Agenda item

Maternity Services - Update


Rosemary Curtis, Commissioning Lead for Children, CAMHS and Maternity Services for NHS Wirral Clinical Commissioning Group provided a written report, on the One to One Maternity Services provision: the written report is detailed below.  Mrs Curtis elaborated on the written report and responded to members questions.


One to One Maternity Services Provision




‘Maternity Matters – choice access and continuity of care in a safe service’ (DH 2007) and Standard 11 of the National Service Framework for Children Young People and Maternity Services (DH 2004) set the standards required for the local development of high quality, safe and accessible maternity services with a ‘choice guarantee’ to ensure all women had a choice around the type of care that they received, together with improved access to services and continuity of midwifery care and support.


To meet these standards, NHS Wirral commissioned a comprehensive range of services to meet the needs of women and their babies during pregnancy, childbirth and postnatally. Several providers of midwifery care were commissioned which enabled women to choose the venue and style of the maternity service that best met their needs and preferences. Current commissioned providers of maternity care included:


Liverpool Women’s Hospital;

Countess of Chester NHS Trust;

Wirral University Hospitals NHS Trust;

One to One Midwives (Northwest) Ltd


The report indicated that women were able to ‘book’ directly with a midwife for their maternity care, and could receive all their maternity care from a midwife (including a home delivery) in community based settings if they had no ‘medical’ needs; in practice most women initially contacted their GP who wouldl then refer on to the provider of the woman’s choice. Women with identified ‘medical’ needs could be referred by their midwife or GP to the obstetrician of their choice. Women with uncomplicated pregnancies could choose a home birth with any of the providers of midwifery care. In the event of complications developing during labour at home, women were transferred to the nearest hospital setting for their delivery.


One to One Midwifery Service


The report indicated that in order to provide choice in the type of care available to women, particularly those from areas with high levels of deprivation who did not always access hospital based services, NHS Wirral commissioned a pilot service from an independent midwifery provider, One to One (NW) Ltd, in 2010; the pilot proved to be very popular with women, and was extended until October 2011 when a standard NHS contract for the provision of (Wirral wide) maternity services was put in place.


The overall aim of the service was to provide a community based, person centred model of care for which improved short and long term health outcomes for women and their infants. Pregnancy and birth were seen as a normal part of a woman's life, with the care providing a trusting, mutually respectful partnership between the woman and her midwife. A named midwife was allocated to each woman as early in pregnancy as possible, with women having continued access to advice, support and face to face contact with the named midwife, maximising continuity for the whole period of care.


The service offered access to screening and associated scanning services in community venues at accessible times and .continued access to telephone advice and support, and face to face contact as often as required to provide high quality care, meeting the identified needs and wishes of women.


The service shared care with other appropriate professionals, including obstetric care where it was required, i.e. there was no need for a woman who needed the care of an obstetrician to transfer to the care of a hospital based midwifery service.


All services commissioned by the NHS which provided ‘regulated’ activities must be registered, met the standards and were inspected by the Care Quality Commission; midwifery standards of care and practice were regulated by the Nursing and Midwifery Council and the Local Supervising Authority (Supervisors of Midwives). From an LSA perspective at the current time the commissioner had been assured that One to One upheld safe practice in the interests of women and babies and had given no concern to the LSA to date. One to One was registered with the CQC, and all One to One midwives are registered with the NMC.


Service and performance data


Since the start of the full contract in October 2011, One to One had:


Received 420 referrals, more than half of which had come directly from women; 100% of women who contacted the service before 12 weeks were ‘booked’ by 12 completed weeks of pregnancy (target is 90%);Delivered 72 babies at home; 7.9% required transfer to hospital either pre or post birth; this rate of transfer compared favourably with the findings of the Birthplace Cohort Study (NPEU 2012) of a 12% transfer rate.



Comparative Data



One to One



Home birth rate



Caesarean section rate



Overall normal vaginal delivery rate



Breastfeeding initiation rate



55% (Wirral)

66% (NW)

74% (England)

Women intending to breastfeed who initiated breastfeeding



Named Midwife attendance for routine care



Average number of antenatal visits



Average number of postnatal visits



% Babies admitted to Neonatal Unit


10% (Liverpool Women’s Hospital)


Evaluation and Future Commissioning Intentions


An evaluation of the 2010/11 pilot informed the commissioning of the currently contracted service; this was now being followed up by an independent evaluation of the maternity services currently available to women in Wirral, carried out by Mott Macdonald on behalf of NHS Wirral. The results and recommendations of the evaluation would inform the future commissioning intentions of the Wirral Clinical Commissioning Group. The final report of the evaluation was expected by September 2012.


Dr Abhi Mangani, (Clinical Commissioning Group) indicated that the One to One pilot was undertaken as a result of the findings of a review of maternity services in 2007 held, when women had indicated that although it was felt that the services provided by the hospital were good, they wanted more, and as a result women now have a choice.


Mr David Allison, Chief Executive Wirral University Teaching Hospital indicated that the hospital would still be dealing with the more complex cases and working closely with One to One Maternity Services and Commissioners to provide the best services for women..


In response to members questions Mrs Curtis indicated that the Wirral Health Visiting service had been redesigned and was now providing a high quality service delivering the ‘Healthy Child Programme’ for under 5s which was integrated with both maternity providers and Children’s Centre services.


In relation to access to the One to One service, information regarding the service was made available at GP Surgeries, the One to One website and via a Facebook page.


Mrs Curtis concluded that the protocol followed by the One to One Midwives allowed the midwife to accompany, stay and support the woman at the hospital, where possible, but the birth would be managed by the hospital midwifery staff. 







(1)  Ms Curtis be thanked for her written report and supporting verbal information; and


(2)  An update report detailing the outcome of the evaluation of Wirrals maternity services be submitted to a future meeting.