Leeds Commissioned Maternity Services FAQs
The questions below have been raised by women in Leeds and fed through to the Leeds Clinical Commissioning Group through a number of channels including the Maternity Services Liaison Committee and via GP Practices.
The responses below are provided directly by Leeds CCG and One to One have outlined their responses in red. All One to One responses are given by CEO, Joanne Parkington.
1. Who is responsible for commissioning maternity services in Leeds?
Maternity services in Leeds are commissioned (purchased by) Leeds South and East Clinical Commissioning Group (LSECCG) on behalf of all the CCGs in Leeds. LSECCG also monitor the quality and safety of commissioned services.
2. What is the current policy for selecting maternity service providers?
Our policy is to commission excellent and integrated maternity services that meet the needs of Leeds women and families, offer them choice of where to have their babies, and most importantly services that are safe, personalised and of high quality.
We are working with the hospitals we commission maternity care from to improve pathways and increase the personalisation of the care they offer. A pathway is the clinical term used to describe agreed process and standards for women’s care as they transfer from GP care, to maternity services and then back to GP practice and the health visiting service.
We are particularly keen to ensure all women have a named midwife through their pregnancy and delivery.
We know that mothers who live in the Leeds area generally choose to give birth at St James’s or the LGI, but we also have mothers who choose to give birth in Harrogate, Wakefield, Dewsbury or Bradford and all of these hospitals are working hard this year to increase the personalisation of maternity care and continuity of care.
3. If One to One (North West) Ltd is commissioned in the North West area, why not in Leeds?
The CCGs in Leeds already commission a wide range of maternity services, which offer choice for the women and families of Leeds; we have confidence in our commissioned providers and have no concerns about their performance or capacity. A number of hospitals have had to close their doors frequently last year due to capacity issues, we believe Leeds infirmary was ranked as one of the highest.
CCGs in other areas may not be able to access the wide range of NHS providers that we can in Leeds. This may be because we are a large city close to other large towns and cities, which is not the case in more rural areas.
4.Why does the CCG recommend that my GP does not refer me?
We know that One to One (North West) Ltd would like to provide services in Leeds and across West Yorkshire and they are advising women to ask their GP for a referral to the service. Leeds CCGs are very clear that we do not support referrals to maternity services that are not on our NHS funded list. This is because such services do not have established care pathways with local maternity services and so there is no guarantee of speedy and safe transfer back to the NHS if there are complications and a woman needs emergency specialist care.
One to One would like to provide our service in Leeds but only because women in the Leeds are requesting it. This is evidence of a demand and a desire to access a model of care from a provider with proven positive outcomes. It has been stated that One to One are aggressively marketing our service in the Yorkshire region and I feel it is important to state that One to One do not aggressively market our service, it is women themselves who ‘market’ the service by telling their relatives, friends and colleagues. Our highest referral source is through ‘word of mouth’. One to One do not define aggressive marketing by the circulation of information leaflets which we have done at the request of community and women’s groups in the Yorkshire region.
I cannot stress enough that One to One DO HAVE care pathways into other providers. Our CQC registration process, which has taken place in the Yorkshire region, has reviewed these pathways and deemed them to be an appropriate approach to ensuring that seamless care takes place between providers, either in an emergency or routine situation. These pathways have been circulated to all providers where One to One are looking after women and we have requested that the providers should contact us if they require clarity or wish to discuss them. We have had no such request from any Leeds provider.
One to One have provided care for a large number of women across the Yorkshire and Humber region and some of these women have also chosen or have needed to access the care of another provider. ALL of these women had access to this care and this was provided under these care pathways.
In Leeds, over half of the women booked with One to One have accessed an acute provider and a small percentage of those women needed to access this care under an emergency situation – this was done with no problem and appropriate care was provided by all caregivers involved. It is equally important to note that One to One have met with Leeds CCG and have also communicated with Leeds CCG and we have not been asked for any further information or clarity on what these pathways are or how they work. Leeds CCG just keep stating that they are not in place but a responsible commissioner would facilitate these to ensure that women booked under the service received appropriate seamless and integrated care. So we can only assume that Leeds CCG must be confident that women booked with One to One can access emergency care or shared care for complex pregnancies from Leeds providers.
5. Can my GP refer me to One to One (North West) Ltd?
They could, although Leeds CCGs do not support referrals to One to One, or any other maternity services provider that are not on our NHS funded list. This is because such services do not have established care pathways with local maternity services and so there is no guarantee of speedy and safe transfer back to the NHS if there are complications and a woman needs emergency specialist care.
This is misleading – any patient under the NHS has access to emergency care for any treatment. This is a patient right – regardless of what that treatment is. One to One would initiate emergency transfer, should it be required, in any circumstance via the ambulance service who would then take the woman to the nearest hospital. This is a national agreement to ensure that emergency care is initiated as soon as possible at the nearest available hospital.
6. Will the NHS homebirth team and One to One (North West) Ltd provide the same type and level of care?
Both services are based on the case-loading model and so provide the same type and level of care, however One to One (North West) Ltd do not have the agreed pathways back into emergency care should an issue arise with a home birth. They also do not have the pathways with local services to share the care for women with more complex health needs.
I would like to dispute that both services provide the same type and level of care. One to One have the best outcomes in the UK. Our normal birth rate is 80% for women of all risk, cesarean section rate is 16% and our homebirth rate is 34% for women of all risk. Our breastfeeding rates are consistently 88% at initiation and 80% at 6 weeks. One to One do not restrict the number of visits and care is provided in the home at times convenient to the woman and her family. We average 10 postnatal visits. I cannot comment on the Leeds service as these statistics are not publicly available but the outcomes of a service are a good benchmark on which to assess ‘the type and level of care’.
7. Where does One to One (North West) Ltd operate?
It is commissioned to work in particular areas in North West England. It is not commissioned in Yorkshire, and so does not have an NHS funded contract here.
One to One do not hold a direct contract with Leeds CCGs but as an accredited NHS provider of maternity services we are able to provide our services across the NHS – just like any other provider. For example - as a patient if you travelled outside of your commissioned area (Leeds) you would still expect to access care from a provider that meets all NHS and regulatory standards regardless of whether Leeds formally commission the provider or not. Some women in Leeds may choose to access a provider far outside of where they live for many reasons, including staying with relatives etc and Leeds CCG would fund this care as non contracted activity.
One to One do not understand why we are being treated differently to any other NHS provider who do not hold an NHS funded contract with Leeds CCG.
It is important to note that some CCGs, who do not wish to formally commission One to One, have respected women’s wishes and agreed to fund her care even without the need for a GP referral. This demonstrates that NHS guidance can be interpreted in many different ways and you can use it to empower women to make their own decisions, or as is the case with some CCGs, use it to create barriers and deny access.