Insight: Happy Families

Anyone working within commissioning can appreciate the importance and complexity of getting meaningful public feedback to inform service changes. This can be even more problematic with certain groups who – understandably – may have other priorities including mums-to-be, new mums and their partners. 

NHS Dorset clinical commissioning group (CCG) faced this scenario when developing a maternity strategy for 2014-19. Their innovative approach has been recognised by being highly commended in the national NHS England Excellence in Participation Awards which were awarded at the 2014 NHS Expo in Manchester, coming within the top four nationally in  their category.  

Developing a maternity strategy for 2014-19 was a top priority for the CCG this year and from the outset it was vital that this work was informed by families’ insight and feedback. However successfully achieving this meant looking at employing some innovative methods.

Programme lead for maternity, family and reproductive health clinical commissioning programme (CCP) within the CCG Natalie Bain explains: “At the outset of this project we wanted to make sure that all users of maternity services across the county were able to input, regardless of their circumstances and wanted to offer them equal opportunities to do so. 

“Providing opportunities for involvement which are fully accessible to all – including pregnant working mums, new mums with babies and working partners – can be difficult. But working closely with this cohort we introduced some innovative ways of working which we hope will serve as an excellent example to other organisations of how to adapt their usual working practices to get the best possible involvement from the people they should be talking to”. 

Remote opportunities

New parents are busy parents. Couple this with Dorset having quite a rural population and it is easy to see how attending meetings can often mean a great deal of travelling which can be difficult. 

To counter this, ways of working were introduced which meant engagement could take place without parents having to physically attend events. 

With social media fast becoming a preferred method of communication for all ages, a Facebook page was launched which provided an accessible platform for ongoing two-way communication. This quickly grew in popularity and to date has been accessed by over 5,000 local people with 366 mums and dads being regularly engaged. 

Those people using it say it enables them to be kept informed and provide their views in a way that is convenient to them. As with all social media, the page requires ongoing regular monitoring and updating to ensure content is current and relevant. 

To achieve this a number of teams including the CCG Engagement and Communications Team, the Maternity Project team and other designated staff committed to checking the page daily, having the credentials to maintain the page at all times.

The social media approach was coupled with an online survey which sought the views of local parents-to-be on a range of issues which helped inform the selection of commissioning priority work streams for the strategy. 

Let’s hear your voice

For those people who were able to travel, a quarterly user reference group takes place called Dorset Maternity Voices. The groups are booked to take place in a children’s centre but with the added incentive of a crèche for small children. This has been welcomed by attendees, but for those who want to keep their children with them, a range of distractions are available including toys and healthy snacks. 

Finding locations that have crèche facilities for Maternity Voices meetings that are accessible for all can be problematic as Dorset is a large and predominantly rural county. This is an ongoing challenge with plans to vary the venues around the county enabling an equitable approach. 

While the groups were running, the team also took the opportunity to interview participants and get their views on a range of subjects. With permission from the interviewees, these have been used to inform other members of the public and local healthcare professionals. They have been made available on the NHS Dorset CCG website.

In order to capture these views, a policy around capturing, sharing and storing patient and carer stories (including the consenting process) had to be developed. 

While this proved time consuming, it also meant that interviews could be carried out professionally to a high standard and shared at staff engagement events. This policy is being adopted by the whole of the organisation and will become standard practice. 

Each group meeting begins with the CCG asking parents to give their views on a current piece of work that the CCG is undertaking, for example at the last group, parents were asked what outcomes they thought should be monitored that would indicate a quality maternity service. 

Heads of midwifery give a brief service update and the rest of the meeting is a chance for families to question the heads of midwifery and commissioners on any areas they feel are important. Families are also able to inform the CCG what topics they want discussed in more detail at the upcoming meeting via the Facebook page. 

Partner working

The CCG has a responsibility to ensure that maternity services meet the needs of the population, and seeking families’ insight and feedback is a key part of informing commissioning. In order to make this meaningful, it is essential that local maternity providers are on board with this work. 

Good relationships with local providers mean that all feedback is used to effectively support business cases and develop good working practices.

Feedback from users

The work of the team has been led by the desire to work closely with families to ensure that services that are designed and commissioned meet their needs and are acceptable and accessible to them. From the start it was realised that a range of approaches were needed to ensure that the views we received were representative of the whole population, rather than the vocal few. 

Measuring experience is an important aspect of this work and a survey has been carried out asking families “What makes a quality maternity service?”.

The results are to be used to feed in to Patient Reported Outcome and Experience Measures which will become a routine part of the CCGs performance management of maternity providers. 

One example of how feedback is used is that it showed there was an appetite to improve breastfeeding support in the early days, especially on hospital wards. This helped support the business case for increasing designated breastfeeding roles on maternity wards. The CCG measures the initiation of breastfeeding through contract monitoring and future performance indicators are likely to include the family defined outcome ‘I felt well supported to feed my baby’.

Helen Williams, deputy head of midwifery at Poole Hospital NHS Foundation Trust said: “The work of the maternity team at the CCG has been instrumental in bringing about real and sustainable improvements in communications pathways between us as an acute provider of maternity services, our commissioners and the women and families of Dorset. 

“Never before have we had such an enthusiastic and committed forum such has Maternity Voices whereby we are able to really hear what women want from their maternity service.

“The messages coming through have been extremely powerful and we have been able to use this feedback positively to further improve our services to women and their babies. We are grateful to the team for facilitating such positive user involvement in the planning of our services and enabling frontline staff to gain valuable feedback”.

 

Frances Aviss is engagement and communication lead and Natalie Bain is programme lead for maternity, family and reproductive health CCP at NHS Dorset CCG.