Evaluating maternity and neonatal services in Dorset

Dorset MNVP regularly carry out ’15 Steps’ and ‘Walk the Patch’ visits to Dorset’s maternity and neonatal services to observe and evaluate the care environments and staff interactions from a service users’ perspective, and to gather service user feedback. They share their findings and recommendations with those responsible for delivering and improving services.

15 Steps to quality care

During the 15 Steps visits Dorset MNVP use the NHS England toolkit to observe and record first impressions, and identify strengths and areas for improvement under the following themes:

• Welcoming and informative
• Safe and clear
• Friendly and personal
• Organised and calm

Throughout the year they aim to carry out 15 Steps visits to all maternity and neonatal service areas across the Dorset NHS Trusts. During these visits they have identified many suggestions for improvements, which they shared with the Trusts to guide their ongoing programme of improvement for services users. This includes, for example, the addition of staff photo boards and increased patient information displayed throughout maternity departments.

Walk the Patch visits

Dorset MNVP use these monthly visits to gather feedback directly from people attending antenatal and postnatal wards, and they also visit Special Care Baby Units and Neonatal Intensive Care Units.

Dorset MNVP report feedback to the Head of Midwifery and the management team at each Trust. Where required, we suggest improvements and work with the team to implement changes. We also share positive feedback to ensure staff are recognised for the good care they have given.

Making sure you have the information you need

The Maternity Matters Dorset NHS website aims to provide people with a wide range of useful information about pregnancy, birth, and all aspects of maternity and neonatal services and support in Dorset.

Dorset MNVP worked with NHS Dorset to co-produce content for the website and they continue to be involved to ensure content is up-to-date and easy to use.

In 2022, Dorset MNVP reviewed the website and identified areas that needed additional information to enable all service users to make informed choices about their care. They are working with maternity staff to develop content to close these information gaps.

Dorset MNVP are also helping to produce patient information on a range of topics to make sure it is clear and accessible.

Finding out what matters most to you

In 2022, Dorset MNVP asked those who use and deliver maternity and neonatal care in the county, to share their views about local services; over 270 people completed our survey.

Dorset MNVP analysed and reviewed the responses to inform their work plan and priorities, and they discussed the findings with senior staff at Dorset’s NHS Trusts to highlight areas and issues that need to be addressed.

Our work plan 2023-24

Dorset MNVP is seeking to connect and engage with more people from across Dorset, including harder to reach communities. And is building relationships and collaboration between service users, commissioners, clinicians, charities and voluntary groups, through involvement in many ongoing projects, working groups and meetings, including around strategy, governance, safety and equality.

Find out more and get involved

Using our online forms, share your views and experiences about any aspect of maternity and neonatal care in Dorset, or if you would like to get involved as a volunteer with our work  or by attending one of our regular meetings.

Engaging with communities in the Isles of Scilly

It’s important to amplify the voices of families and professionals from the Isles of Scilly to ensure decision makers consider the impact on these families when designing and updating services, so that they ensure safe, personalised and equitable care across the islands.

Kernow MNVP visited the islands in Spring 2023 and felt a strong sense of community and support. People shared open and honest accounts of their experiences, helping them understand the highs and lows of island life and the impact of living remotely, and how things might be done differently to better support their maternity and neonatal care needs.

While there Kernow MNVP connected with over 60 families and staff by:

• Visiting the community hospital and birth centre.
• Holding two focus groups at a local authority stay and play group.
• Organising a conference for medical staff.
• Hosting a celebration lunch for families and professionals.

Their report details the issues they identified and the recommendations made for change and improvement.

Personalised Care and Support Plan

In February 2023, during a focus group, Kernow MNVP found that the nationally required Personalised Care and Support Plan was not being embraced by local maternity staff, and service users often hadn’t seen it or didn’t understand it.

Kernow MNVP brought together service users and community teams to reimagine and coproduce this important planning document.

They used the core values and principles of the Kernow Parenting Journey to make sure the document uses accessible language, imagery where appropriate, time appropriate information, and consistent and clear messaging throughout the parenting journey to support informed decision-making.

The Personalised Care Plan work has informed development of the digital offer – Natters Bitesize – which contains a series of educational videos and resources to support individuals through the four trimesters of pregnancy.

Quality surveillance and governance

[Pictured: Donna Ockenden visit, March 2024]

Kernow MNVP continue to develop and embed their involvement in quality surveillance and governance across the Royal Cornwall Hospitals NHS Trust (RCHT).

Kernow MNVP is involved in several monthly forums where they share insight and intelligence gathered through their engagement work, provide critical friendship and challenge through a service user lens, and support the system to develop and ensure a transparent safety culture. Kernow MNVP also support the governance processes at system level through our involvement in the LMNS board, which receives a monthly maternity and neonatal safety report from RCHT, enabling escalation of any safety concerns or support needs through the system, up to regional level if required.

Regular monthly oversight and governance meetings attended by Kernow MNVP:

• LMNS Board
• LMNS Transformation Steering Group
• Maternity and obstetric business and governance
• Maternity audit review meeting
• Maternity Forum
• Maternity guidelines
• Maternity improvement plan review
• Neonatal audit and guidelines
• Neonatal business and governance
• Ockenden actions compliance review
• Patient Experience Group
• Perinatal mortality review meeting
• Perinatal patient safety
• PULSE (senior midwifery leadership group)
• RCHT Infant Feeding Steering Group
• Safety Champions
• Staff and patient feedback triangulation meeting

By embedding the service user voice within the quality surveillance pathway locally, Kernow MNVP ensures the feedback from families is truly influential in making changes to improve care.

Kernow Parenting Journey (KPJ)

The Kernow Parenting Journey (KPJ) was originally an independent engagement and research project which ran from June 2021. In April 2023, the project moved into a delivery phase which aligned with Kernow MNVP’s work to ensure robust collaboration and coproduction, maintaining its strongly developed multiagency partnership approach.

The focus of the project remains to develop recommendations, embed core values and principles, and shape the system offer with delivery of information and support to families across their parenting journey for children aged 0-2 years.

June 2023: Developing a maternity antenatal programme

KPJ’s recommendations for a tiered maternity antenatal programme were developed, and the Silver option was implemented by the LMNS.

• Gold – Full Pregnancy Circles with trained facilitators, parent education and clinical care combined.
• Silver – Three points of face-to-face contact: baby care session led by Midwifery Support Workers, birth planning at 36 weeks and a postnatal group, often run in conjunction with the Health Visiting Team.
• Bronze – Maternity Natters Digital, where all antenatal contact is online via Zoom.

October 2023: Pregnancy Circle Group – care facilitation training

Members of the community midwifery team from across Cornwall and the KPJ Lead were trained in this UCL accredited course ahead of the full Pregnancy Circle programme launch in 2024.

November 2023: KPJ core values and principles

KPJ values and principles were adopted by the Start for Life programme for supporting parents with children aged 0 to 25 and shaping multiagency and partnership working.

December 2023 – March 2024: Maternity Natters Bitesize

A move away from existing online classes to a video resource library, presenting a parenting road map linked to the Personalised Care and Support Plan and a series of antenatal videos (KPJ website to be live in due course).

Read the report

Shaping and supporting MNVPs nationally

In 2023, following the publication of the NHS England delivery plan, neonatal care was formally added to the MVP remit. Kernow MVP became Kernow MNVP and the team worked to include and embed neonatal care into their work locally.

Kernow MNVP worked with the Cornwall Integrated Care Board, NHS England and representatives from around the country to develop new national MNVP guidance (published November 2023). This gives systems a framework of principles to support them to effectively commission and set up an MNVP.

Kernow MNVP continues to lead the way nationally for MNVP development and are supporting other systems as they work towards embedding service user voice in their work.

The main principles of the new guidance include:

• Engagement and listening to families: This includes things such as community engagement, surveys and 15 steps visits, and involves collecting, analysing and reporting the findings and intelligence gathered.
• Strategic influence and decision making: This includes involvement in quality surveillance, governance and service development. The guidance requires the MNVP to have strategic leadership that is enabled to work alongside the senior leadership team at provider level.
• Infrastructure: This includes things like administrative support, project management and the infrastructure needed to run a successful programme of work. In Cornwall this is provided through a commissioning arrangement with external organisation such as Evolving Communities.

15 Steps to good maternity and neonatal services at Royal Cornwall Hospital

In October 2023, Kernow MNVP visited the Royal Cornwall Hospital and used NHS England’s 15 Steps checklist to reflect on whether the maternity and neonatal settings and staff were:

Welcoming and informative

Safe and clear

Friendly and personal

Organised and calm

Accessible and inclusive.

The visiting group included staff and volunteers from Kernow MNVP and Healthwatch Cornwall, service users and midwives. During the day they observed: Wheal Fortune, Neonatal Unit, Truro Birth Centre, Wheal Rose, Day Assessment Unit and the Delivery Suite.

Their report presents the group’s findings, highlighting what they liked and what they felt could be improved. It includes recommendations for change and reflects on progress made since their previous visits and recommendations.

Kernow MNVP has shared the report with the Local Maternity and Neonatal System (LMNS) and the hospital leadership team. They will monitor progress made by the Royal Cornwall Hospitals NHS Trust and repeat the 15 Steps visit in 2024.