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NHS North Tyneside CCG Maternity care research September 2013 Delivered by Joanne Loughlin-Ridley

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NHS North Tyneside CCG. Maternity care research . September 2013. Delivered by Joanne Loughlin-Ridley. Project background . This section of the report provides detail on the research objectives, methodology and sample, providing context behind the insight. . Project background. - PowerPoint PPT Presentation

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Page 1: NHS North Tyneside CCG

NHS North Tyneside CCGMaternity care research

September 2013Delivered by Joanne Loughlin-Ridley

Page 2: NHS North Tyneside CCG

Project background This section of the report provides detail on the research objectives, methodology and sample, providing context behind the insight.

Page 3: NHS North Tyneside CCG

• Explain was commissioned in early 2012 by NHS North of Tyne to carry out a comprehensive evaluation of maternity care services across the North East

• The research detailed within this report aimed to build upon the qualitative insight that was completed and delivered to NHS North of Tyne in April 2012

• An on-street survey was commissioned by NHS North Tyneside CCG, to engage a random sample of local ‘mothers’ and ‘future mothers’– ‘Mothers’ includes women whose youngest child is five years or younger, and ‘future mothers’

includes pregnant women and those without children that plan to have a family of their own in the future

– Quotas / targets were set for the survey sample based on age using the most up to date birth data available publically

• Fieldwork took place across a four week period, ending in early September 2013. Alongside the on-street approach, researchers were able to flexibly attend relevant sessions at local children’s centers as a means to gain access to the eligible target audience

Project background

Page 4: NHS North Tyneside CCG

• As with any data collection where a sample is drawn to represent a population, there is a potential difference between the response from the sample and the true situation in the population as a whole (a census). This is known as a standard error which is estimated using statistical calculations based on the sample size and the population size, normally expressed as a confidence interval for the results

• To achieve 100% accuracy in results would require the entire population to participate (a census). The usual confidence interval used in market research is 95% which means that you can be confident that in 19 out of 20 instances the actual population behaviour will be within the confidence interval range. The table below gives an indication of the 95% confidence interval for the data within this report at different sample sizes

• For example, if a result was 50% we can be confident that the true result if a census was completed for an 1100 sample survey would be actually ±3.0 (therefore between 47% - 53%)

• Please also note that respondents that did not or could not answer a question were removed from the data and therefore the base size in charts fluctuates from question to question

Project background

Sample size 95% Confidence IntervalSample: 1100 ±3.0Sample: 600 ±4.0

Sample: 500 ±4.4

Sub-Sample: 100 ±9.8

Sub-Sample: 70 ±11.7

Page 5: NHS North Tyneside CCG

• 1,145 took part in the on-street survey, including 595 mothers and 553 future mothers

• 4% of mothers and future mothers indicated they suffered a long-term illness / disability• 7% of future mothers were pregnant at the point of interview• 46% of mothers had only one child, meaning 54% were ‘multiple mothers’ • 75% of mothers had a youngest child under 24 months,

Project background

16-19 20-29 30+ White - UK ABC1 C2DEAge Ethnicity Socio-economic group

26%

49%

26%

96%

38%

62%

46% 48%

6%

97%

42%

58%

7%

49%44%

96%

35%

65%

Overall (1144) Future mothers (552) Mothers (592)

Page 6: NHS North Tyneside CCG

• Whilst a target was set for an equal proportion of interviews to be carried out across the four areas within North Tyneside, researchers found it challenging to locate eligible women to take part in the North West area specifically

• Analysis has revealed interesting variations in response when comparing residents from the West (North West and South West) to the East (North East and South East) and so throughout this report comparisons are made on this basis

Project background

North West North East South East South WestArea of residence

11%

26%

34%

29%

11%

27%

32%30%

12%

24%

37%

28%

Overall (1139-1145) Future mothers (551-553) Mothers (588-592)

Page 7: NHS North Tyneside CCG

Antenatal careWithin this section of the report you will find details as to the quantitative insight generated from the mothers research which focused on antenatal care. Please note that future mothers were not asked questions relating to antenatal care on the basis that previous insight had confirmed a lack of knowledge and therefore expectations.

Page 8: NHS North Tyneside CCG

• The majority of mothers had experienced their most recent antenatal care in North Tyneside

• Mothers were asked to indicate in their own words, the ONE thing that could have been changed about their antenatal care experience that would have made it better

• Unprompted there was no evidence of a consistent area to improve and no significant variation found between care in Newcastle, North Tyneside and Northumberland

Antenatal care

Nothing /unsure(306 = 52%)

More appointments

(39 = 7%)

More information

(28 = 5%)

Attitude of staff (22 = 4%)

More hospital checks/scans

(21 = 4%)

More support/advice

(15 = 3%)

Closer to home(13 = 2%)

See same midwife

(13 = 2%)

Newcastle North Tyneside NorthumberlandWhere antenatal care had been previously experienced (Mothers overall 593)

35%

63%

3%

Page 9: NHS North Tyneside CCG

Antenatal care

‘Better staff, as they are not very friendly’

‘More classes throughout pregnancy, start them at an earlier stage of

pregnancy’

‘A consistent midwife

throughout pregnancy’

‘Every time I tried to discuss the

birthing plan it was put off’

‘It would have been better to stay at North Tyneside as I was taken

from hospital to hospital’

‘For someone to see me close to home’

‘Have more scans when you have complications’

‘More information in early stages and

more check ups’

Nothing /unsure(306 = 52%)

More appointments

(39 = 7%)

More information

(28 = 5%)

Attitude of staff (22 = 4%)

More hospital checks/scans

(21 = 4%)

More support/advice

(15 = 3%)

Closer to home(13 = 2%)

See same midwife

(13 = 2%)

Page 10: NHS North Tyneside CCG

• A series of statements were given to mothers for them to rate their level of agreement using a scale of 1 to 10 (1 was ‘Strongly disagree’ and 10 was ‘Strongly agree’)

• No significant variations were found by age, socio-economic group, number of children or where previous experience of antenatal care had been

Antenatal care

I w

I w

I w

I w

I w

Ante

nata

l car

e (m

othe

rs o

vera

l...

7.63

7.73

8.96

9.32

9.35000000000001

Page 11: NHS North Tyneside CCG

• When comparing responses from mothers that lived in the West to those that lived in the East, across three of the statements shown below there was significant variation found with mothers in the West more likely to ‘strongly agree’ and give 10 out of 10

Antenatal care

I w

I w

I w

Stro

ngly

agr

eed

(10

out .

..

60%

70%

65%

75%

80%

84%

66%

74%

72%

Mothers overall (591) West (234) East (357)

*significant variations are circled in the graph

Page 12: NHS North Tyneside CCG

• Mothers were then asked to indicate from a showcard, which of the following were MOST and LEAST important to them overall in regards to antenatal care

• With the exception of mothers aged 16-19, all profiles rated ‘Partners being given advice and information to help them prepare’ to be the LEAST important overall– Least important to 16-19s was ‘Having opportunities to meet other mothers’ (48%)

Antenatal care

Seeing the same midwife at each routine check

For midwife appointments to be carried out in the local

community, e.g. GP surgery, children's centres

Access to advice 24 hours a day by telephone

Having opportunities to meet other mothers

Partners being given advice and information to help

them prepare

Level of importance

47%

29%

18%

3% 3%6%

2% 5%

37%

50%

Most important (591) Least important (589)

Page 13: NHS North Tyneside CCG

Seei

ng th

e sa

me

mid

wife

at

each

routi

ne ch

eck

For m

idw

ife a

ppoi

ntm

ents

to

be ca

rrie

d ou

t in

the

loca

l co

mm

unity

, e.g

. GP

surg

ery,

ch

ildre

n's c

entr

es

Havi

ng o

ppor

tuni

ties t

o m

eet

othe

r mot

hers

Part

ners

bei

ng g

iven

adv

ice

and

info

rmati

on to

hel

p th

em p

repa

re

MOST important LEAST important

47%

29%

37%

50%45%

36%

44%47%48%

24%

32%

52%

43%

30%

40%

45%

50%

28%

35%

55%55%

20%

41%44%

42%

33%35%

53%

Mothers overall (589-591) West (232-234) East (357) First time mothers (271) Multiple mothers (317-319) ABC1 (205)C2DE (380-382)

• Variation in response was found for four of the statements rated in terms of what was MOST and LEAST important, when comparing responses by the area of residence and the number of children mothers had

Antenatal care

Page 14: NHS North Tyneside CCG

Labour and delivery careWithin this section of the report you will find details as to the quantitative insight generated from the mothers and future mothers research which focused on labour and delivery care. Please note that the sample of mothers and future mothers has also been combined within this section to give indications of trends by profile on a large sample base of over 1,100.

Page 15: NHS North Tyneside CCG

• The majority of mothers had experienced their most recent labour and delivery care in Newcastle

• Mothers were asked to indicate in their own words, the ONE thing that could have been changed about their labour and delivery care experience that would have made it better

• Unprompted there was no evidence of a consistent area to improve

• Those that had their care in Northumberland were more likely to state ‘Closer to home’

Labour and delivery care

Nothing / unsure(268 = 45%)

Attitude of staff / communication

(60 = 10%)

More midwives(33 = 6%)

Facilities / hospital policies

(24 = 4%)

Early admittance (21 = 4%)

Pain relief choice / administration

(22 = 4%)

Same midwife (14 = 2%)

Closer to home(12 = 2%)

Caesarean(10 = 2%)

Newcastle North Tyneside NorthumberlandWhere labour and delivery care had been received previously (Mothers overall 593)

63%

25%

13%

Page 16: NHS North Tyneside CCG

Labour and delivery care

‘I would prefer a private room

next time’

‘Nicer midwives, they have bad manners’

‘Same midwife, I had 3 different

ones’

‘More staff to assist you to

be more supportive’

‘Not to be sent home when in

labour’

‘Have more pain relief ’

‘I would rather have been closer to home than going to Wansbeck’

‘Give me more time to give birth instead of getting a C section’

‘The same midwife throughout labour’

‘The staff didn't care about me they just left me to get on with it’

‘You shouldn't be sent home when your

waters have broke’

Nothing / unsure(268 = 45%)

Attitude of staff / communication

(60 = 10%)

More midwives(33 = 6%)

Facilities / hospital policies

(24 = 4%)

Early admittance (21 = 4%)

Pain relief choice / administration

(22 = 4%)

Same midwife (14 = 2%)

Closer to home(12 = 2%)

Caesarean(10 = 2%)

Page 17: NHS North Tyneside CCG

• A series of statements were given to mothers and future mothers for them to rate their level of agreement using a scale of 1 to 10 (1 was ‘Strongly disagree’ and 10 was ‘Strongly agree’)

Labour and delivery care

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

Labo

ur a

nd d

eliv

ery

care

(ove

rall

1135

...

6.10

7.04

7.20

7.43

7.59

7.70

7.85

8.15

8.31

8.84

8.91

8.98

9.05

9.18

9.48

9.56

Page 18: NHS North Tyneside CCG

I w

I w

I w

I w

I w

I w

I w

I w

I w

Stro

ngly

agr

ee (1

0 ou

t ...

43%

43%

52%

43%

56%

62%

66%

71%

66%

31%

37%

45%

49%

43%

40%

48%

62%

60%

36%

40%

49%

49%

49%

51%

57%

66%

63%

Overall (1135-1143) Mothers (584-591) Future mothers (550-552)

• Across ten of the statements there was variation evident between mothers and future mothers in terms of the proportion that ‘strongly agreed’ and gave 10 out of 10

Labour and delivery care

*significant variations are circled in the graph

Page 19: NHS North Tyneside CCG

I w

I w

I w

I w

I w

I w

Stro

ngly

disa

gree

(1 o

ut ..

.

9%

5%

7%

3%

3%

1%

14%

11%

14%

11%

11%

5%

11%

8%

11%

7%

7%

3%

Overall (1135-1143) Mothers (584-591) Future mothers (550-552)

• Across six of the statements there was also variation evident between mothers and future mothers in terms of the proportion that ‘strongly disagreed’ and gave 1 out of 10

Labour and delivery care

*significant variations are circled in the graph

Page 20: NHS North Tyneside CCG

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

I w

Stro

ngly

agr

ee (1

0 ou

t ...

40%

42%

44%

53%

62%

64%

56%

65%

68%

78%

77%

46%

58%

55%

64%

73%

75%

73%

78%

80%

88%

89%

42%

49%

49%

57%

66%

68%

63%

70%

73%

82%

82%

Overall (1135-1143) West (455-458) East (679-684)

• Across 11 of the statements a significantly higher proportion of mothers living in the West ‘strongly agreed’ and gave 10 out of 10

Labour and delivery care

*significant variations are circled in the graph

Page 21: NHS North Tyneside CCG

I wan

t to

be in

a se

rvice

dur-

ing

early

labo

ur in

stea

d of

w

aitin

g at

hom

e to

pro

gres

s

I wan

t my

care

to b

e le

d by

a

mid

wife

I wan

t the

sam

e m

idw

ife to

ca

re fo

r me

thro

ugho

ut m

y la

bour

and

del

iver

y

I wan

t all

optio

ns fo

r pai

n re

lief a

vaila

ble

shou

ld I

need

th

em o

r cha

nge

my

min

d

I wan

t doc

tors

and

spec

ial-

ists o

n-ha

nd in

the

sam

e bu

ildin

g sh

ould

I ne

ed th

em

Strongly agree (10 out 0f 10)

45%

60%

71%

82% 82%

48%

64%

74%

84% 86%

46%

55%

68%

82%77%

33%

51%

61%

73% 75%

Mothers (589-591) Previous experience in Newcastle (369-371) Previous experience in North Tyneside (145)Previous experience in Northumberland (79)

• Across five of the statements there was variation found in terms of the proportion that ‘strongly agreed’ and gave 10 out of 10, when looking at the response of mothers in terms of where they had most recently experienced labour and delivery care

Labour and delivery care

*significant variations are circled in the graph

Page 22: NHS North Tyneside CCG

I w

I w

I w

I w

Stro

ngly

agr

ee (1

0 ou

t ...

31%

39%

48%

60%

37%

53%

56%

67%

40%

57%

67%

71%

36%

51%

57%

66%

Overall (1135-1143) 16-19 (295) 20-29 (551-554) 30+ (292-293)

Labour and delivery care

• Across four of the statements a trend was found whereby the younger the respondent, the higher the proportion that ‘strongly agreed’ and gave 10 out of 10

*significant variations are circled in the graph

Page 23: NHS North Tyneside CCG

I w

I w

I w

I w

I w

I w

Stro

ngly

agr

ee (1

0 ou

t ...

34%

39%

46%

46%

48%

72%

40%

48%

53%

54%

55%

66%

36%

42%

49%

49%

51%

70%

Overall (1135-1143) ABC1 (432-434) C2DE (7698-701)

• Across six of the statements there was variation found by socio-economic group in terms of the proportion rating ‘strongly agree’ and giving 10 out of 10

Labour and delivery care

*significant variations are circled in the graph

Page 24: NHS North Tyneside CCG

I wan

t opp

ortu

nitie

s to

mee

t ot

her m

othe

rs, e

.g. c

omm

unca

l ki

tche

n, T

V ro

om

I wan

t to

stay

in a

serv

ice fo

r a

num

ber o

f day

s afte

r giv

ing

birt

h

I wan

t to

be in

a se

rvice

dur

ing

early

labo

ur in

stea

d of

wai

ting

at h

ome

to p

rogr

ess

I wan

t one

to o

ne su

ppor

t with

br

eastf

eedi

ng in

the

serv

ice

I wan

t my

part

ner t

o be

show

n ho

w to

care

for b

aby,

e.g

. ba

thin

g, n

appi

es, d

ress

ing

I wan

t to

be sh

own

how

to ca

re

for b

aby,

e.g

. bat

hing

, nap

pies

, dr

essin

g

Strongly disagree (1 out of 10)

11%10%

8%

11%

7% 7%7%6%

5%

8%

2%3%

14%13%

7%

13%

8% 8%

12%

9%

11%10%

11%10%

16%

11%10%

12%

7%8%8%

10%

6%

10%

7% 7%

9%10%

7% 7%

5%6%

13%

11%

8%

13%

8% 8%

Overall (1135-1143) 16-19 (293) 20-29 (551-554) 30+ (291-293) West (457) East (680)ABC1 (430-436) C2DE (701)

Labour and delivery care

• Across six of the statements variation was found by area of residence, age and socio-economic group in terms of the proportion that ‘strongly disagree’ and gave 1 out of 10

*significant variations are circled in the graph

Page 25: NHS North Tyneside CCG

• Mothers and future mothers were then asked to indicate from a showcard, which of the following were MOST and LEAST important overall in regards to labour and delivery care

Labour and delivery careSt

ayin

g in

a se

rvice

in e

arly

labo

ur ra

ther

than

wai

ting

at

hom

e to

pro

gres

s

Care

bei

ng le

d by

a m

idw

ife

Doct

ors a

nd sp

ecia

lists

on-

hand

in th

e sa

me

build

ing

shou

ld th

ey b

e ne

eded

The

sam

e m

idw

ife to

pro

vide

care

thro

ugho

ut th

e la

bour

an

d de

liver

y ex

perie

nce

Havi

ng a

ll pa

in re

lief o

ption

s ava

ilabl

e

Birt

hing

poo

l

The

serv

ice to

hav

e a

hom

ely

feel

rath

er th

an li

ke a

hos

pita

l

Priv

ate

room

with

en

suite

bat

hroo

m

Birt

hing

par

tner

to st

ay u

ntil d

ischa

rge,

inclu

ding

ove

rnig

ht

Bein

g sh

own

how

to ca

re fo

r the

bab

y, e

.g. B

athi

ng,

napp

ies,

dres

sing

Part

ner t

o be

show

n ho

w to

care

for t

he b

aby,

e.g

. Bat

hing

, na

ppie

s, dr

essin

g

One

to o

ne su

ppor

t with

bre

astfe

edin

g

Opp

ortu

nitie

s to

mee

t oth

er m

othe

rs, e

.g. C

omm

unca

l ki

tche

n, T

V ro

om

Stay

ing

in th

e se

rvice

for a

num

ber o

f day

s afte

r giv

ing

birt

h

Dedi

cate

d m

ater

nity

car p

arki

ng

Free

car p

arki

ng

Level of importance

12%

7%

33%

15% 14%

2% 2%1%

8%

2% 1% 2% 1% 0% 0% 1%5%

0% 0% 1% 0%

22%

1% 2% 1% 1% 2%4%

12%

5%

11%

32%

Most important (1137) Least important (1127)

Page 26: NHS North Tyneside CCG

Staying in a service in early labour rather than

waiting at home to progress

Birthing partner to stay until discharge, including

overnight

Staying in the service for a number of days after

giving birth

Opportunities to meet other mothers, e.g.

Communcal kitchen, TV room

Birthing pool Free car parking

MOST important LEAST important

12%

8%

5%

12%

22%

32%

11%9%

6%

9%

25%

34%

15%

7%

4%

13%

21%

32%

8% 7% 8%

13%

20%

29%

17%

5% 5%

16%

25% 26%

9% 10%

6%

9%

20%

35%

Overall 1127-1137) 16-19 (292) 20-29 (545-552) 30+ (290-293) West (451-457) East (675-679)

• Variation in response was found for six of the statements rated in terms of what was MOST and LEAST important, when comparing responses by age and area of residence

Labour and delivery care

*significant variations are circled in the graph

Page 27: NHS North Tyneside CCG

• Following a description of what it would mean to give birth at home, in a midwifery led unit, a maternity care unit and a birthing centre, mothers and future mothers were asked to indicate which option they would choose if giving birth in the future

• First time mothers were more likely than multiple mothers to opt for a ‘Birthing centre’ (21% V 13%), and were less likely to select ‘Home’ (8% V 13%)

• Respondents from the West were more likely to opt for a ‘Birthing centre’ (21% V 12%)

Labour and delivery care

Home Midwifery led unit Maternity care unit Birthing centreChoice of birth place

9%15%

61%

16%

6%

13%

67%

15%11%

17%

55%

17%

Overall (1123) Future mothers (542) Mothers (581)

*significant variations are circled in the graph

Page 28: NHS North Tyneside CCG

Labour and delivery care

Home (95 = 9% overall)

Midwifery led unit(169 = 15% overall)

Maternity care unit(682 = 61% overall)

Birthing centre (177 = 16% overall)

Comfortable / relaxing (63 = 66%)

• When asked to explain the reason for their choice, the following themes were found

Family to be there (15 = 16%)

Don’t like hospitals (7 = 7%)

Convenience (4 = 4%)

No intervention (3 = 3%)

Previous experience (2 = 2%)

Level of care / staff(51 = 30%)

Homely / relaxed (42 = 25%)

Previous experience (20 = 12%)

Facilities (28 = 17%)

Closer to home (21 = 12%)

Recommended (10 = 6%)

Clinical staff on-hand (189 = 28%)

No choice (risk) (46 = 7%)

Previous experience (30 = 4%)

The ‘norm’ (8 = 1%)

Recommendation (10 = 1%)

Atmosphere (53 = 30%)

Just ‘in case’ (22 = 12%)

Previous experience (21 = 12%)

Level of care / staff (18 = 10%)

Natural (8 = 5%)

Partner can stay (7 = 4%)

Recommendation (3 = 2%)

Private (4 = 2%)

Facilities (23 = 13%) Just ‘in case’ (185 = 27%)

Facilities (120 = 18%)

Pain relief (97 = 14%)

Convenience (13 = 2%)

Page 29: NHS North Tyneside CCG

Labour and delivery care

Home (95 = 9% overall)

Midwifery led unit(169 = 15% overall)

Maternity care unit(682 = 61% overall)

Birthing centre (177 = 16% overall)

Comfortable / relaxing (63 = 66%)

• When asked to explain the reason for their choice, the following themes were found

Clinical staff on-hand (189 = 28%)

Atmosphere (53 = 30%)

Just ‘in case’ (185 = 27%)

‘It is more natural and

homely’

‘It will be more comfortable at

home’

‘There is more one to one support’

‘There are doctors on duty’

‘It is more relaxed at

home’

‘I would feel more comfortable having

family with me’

‘It was comfortable and has brilliant staff, it wasn't like a cattle

market’

‘It has a homely feel and a nicer environment’

‘There are doctors there ’

‘I would feel safer’

‘In case something goes wrong ’

‘It is a more relaxing place’

‘It has a more relaxed atmosphere

and it is more like home’

‘They are more caring’

Level of care / staff(51 = 30%)

Homely / relaxed (42 = 25%)

Page 30: NHS North Tyneside CCG

Labour and delivery care

Not a home birth(1028 = 92%)

Not a midwifery led unit (954 = 85%)

Not a maternity care unit (441 = 39% )

Not a birthing centre (946 = 84% )

• When asked why they would not choose the other options, the following themes were found

Just ‘in case’ (448 = 44%)

No clinicians (92 = 9%)

Pain relief (73 = 7%)

Scared (62 = 6%)

Messy (60 = 6%)

Couldn’t (40 = 4%)

Inconvenient (35 = 3%)

Unsure (80 = 8%)

No equipment (36 = 4%)

Transfer time (32 = 3%)

Not sterile (31 = 3%)

Negative (31 = 3%)

Pain relief (266 = 28%)

No clinicians (161 = 17%)

Transfer (80 = 8%)

Dislike hospitals (45 = 5%)

Facilities / equipment(45 = 5%)

Couldn’t (40 = 4%)

Just ‘in case’ (38 = 4%)

Prefer hospital (27 = 3%)

Not 1st choice (16 = 2%)

One to one care (11 = 1%)

Dislike hospitals (98 = 22%)

Unsure (90 = 20%)

Too busy (86 = 20%)

Impersonal care (39 = 9%)

Not 1st choice (32 = 7%)

Unnecessary (21 = 5%)

Too far away (16 = 4%)

Unsure (192= 20%)

No clinicians (90 = 10%)

Pain relief (50 = 5%)

Prefer hospital (30 = 3%)

Transfer (51 = 5%)

Unfamiliar (39 = 4%)

Not 1st choice (18 = 2%)

Just ‘in case’ (18 = 2%)

Facilities (27 = 3%)

Dislike hospitals (39 = 4%)

Couldn’t (22 = 2%)

Too far away (17 = 2%)

Page 31: NHS North Tyneside CCG

Labour and delivery care

• When asked why they would not choose the other options, the following themes were found

Just ‘in case’ (448 = 44%) Pain relief (266 = 28%)

No clinicians (161 = 17%)

Dislike hospitals (98 = 22%)

Unsure (90 = 20%)

Too busy (86 = 20%)

Unsure (192= 20%)

No clinicians (90 = 10%)

‘No reason’

‘It is too clinical ’

‘I don't think it is as safe ’ ‘Limited pain control’

‘I would be scared things

would go wrong ’

‘In case things went wrong’

‘In case of any complications’

‘There is not enough pain relief’

‘Not enough medical back up staff if needed’

‘There are no doctors ’

‘It is a hospital environment’

‘No reason’

‘It is too busy’

‘There is no doctor on duty, would not

feel as safe’

‘There are no doctors there’

‘It is too busy it is like a cattle market ’

‘There are not as many medical staff ’

‘The staff are not experienced enough’

Not a home birth(1028 = 92%)

Not a midwifery led unit (954 = 85%)

Not a maternity care unit (441 = 39% )

Not a birthing centre (946 = 84% )

Page 32: NHS North Tyneside CCG

• When provided with a list of current options in the North East, the RVI’s maternity care unit was found to be most preferable by both mothers and future mothers

• First time mothers were more likely than multiple mothers to opt for ‘Birthing centre – RVI’ (21% V 15%)

• There was no significant variation found by age when comparing responses

Labour and delivery care

Hom

e

Mid

wife

ry le

d un

it -

Rake

Lane

, Nor

th

Shie

lds

Mat

erni

ty ca

re u

nit -

W

ansb

eck,

Ash

ingt

on

Mat

erni

ty ca

re u

nit -

RV

I, Ne

wca

stle

Mat

erni

ty ca

re u

nit -

Cr

amlin

gton

(due

to

open

in 2

015)

Birt

hing

cent

re -

RVI,

New

cast

le

Specific choice of birth place

7%

22%

6%

49%

2%

15%

6%

21%

4%

54%

2%

13%9%

22%

7%

43%

1%

18%

Overall (1141) Future mothers (551) Mothers (590)

*significant variations are circled in the graph

Page 33: NHS North Tyneside CCG

• When comparing choice of service type by the location of the mothers most recent experience of labour and delivery care, variation was found

• Mothers that most recently experienced labour and delivery care in North Tyneside were more likely to opt for a ‘Midwifery led unit’ and were less likely to opt for a ‘Maternity care unit’

• Mothers that most recently experienced labour and delivery care in Newcastle, were more likely to opt for a ‘Birthing Centre’

Home Midwifery led unit Maternity care unit Birthing centreChoice of birth place

11%

17%

55%

17%

9%11%

57%

23%

12%

29%

50%

8%

13%

23%

60%

4%

Mothers overall (581) Previous experience in Newcastle (363)Previous experience in North Tyneside (145) Previous experience in Northumberland (77)

Labour and delivery care

*significant variations are circled in the graph

Page 34: NHS North Tyneside CCG

Home Midwifery led unit - Rake Lane, North

Shields

Maternity care unit - Wansbeck, Ashington

Maternity care unit - RVI, Newcastle

Maternity care unit - Cramlington (due to

open in 2015)

Birthing centre - RVI, Newcastle

Specific choice of birth place

7%

22%

6%

49%

2%

15%

8%13%

1%

56%

1%

20%

7%

27%

9%

43%

2%

12%

6%

25%

7%

46%

1%

17%

8%

20%

5%

51%

2%

14%

Overall (1141) West (458) East (664) ABC1 (435) C2DE (701)

• Comparing response by area of residence and socio-economic group revealed variation

Labour and delivery care

*significant variations are circled in the graph

Page 35: NHS North Tyneside CCG

Labour and delivery care

• When asked why they had chosen that specific option, the following themes were found

RVI, maternity care unit (553 = 49%)

Rake Lane, midwifery led unit

(248 = 22%)

RVI, birthing centre (172 = 15%)

Home (83 = 7%)

Wansbeck, maternity care unit

(67 = 6%)

Cramlington, maternity care unit

(17 = 2%)

Past experience / familiarity (47 = 19%)

Recommendation (12 = 5%)

Past experience / familiarity (24 = 14%)

Quality of care (10 = 6%)

Good reputation (15 = 9%)

Partners can stay (3 = 2%)

Close to home (137 = 55%)

Atmosphere (29 = 12%)

Close to home (9 = 5%)

Atmosphere (35 = 20%)

Only birthing centre (11 = 6%)

Clinicians nearby (16 = 9%)

Quality of care (41 = 17%)

Comfortable / relaxing (68 = 82%)

Family can be there (9 = 11%)

Previous experience / familiarity (42 = 63%

Close to home (14 = 21%

Reputation / better than others (10 = 15%

Clinicians on-hand (6 = 9%

It’s a new unit (10 = 59%)

Close to home (9 = 53%

Specialists / doctors on-hand (56 = 10%)

Big / good hospital (55 = 10%)

Previous experience / familiarity (55 = 10%)

Safer (26 = 5%)

Good reputation / better than others (85 = 15%)

Facilities (67 = 12%)

Quality of care (40 = 7%)

Close to home (54 = 10%)

Page 36: NHS North Tyneside CCG

Labour and delivery care

• When asked why they had chosen that specific option, the following themes were found

RVI, maternity care unit (553 = 49%)

Rake Lane, midwifery led unit

(248 = 22%)

RVI, birthing centre (172 = 15%)

Home (83 = 7%)

Wansbeck, maternity care unit

(67 = 6%)

Cramlington, maternity care unit

(17 = 2%)

Specialists / doctors on-hand (56 = 10%)

Big / good hospital (55 = 10%)

Previous experience / familiarity (55 = 10%)

‘Family had their babies there, they say it's good and

it has a better reputation’

‘It is a better hospital overall’

‘Rake lane has a bad reputation’

‘There are doctors on hand if needed’

‘They have excellent

staff’

‘Excellent after care’

‘Has everything on hand’

‘I had a good experience the first time’

‘I would feel safe’

‘It has got all the

things you need’

‘It is the closest maternity care

hospital’

‘It is a bigger hospital’

‘It is the best

option’

Good reputation / better than others (85 = 15%)

Facilities (67 = 12%)

Quality of care (40 = 7%)

Close to home (54 = 10%)

Safer (26 = 5%)

Page 37: NHS North Tyneside CCG

• The maternity care unit at the RVI was also most preferred for mothers and future mothers, should they need to stay within a service for several days following delivery

• First time mothers were more likely than multiple mothers to opt for ‘Birthing centre – RVI’ (12% V 7%), whilst being less likely to opt for ‘Maternity care unit – RVI’ (53% V 63%)

• There was no significant variation found by age or SEG when comparing responses

Mid

wife

ry le

d un

it - R

ake

Lane

, Nor

th S

hiel

ds

Mat

erni

ty ca

re u

nit -

W

ansb

eck,

Ash

ingt

on

Mat

erni

ty ca

re u

nit -

RVI

, Ne

wca

stle

Mat

erni

ty ca

re u

nit -

Cra

m-lin

gton

(due

to o

pen

in

2015

)

Birt

hing

cent

re -

RVI,

New

cast

le

Choice of aftercare, if required to stay in a service

20%

7%

61%

3%8%

20%

5%

64%

4%7%

20%

9%

58%

3%9%

Overall (1141) Future mothers (553) Mothers (588)

Labour and delivery care

*significant variations are circled in the graph

Page 38: NHS North Tyneside CCG

• When comparing specific choice of service by the location of the mothers most recent experience of labour and delivery care, variation was found

• Mothers that most recently experienced labour and delivery care in North Tyneside were more likely to opt for ‘Rake Lane’

• Mothers that most recently experienced labour and delivery care in Newcastle, were more likely to opt for a ‘RVI – maternity’ and ‘RVI – birthing centre’

• Mothers that most recently experienced labour and delivery care in Northumberland, were more likely to opt for ‘Wansbeck’

Home Midwifery led unit - Rake Lane, North

Shields

Maternity care unit - Wansbeck, Ashington

Maternity care unit - RVI, Newcastle

Maternity care unit - Cramlington (due to

open in 2015)

Birthing centre - RVI, Newcastle

Specific choice of birth place

9%

22%

7%

43%

1%

18%

8%11%

2%

56%

0%

24%

10%

48%

8%

25%

1%

8%11%

27%

34%

18%

5% 5%

Mothers (590) Previous experience in Newcastle (371)Previous experience in North Tyneside (144) Previous experience in Northumberland (79)

Labour and delivery care

*significant variations are circled in the graph

Page 39: NHS North Tyneside CCG

Mid

wife

ry le

d un

it -

Rake

Lane

, Nor

th

Shie

lds

Mat

erni

ty ca

re u

nit -

W

ansb

eck,

Ash

ingt

on

Mat

erni

ty ca

re u

nit -

RV

I, Ne

wca

stle

Mat

erni

ty ca

re u

nit -

Cr

amlin

gton

(due

to

open

in 2

015)

Birt

hing

cent

re -

RVI,

New

cast

le

Choice of aftercare, if required to stay in a service

20%

7%

61%

3%8%

14%

2%

69%

3%

12%

24%

11%

56%

3%6%

Overall (1141) West (458) East (682)

• There was variation evidence in choice of service when comparing responses by area of residence

• Significantly more respondents living in the East opted for ‘Rake Lane’ and ‘Wansbeck’

• Significantly more respondents living in the West opted for the ‘RVI’ (maternity care unit and birthing centre)

Labour and delivery care

*significant variations are circled in the graph

Page 40: NHS North Tyneside CCG

Labour and delivery care

• When asked why they had chosen that specific option, the following themes were found

RVI, maternity care unit (694 = 61%)

Rake Lane, midwifery led unit

(229 = 20%)

RVI, birthing centre (94 = 8%)

Wansbeck, maternity care unit

(83 = 7%)

Cramlington, maternity care unit

(35 = 3%)

Good reputation / better than others (150 = 22%)

Previous experience / familiarity (68 = 10%)

Quality of care (57 = 8%)

Specialists / doctors on-hand (188 = 27%)

Facilities (144 = 21%)

Close to home (84 = 12%)

Atmosphere (6 = 1%)

Atmosphere (39 = 16%)

Previous experience / familiarity (27 = 11%)

Quality of care (27 = 11%)

Close to home (149 = 60%)

Facilities (14 = 6%)

Quality of care (14 = 15%)

Atmosphere (35 = 37%)

Good reputation (8 = 9%)

Clinicians nearby (26 = 28%)

Only birthing centre (8 = 9%)

Close to home (16 = 19%)

Quality of care (14 = 17%)

Previous experience / familiarity (18 = 22%)

Atmosphere (14 = 17%)

Specialists / doctors on-hand (16= 46%)

Close to home (7 = 20%)

It’s a new unit (4 = 11%)

Specialists / doctors on-hand (12= 14%)

Page 41: NHS North Tyneside CCG

Labour and delivery care

• When asked why they had chosen that specific option, the following themes were found

RVI, maternity care unit (694 = 61%)

Rake Lane, midwifery led unit

(229 = 20%)

RVI, birthing centre (94 = 8%)

Wansbeck, maternity care unit

(83 = 7%)

Cramlington, maternity care unit

(35 = 3%)

Good reputation / better than others (150 = 22%)

Previous experience / familiarity (68 = 10%)

Quality of care (57 = 8%)

Specialists / doctors on-hand (188 = 27%)

Facilities (144 = 21%)

Close to home (84 = 12%)

Atmosphere (6 = 1%)

‘There are more doctors there ’

‘There are specialists on

hand’

‘It has the best reputation ’

‘It is a better hospital ’

‘There are more specialist staff

‘They have everything there’

‘It has everything you need ’

Page 42: NHS North Tyneside CCG

Postnatal careWithin this section of the report you will find details as to the quantitative insight generated from the mothers research which focused on postnatal care. Please note that future mothers were not asked questions relating to postnatal care on the basis that previous insight had confirmed a lack of knowledge and therefore expectations.

Page 43: NHS North Tyneside CCG

• The majority of mothers had experienced their most recent postnatal care in North Tyneside

• Mothers were asked to indicate in their own words, the ONE thing that could have been changed about their postnatal care experience that would have made it better

• Unprompted there was no evidence of a consistent area to improve and no significant variation found between care in Newcastle, North Tyneside and Northumberland

Postnatal care

Nothing / unsure(293 = 49%)

More advice/support/information

(56 = 9%)

Earlier follow-ups / longer visits

(51 = 9%)

Staff attitude / training (24 = 4%)

Same midwife / health visitor

(23 = 4%)

Hospital policies(21 = 4%)

Newcastle North Tyneside NorthumberlandWhere postnatal care had been received previously (Mothers overall 593)

31%

66%

4%

Page 44: NHS North Tyneside CCG

Postnatal care

‘Friendly midwife where you can feel comfortable with them

as they are the same one’

‘I was left on my own, there was no space in Rake Lane for

me, more help with breastfeeding’

‘At the RVI I didn't like being

on ward, I could not relax’

‘More health visits after you get home’

‘To see the midwife for a longer period of time at home’

‘To be more aware of where I can get

help after the birth’

‘Midwife to be more

caring after I got home’

‘For the midwives to be more pleasant and to give more

hands on help’

‘To see the same midwife each time would be better’

‘Just being allowed visitors anytime’

‘For my partner to be able to stay with me

longer after the baby is born’

‘Help with breast feeding’

Nothing / unsure(293 = 49%)

More advice/support/information

(56 = 9%)

Earlier follow-ups / longer visits

(51 = 9%)

Staff attitude / training (24 = 4%)

Same midwife / health visitor

(23 = 4%)

Hospital policies(21 = 4%)

Page 45: NHS North Tyneside CCG

• A series of statements were given to mothers for them to rate their level of agreement using a scale of 1 to 10 (1 was ‘Strongly disagree’ and 10 was ‘Strongly agree’)

• There was no significant variations found by age or where the mothers had previously experienced postnatal care from

Postnatal care

I w

I w

I w

I w

I w

I w

Aft

Post

nata

l car

e (m

othe

rs o

vera

ll 58

...

6.72

6.74

6.92

7.37

9.08

9.13

9.36000000000001

Page 46: NHS North Tyneside CCG

I wan

t gro

up su

ppor

t with

br

eastf

eedi

ng w

here

I ca

n m

eet

othe

r mot

hers

I wan

t my

part

ner t

o be

giv

en

advi

ce a

nd in

form

ation

to h

elp

them

care

for t

he b

aby

I wan

t one

to o

ne su

ppor

t with

br

eastf

eedi

ng

I wan

t the

sam

e he

alth

pro-

fess

iona

l to

visit

my

hom

e fo

r ro

utine

chec

ks e

ach

time

After

hom

e vi

sits s

top

I wan

t ap

poin

tmen

ts to

be

carr

ied

out

with

in th

e lo

cal c

omm

unity

su

ch a

s bab

y w

eigh

-in cl

inics

Strongly agree (10 out of 10)

34% 36%

44%

66%71%

34%38%

49%

73%

83%

34% 35%41%

61% 63%

38% 40%

50%

65%71%

30% 32%

39%

66%71%

38% 40%

51%

68%71%

31%34%

40%

64%

71%

Mothers overall (589-592) West (232-234) East (356-358) First time mothers (270-272) Multiple mothers (317-319) ABC1 (205) C2DE (380-383)

• Across five of the statements variation was found by area of residence, socio-economic group and number of children mothers had, in terms of the proportion that ‘strongly agreed’ and gave 10 out of 10

Postnatal care

*significant variations are circled in the graph

Page 47: NHS North Tyneside CCG

I wan

t opp

ortu

nitie

s to

mee

t ot

her m

othe

rs

I wan

t gro

up su

ppor

t with

bre

ast-

feed

ing

whe

re I

can

mee

t oth

er

mot

hers

I wan

t my

part

ner t

o be

giv

en a

d-vi

ce a

nd in

form

ation

to h

elp

them

ca

re fo

r the

bab

y

I wan

t one

to o

ne su

ppor

t with

br

eastf

eedi

ng

Strongly disagree (1 out of 10)

14%

17%

14% 14%

20%

17%

14%

12%11%

17%

15% 15%

11%

13%12%

10%

17%

20%

17% 17%

10%

13%

11%

9%

17%

20%

17% 17%

Mothers overall (590-592) West (232-234) East (356-358) First time mothers (270-272) Multiple mothers (317-319) ABC1 (204-205) C2DE (380-383)

• Across five of the statements variation was found by area of residence, socio-economic group and number of children mothers had, in terms of the proportion that ‘strongly disagreed’ and gave 1 out of 10

Postnatal care

*significant variations are circled in the graph

Page 48: NHS North Tyneside CCG

• Mothers were then asked to indicate from a showcard, which of the following were MOST and LEAST important to them overall in regards to antenatal care

• With the exception of mothers living in the West, all profiles rated ‘Partners being given advice and information to help them care for the baby’ to be the LEAST important overall– Least important to mothers from the West was ‘Having opportunities to meet other mothers’ (30%)

Postnatal care

Seei

ng th

e sa

me

prof

essio

nal a

t ea

ch h

ome

visit

For a

ppoi

ntm

ents

such

as b

aby

wei

gh-in

clin

ics to

be

carr

ied

out

in th

e lo

cal c

omm

unity

afte

r ho

me

visit

s sto

p

One

to o

ne su

ppor

t with

bre

ast-

feed

ing

Grou

p su

ppor

t with

bre

astfe

ed-in

g w

here

you

mee

t oth

er

mot

hers

Acce

ss to

adv

ice 2

4 ho

urs a

day

by

tele

phon

e

Havi

ng o

ppor

tuni

ties t

o m

eet

othe

r mot

hers

Part

ners

bei

ng g

iven

adv

ice a

nd

info

rmati

on to

hel

p th

em ca

re fo

r th

e ba

by

Level of importance

41%

24%

12%

2%

17%

2% 2%4%

1%

8%

15%

10%

25%

36%

Most important (589) Least important (587)

Page 49: NHS North Tyneside CCG

Seeing the same professional at each home visit For appointments such as baby weigh-in clinics to be carried out in the local community after

home visits stop

One to one support with breastfeeding

MOST important

41%

24%

12%

46%

31%

7%

38%

19%

15%

43%

19%16%

41%

27%

9%

Mothers overall (589) West (233) East (356) ABC1 (205) C2DE (380)

• Comparing results of MOST important, there were interesting variations found by area of residence and socio-economic group when looking at three statements in particular

Postnatal care

*significant variations are circled in the graph

Page 50: NHS North Tyneside CCG

One

to o

ne su

ppor

t with

br

eastf

eedi

ng

Grou

p su

ppor

t with

bre

ast-

feed

ing

whe

re y

ou m

eet

othe

r mot

hers

Havi

ng o

ppor

tuni

ties t

o m

eet

othe

r mot

hers

Part

ners

bei

ng g

iven

adv

ice

and

info

rmati

on to

hel

p th

em

care

for t

he b

aby

LEAST important

8%

15%

25%

36%

5%

22%

30%28%

10% 10%

22%

42%

8%

18%

25%

33%

9%

13%

26%

40%

Mothers overall (587) West (232) East (355) First time mothers (270) Multiple mothers (316)

• Comparing results of LEAST important, there were interesting variations found by area of residence and the number of children mothers had, across four statements

Postnatal care

*significant variations are circled in the graph

Page 51: NHS North Tyneside CCG

Next stepsBased on the quantitative insight, Explain has developed within this section of the report key considerations and recommendations for NHS North Tyneside CCG, to inform plans for the future.

Page 52: NHS North Tyneside CCG

Key considerations

High levels of agreement were found across the maternity care journey in regards to what local women want from services (top five overall are displayed in the graph below)

Postnatal care - I want to have access to advice 24 hours a day by telephone

Antenatal Care - I want my midwife appointments to be carried out in the local community

Postnatal care - After home visits stop I want appointments to be carried out within the local community such as baby weigh-in clinics

Labour and delivery care - I want all options for pain relief available should I need them or change my mind

Labour and delivery care - I want doctors and specialists on-hand in the same building should I need them

9.13

9.35000000000001

9.36000000000001

9.48

9.56

Whilst many mothers indicated ‘nothing’ could be improved about their experience, when looking across the whole of the maternity care journey, the most common theme in the literal comments collected calls for consistency in seeing the same health professional

Page 53: NHS North Tyneside CCG

Key considerations

When asked to indicate what was MOST important, consistency in seeing the same health professional for antenatal and postnatal care stood out overall (top three shown below)

Revealed as the LEAST important overall was ‘Partners being given advice and information to help them prepare’ in regards to antenatal care (50%), followed by postnatal care (36%)

Labour and delivery care - Doctors and specialists on-hand in the same

building should they be needed

Postnatal care - Seeing the same professional at

each home visit

Antenatal care - Seeing the same midwife at each

routine check

33%

41%

47%

Page 54: NHS North Tyneside CCG

Key considerations

A majority of 61% would opt for a maternity care unit in the future, with high ratings given to statements regarding ‘doctors and specialists’ as well as ‘pain relief’

Most mothers (63%) had experienced labour and delivery care in Newcastle, a trend that is anticipated to continue with 64% overall opting for the RVI if giving birth in the future

The RVI was found to have a strong and positive reputation, notably very popular with residents of the West as well as future mothers

Variations found by demographic profiles as well as by location, confirm that a ‘truly ideal’ maternity care service would require a high level of flexibility and tailoring to the individual

Page 55: NHS North Tyneside CCG