Specialised Care

Each Local Maternity and Neonatal System (LMNS) supports their region to provide a range of services so that women and babies with specialised needs can access the care and support they need.

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Mental health

Objective

Each region is required to have plans in place to develop, maintain or expand their Maternal Mental Health Services working between mental health, maternity and neonatal services.

WHERE ARE WE NOW?

The North East and North Cumbria (NENC) Integrated Care System successfully bid to pilot maternal mental health services.

There are two pilot sites based in Sunderland and South Tyneside NHS Foundation Trust and North Cumbria Integrated Care NHS Foundation Trust. The pilot services launched early in 2022 and are seeing women with moderate to severe or complex psychological difficulties arising from, or relating to, pregnancy and childbirth (mainly trauma, loss or fear).

These pilots and others around the country are informing the development of a business case which will propose options for developing maternal mental health services for women across the whole of the NENC.

A Maternal Mental Health Services Task and Finish Group has been set up, chaired by Andie Johnson, consultant obstetrician at South Tees Hospitals NHS Foundation Trust, working with providers across NENC to ensure maternal mental health services:

  • Offer timely access to specialist assessment and evidence-based treatment with a focus on psychological interventions for women having moderate to severe or complex psychological difficulties arising from, or relating to, pregnancy and childbirth (mainly trauma, loss or fear).
  • Integrates psychology into maternity care (including building upon the Afterthoughts Service) and also developing strong links with services providing mental health or psychological input in the perinatal period e.g. Improving Access to Psychological Therapies (IAPT) and Community Perinatal Mental Health (CPNMH).
  • Work with a range of delivery partners to deliver a co-produced, holistic, personalised and trauma-informed approach to care – within the service and to ensure how it connects and links to the rest of the system when it is launched across NENC.

Neonatal care

OBJECTIVE

Ensure that at least 85% of births at less than 27 weeks take place at a unit with an onsite neonatal intensive care unit. Review all births which don’t and collect data regionally.

WHERE ARE WE NOW?

Partners from across the North East and North Cumbria are working together to ensure that at least 85% of women expect to give birth at less that 27 weeks give birth in a unit with an onsite neonatal intensive care unit (NICU).

This can be challenging at times due to the size of the North East and North Cumbria and the location of the NICUs.

Between January and March 2022, 79% of babies born before 27 weeks were born in a unit with an NICU. The birth of each baby born before 27 weeks and not in unit with a NICU are reviewed on case by case basis to understand why this happened and to learn if something else could be done in similar situation in the future.

OBJECTIVE

Identify capital requirements for neonatal services.

WHERE ARE WE NOW?

The LMNS will work with the Neonatal Network during the remainder of 2022/23 to achieve this objective.

Maternal medicine networks

OBJECTIVE

All providers operating within a commissioned service.

WHERE ARE WE NOW?

The Network footprint has been agreed and the Maternal Medicine Network has been commissioned and is fully operational.

OBJECTIVE

Maternal Medicine Centres are on track to meet or exceed safe staffing levels in the national service specification.

WHERE ARE WE NOW?

The National Service Specification states funded staffing should be:

  • 5 programmed activity/sessions (PAs)/0.5 whole time equivalent (WTE) obstetrician (sub-specialist in maternal fetal medicine or equivalent).
  • 10PAs/1 WTE obstetric physician.
  • 1 WTE specialist midwife (band 8 or in line with local requirements).

We have:

  • 5PAs/0.5 WTE obstetrician (sub-specialist in maternal fetal medicine or equivalent).
  • 5PAs/1 WTE obstetric physician.
  • 1 WTE specialist midwife (band 8 or in line with local requirements).

Glucose monitoring

Objective

All women with type 1 diabetes to be offered continuous glucose monitoring, focus on ensuring equity of access.

Where are we now?

All pregnant women with type 1 diabetes in the North East and North Cumbria are offered continuous glucose monitoring. Doctors and nurse with local diabetes teams work with their midwifery colleagues to make sure pregnant women with type 1 diabetes receive appropriate care.

We also produced a quarterly report which tracks how many women with type 1 diabetes are pregnant and contains a wide range of data so that we can monitor progress and in addition to equity of access.