To review the outcomes from the Director of Public Health’s Annual Report in relation to Women’s Health in Torbay.

Key Lines of Enquiry:

• Is the Maternity Unit being closed? What maternity services are available within the community?
• What provision is there for access to sexual health and timely gynaecological help?
• Additional Maternal and neonatal mortality and morbidity rates for Torbay and how we compare to other areas?

The Public Health Specialist, Public Health, Sarah Aston, Chief Nurse and Director of Infection Prevention, Nicola McMinn and Director of Midwifery and Gynaecology, Torbay and South Devon NHS Foundation Trust, Jo Bassett provided an update on the review of women’s health and maternity services as set out in the submitted paper and responded to questions.

Members asked questions in relation to the following:

·                     who delivers the menopause and intrauterine devices (IUD);

·                     how could the Council increase coverage of IUD devices;

·                     was work being done with employers to alert them on what to look out for to identify signs of menopause e.g. if they were seeing an increase in sickness or lack of productivity;

·                     when young women were given contraceptive tablets from the Health Centre did they understand that they do not need to go back to their GP and do patients using the Health Centre know that their information would not automatically be shared with their GP;

·                     when people visit the Sexual Health Clinic were they asked if they want their GP notified;

·                     there could be a potential risk of harm if people were receiving support from another centre and the GP does not know e.g. if they were prescribed antibiotics;

·                     does Torbay Hospital have dedicated theatre staff in the maternity unit;

·                     how quickly could the team get from the delivery room to the theatre;

·                     what was the main cause of any mortality for baby and mother;

·                     what was being done to hear the voice of the patient on maternity services;

·                     what was being done about people not getting the right equipment for maternity services;

·                     what was the worse experience of maternity services;

·                     how does Torbay’s maternity unity compare to other Trusts;

·                     how many home births were there;

·                     have the number of maternity medical staff increased;

·                     was there a reason for the decrease in birth rates;

·                     was Torbay Hospital expecting another inspection soon;

·                     was there any risk that people were not coming through the system e.g. concealed pregnancies;

The Public Health Specialist, Public Health, Chief Nurse and Director of Infection Prevention, and Director of Midwifery and Gynaecology, Torbay and South Devon NHS Foundation Trust provided the following responses:

·                     Anyone who was qualified by the Faculty of Sexual and Reproductive Healthcare (FSRH) who has baseline clinical competence could deliver LARCs, including nurses, doctors or consultants which alleviates pressures on GP surgeries.  LARC methods, such as IUD’s or ‘the coil’ were the most effective form of contraception and could last up to five to seven years.  It was noted that lack of access to LARC in primary care was flagged on the Council’s risk register.

·                     Public Health provided one off grants to GP surgeries to provide equipment to help them improve LARC delivery, as well as backfill to allow release of nurses to engage in training to deliver sexual health procedures.  This training was provided at nil cost to the GP surgeries with an aim to improve the service and provide local access.

·                     There was no specific work being carried out by Public Health on menopause awareness but there were different schemes available, which the current Government was going to make mandatory for organisations employing more than 50 people.  This did not apply to self-employed people.  It was agreed that a written list would be provided to the Sub-Board Members and Co-opted Members on the support that was available for employers regarding the menopause.

·                     It was acknowledged that although people were asked if they want their GP notified it may not be clear to all patients receiving treatment at the sexual health centre that their information will not automatically be shared with their GP due to confidentiality and some patients may not want their details shared with their GP.  It was important that people were not prevented from accessing support if they were worried about confidentiality.  It was agreed that more action could be done to make this clearer to patients receiving treatment at the Health Centre.  It was noted that Public Health had recommissioned the service with patients opting in for information sharing rather than opting out with the patient’s interests being put first.  A GP would ask a person if they were on any other medication before prescribing a new medication and it was the responsibility of the person to disclose this.  A written response would be provided on how communications with GPs was carried out from the Health Centre.

·                     It was noted that some patient information was available on the NHS App but this depended on where the patient was receiving treatment.

·                     At Torbay Hospital midwives go into the theatre with the mother for support with a dedicated theatre team including a scrub nurse, operating department practitioner (ODP) worker to assist the anaesthetist and a theatre assistant with a second team on call.  There was mitigation if they needed two teams at the same time.  Activity was being managed but the Hospital was trying to increase the required workforce so the second team were resident on site.  There was a dedicated theatre next to the delivery suite with a second theatre adjacent so that they could be accessed immediately when required.  There were not many units in the country where midwives continue to scrub in theatre.

·                     Focus had been on improvement in smoking cessation during pregnancy as nationally smoking was one of the biggest causes of deaths of babies in pregnancy.  Comorbidity factors including obesity as well as social deprivation also has an impact on mortality.  National data shows an increased risk in pregnancy and birth to women from ethnic minorities although this has not been a factor particularly in Torbay.

·                     Devon Maternity and Neonatal Voices Partnership has been utilised to gain the input of service users.  This included, 15 Steps visit where the team had walked around to see what it was like to be a patient.  There is a Maternity and Neonatal Independent Advocate who works across the service to provide additional support if required when.  The Trust also works closely with Torbay Council and has a good presence within the Health Hubs where they also hear the voice of service users.

·                     Torbay maternity also triangulate experiences/feedback alongside complaints.  A common area of feedback was around partners not being able to stay as long as they would like on the wards.  Some of this was due to the footprint of the building and the facilities such as toilets.  A solution was being worked on.  Generally feedback was positive and responded to when required.  The Independent Advocate had been welcomed as a critical friend and to be referred to when women are seeking an independent view.

·                     Devon maternity units were all rated ‘requires improvement’ by the CQC during the latest round of inspections.  Nationally two-thirds were ‘requires improvement’ or ‘adequate’ with one third rated ‘good’.  The national picture had changed and regulators have taken a different approach over the last few years with the whole inspection programme changing considerably.  Devon is part of the National Oversight Framework Programme due to financial and performance challenges.  Clinical Care was rated as ‘good’.

·                     The Whitelake Unit in Newton Abbot was a free-standing midwifery unit with two rooms with a pool to have a water birth, which was not being utilised well.  This is due to women’s choice.  Out of approximately 1700 births 2.5% were home births which equates to an average of four or five a month.  The demographics showed a lot of women require induction so have to be in a consultant led unit rather than a freestanding unit   There were a number of freestanding maternity units across the country and around 1% of births take place in these settings.

·                     Two additional consultants had been recruited to the maternity unit who started in Spring 2025.  There had been an improvement in staffing levels to try to mitigate some of the challenges.

·                     There was a new mother and baby unit built in Exeter in 2019 to support mothers with severe post-natal illness.  This was well used with 8 beds available.  It was a purpose-built unit which also provided outreach services.  It was noted that perinatal care was nationally commissioned.  Work was being carried out by the Trust to look at the needs of Torbay and South Devon’s population to see if there were ways to improve the access to services.  There were also a number of babies that were moved into the care of the Local Authority due to safeguarding children requirements.

·                     Nationally there had been a reduction in birth rates and this trend was replicated in Torbay.  People were choosing not to have as many children and those having them were often older now than previous patterns.  Covid had impacted on birth rates.  There was an increase in complexity of women using the service, induction of labour, caesarean and coexisting health needs that complicated pregnancy.  Some women close to the boundary choose to go to Exeter rather than Torbay Hospital as it was a newer hospital.

·                     Torbay Hospital is part of the National Maternity Safety Support Improvement Programme.  A follow up CQC was not anticipated at present.

·                     Concealed pregnancies were rare in Torbay, although there had been an increase across the country of those who choose to free birth without a midwife present.  Parents will notify the Hospital of the birth after it has happened generally to obtain an NHS number for the infant. These numbers still remained low numbers.

Resolved (unanimously):

1.         that Director of Midwifery and Gynaecology, Torbay and South Devon NHS Foundation Trust be requested to provide a written report as outlined at the meeting; and

2.         that the Adult Social Care and Health Overview and Scrutiny Sub-Board thanks Torbay and South Devon NHS Foundation Trust for their hard work regarding maternity services and acknowledges the pressures that staff are under.