Archived: Neighbourhood Midwives Limited

Updated 5 July 2017

Neighbourhood Midwives Limited (NM) is an employee owned midwifery social enterprise, which provides midwifery services through a self-management hub and spoke model. It was launched in 2013, as a self-funding service for women and their families. In response to the NHS maternity review report, 'Better Births', published in February 2016, NM was successful in agreeing a two year pilot continuity and homebirth service, commissioned by Waltham Forest Clinical Commissioning Group (CCG). This pilot launched in November 2016 and offers a service to women in the locality funded by the CCG and runs in addition to the privately funded part of NM. There were 15 practicing midwives in the service at the time of our inspection.

The Waltham Forest NM pilot offers a service to women with low risk pregnancies. They are offered the same two midwives (one primary and one secondary) throughout their pregnancy, childbirth and up to six weeks after the birth, and their midwives are available 24 hours a day. The service includes midwifery care, booking appointments, blood tests, delivery of the baby and additional advice such as breastfeeding. Women can self- refer by telephone or online or be referred by their GP; they are supported to deliver their babies in their preferred place of birth. There were 28 births between November 2016 and April 2017 within the Waltham Forest NHS pilot service.

The self-paying women supported by Neighbourhood Midwives receive the same level of care as that offered to women in the pilot service. However, the pregnancies are not all necessarily assessed as of low risk and NM does not support women to have a planned home birth (up until September 2016 NM provided a private self-pay home birth service, but this has ceased since they transferred that part of the service to another private provider). All women who are self-paying are booked in to their local trust hospital. There were 95 births in the self-paying part of NM between April 2016 and April 2017.

Updated 5 July 2017

Head Office - Neighbourhood Midwives is operated by Neighbourhood Midwives Limited. The service has a registered postal office in North London, a base in Waltham Forest for its NHS work, and a base in South West London where meetings are held. Midwives and the central support team (CST) work remotely and are based at home.

The service provides community maternity and midwifery services, including self-pay private services and a commissioned NHS service. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11-13 April 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate this service but we do not currently have a legal duty to rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary

We found the following areas of good practice:

• We saw evidence that incident reporting, investigation and dissemination of learning were well embedded with incidents being seen as a tool for driving improvement.

• The provider had a robust safer recruitment process in place to ensure that all safety checks were carried out before a member of staff commenced work.

• Compliance with mandatory training was high and was monitored by the central support team.

• Caseloads were capped at a level which ensured safe and consistent care for women

• Care and treatment was provided in line with policies which reflected guidance from the National Institute of Health and Care Excellence (NICE) and Royal College of Midwives.

• We saw that midwives had access to and used evidence-based guidelines to support the delivery of effective treatment and care.

• There was evidence of multidisciplinary working.

• Staff were competent in their roles and undertook appraisals and supervision.

• Women had 24 hour access to their midwives throughout their pregnancy.

• We observed that women were treated with kindness, dignity and respect by midwives.

• Women told us they felt safe in the care of their midwife.

• Feedback from mothers and those close to them was consistently positive.

• Women told us they were partners in care with their midwives and they felt involved in decisions and well informed at all times.

• Women’s’ individual needs and preferences were considered when planning and delivering services.

• People for whom English was their second language were offered translation services.

• Service provision was flexible and provided choice and continuity of care.

• Complaints were managed and resolved in a timely manner.

• There was strong leadership provided by the central support team.

• There were risk management processes in place.

• Communication amongst staff was good and was facilitated by frequent meetings and the use of information technology.

• There was a high level of engagement with those who used the service.

• All staff shared a vision of high quality care and service provision and demonstrated a high degree of loyalty to the service.

However, we also found the following issues that the service provider needs to improve:

• Fridges did not maintain temperatures which were within the range at which drugs should be stored.

• VTE scores were not consistently recorded.

• There was inconsistent quality of record keeping.

• The provider could not ensure that medicines were stored safely and the medicines management policy did not cover all aspects of medicines management for the service.

• The service did not have a safeguarding lead with level 4 safeguarding children training. However, the provider confirmed that the safeguarding lead was working towards level 4.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected maternity services. Details are at the end of the report.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

Updated 5 July 2017

The only service offered by Neighbourhood Midwives was maternity.

We regulate this service but we do not currently have a legal duty to rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.