about feeding your baby? E6. Did you feel that midwives and other health professionals gave you active support and encouragement about feeding your baby? Care at home after the birth Were you given a choice about where your postnatal care would take place? (Postnatal care is any contact with a midwife or other health professional after leaving hospital) When you were at home after the birth of your baby, did you have a telephone number for a midwife or midwifery team that you could contact? If you contacted a midwife were you given the help you needed? 162 8.7 9.0 152 8.7 9.2 161 8.8 8.9 131 7.6 8.0 140 9.1 9.1 136 7.1 6.4 137 8.3 7.8 128 4.8 139 9.7 10.0 Better 106 8.8 9.2 F7 Would you have liked to have seen a midwife 136 7.6 7.8 F8 F9 F10 F11 F12 F13 Did the midwife or midwives that you saw appear to be aware of the medical history of you and your baby? Did you feel that the midwife or midwives that you saw always listened to you? Did the midwife or midwives that you saw take your personal circumstances into account when giving you advice? Did you have confidence and trust in the midwives you saw after going home? Did a midwife or health visitor ask you how you were feeling emotionally? Were you given enough information about your own physical recovery after the birth? 122 6.4 7.3 136 8.5 8.4 121 8.3 8.2 136 8.4 8.4 140 9.5 9.6 133 7.4 6.8

Survey question number Survey question Number of respondents (2017) 2015 score Change from 2015 to 2017 2017 score 2017 banding F14 F15 F16 F17 F18 F19 F20 In the six weeks after the birth of your baby did you receive help and advice from a midwife or health visitor about feeding your baby? If, during evenings, nights or weekends, you needed support or advice about feeding your baby, were you able to get this? In the six weeks after the birth of your baby did you receive help and advice from health professionals about your baby s health and progress? Were you given enough information about any emotional changes you might experience after the birth? Were you told who you could contact if you needed advice about any emotional changes you might experience after the birth? Were you given information or offered advice from a health professional about contraception? Did a midwife tell you that you would need to arrange a postnatal check-up of your own health with your GP? (Around 6-8 weeks after the birth) 126 7.9 8.1 57 7.7 8.0 Better 128 8.6 8.6 131 7.0 7.4 123 6.6 8.0 137 8.4 8.8 133 9.8 Better

Royal United Hospitals Bath NHS Foundation Trust Your sample Your trust Number of respondents 165 Response rate (%) 51 Demographic characteristics (%) Age Group Religion Aged 16-18 0 No religion 58 Aged 19-24 4 Buddhist 1 Aged 25-29 26 Christian 39 Aged 30-34 33 Hindu 1 Aged 35 and over 37 Jewish 0 Muslim 1 Ethnic group Sikh 1 White 94 Other religion 0 Multiple ethnic group 1 Prefer not to say 1 Asian or Asian British 4 Black or Black British 1 Sexual orientation Arab or other ethnic group 0 Heterosexual/straight 98 Not known 1 Gay/lesbian 1 Bisexual 0 Other 0 Prefer not to say 2

Maternity Survey 2017 Sarah Merritt Head of Nursing and Midwifery

Background PICKER was commissioned by 68 Trusts to undertake the survey which is 52% of all eligible trusts in England The survey is based on a sample of mothers who gave birth at the Trust in February 2017 327 questionnaires were sent 165 returned a completed questionnaire, response rate of 52%. Average 36% 38% of respondents were aged 16-29, 57% were 30-39 and 5% were 40+ 95% of respondents stated their ethnic background as White, 1% Mixed, 4% Asian and 1% Black 98% gave birth to single baby and 2% gave birth to twins 58% of respondents have had a previous pregnancy 68% had a vaginal birth and 32% had their baby by caesarean

Responses The survey has highlighted many positive aspects of the patient experience. 90% of respondents were given a choice of where to have their baby. 79% of respondents said that the midwives listened to them during their antenatal check-ups. 82% of respondents felt that they were involved enough in decisions about their antenatal care. 99% of respondents felt that their partner was involved in their care during labour and birth. 93% of respondents said that they were treated with respect and dignity. 70% of respondents said that the hospital room or ward they were in was very clean. 88% of respondents were visited at home by a midwife since the birth of their baby 3 74% of respondents had confidence and trust in the midwives they saw after going home.

Responses Compared to the 68 Trusts who used PICKER the RUH was significantly BETTER than average on 10 questions Your results were significantly better than the Picker Average for the following questions: Lower scores are better Trust Average Antenatal Care: Not given a choice of where to have baby 8 % 12 % During Pregnancy: Did not have midwife telephone number 1 % 3 % During Pregnancy: Midwife did not always give the help needed 18 % 26 % Labour and Birth: Did not get appropriate advice and support from midwife or hospital 6 % 13 % Labour and Birth: Partner not involved enough 1 % 4 % Labour and Birth: Worried when left alone by midwives or doctors 15 % 22 % Labour and birth: Not always able to get help by a member of staff within a reasonable time 12 % 21 % Labour and Birth: Not always treated with respect and dignity 7 % 11 % Postnatal Hospital Care: patient not having anyone close to able to stay as long as they wanted 8 % 28 % Postnatal Care: Did not have contact number for a midwife or midwifery team 0 % 4 % 4

Responses Significantly WORSE than average on 5 questions Your results were significantly worse than the Picker Average for the following questions: Lower scores are better Trust Average Antenatal Check-ups: Midwives not always aware of the medical history 63 % 50 % Feeding: Did not receive consistent advice 52 % 44 % Postnatal Care: Did not see the same midwife each time 37 % 25 % Postnatal Care: Personal circumstances not taken into account 34 % 24 % Postnatal Care: Mother not given enough information about own recovery after the birth 53 % 44 % 5

Section scores 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% B C D E F B. CARE WHILE YOU WERE PREGNANT (ANTENATAL CARE) E. FEEDING YOUR BABY C. YOUR LABOUR AND THE BIRTH OF YOUR BABY F. CARE AT HOME AFTER THE BIRTH D. CARE IN HOSPITAL AFTER THE BIRTH (POSTNATAL CARE) 6

RUH Ranking Royal United Hospitals Bath NHS Foundation Trust Ranking League Table Of the 68 trusts that Picker worked with for the National Maternity Survey 2017 your Trust is ranked no.24 35 National Maternity Survey 2017 Overall Problem Score Summary Worst Performer 30 25 Best Performer 20 15 10 5 7

Areas for improvement - Action Plan 1. Did not receive consistent feeding advice Team of key workers in each clinical area Training to ensure standards maintained Consistent information is provided 2. Midwives not always aware of the medical history during antenatal period Booking appointment time increased by 15 minutes to support taking medical history GP s supply community midwives with medical history 8

Action Plan 3. Did not see the same midwife each time during P/N Combined community clinics (AN/PN) introduced Women now book repeat appointments with same m/w enabling continuity Appointments extended from 20 to 30 mins Increased knowledge of medical and obstetric history 4. Personal circumstances not taken into account P/N New notes have information pages both on general recovery and when to contact a midwife 5. Mother not given enough information about recovery Discussion takes place with all women prior to discharge from hospital or birth centre covering general recovery after birth 9

Other service improvement actions completed Labour and birth Increased selection of birthing equipment Birth rooms have a home from home feel with decoration, low lighting, birthing couches and balls. Staffing shortages More robust reporting of staff shortages using red flag indication. Standardised action is taken at the time to protect safety and quality and is included on the Datix. Care in hospital after birth Introduction of a graffiti board on Mary Ward 10 Increased the number of sleeper chairs and a dedicated shower for partners who stay overnight.

Other service improvement actions completed Feeding your baby Continual promotion of skin to skin in theatre and babies remaining with their parents after birth if mum need to go to theatre. Tongue tie training planned for 2 more practitioners. Care at home after birth Introduction of day 5 screening team. All blood spot and hearing tests are completed by this team. Planned increased establishment for midwives and MA s in some community areas which will support postnatal care. Established Bluebell team for vulnerable women with protected time. 11