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NHS North Tyneside CCG

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.

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NHS North Tyneside CCG

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

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

  3. Project background • 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

  4. Project background • 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

  5. Project background • 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,

  6. Project background • 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

  7. Antenatal care Within 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.

  8. Antenatal care • 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

  9. Antenatal care ‘For someone to see me close to home’ ‘A consistent midwife throughout pregnancy’ ‘Every time I tried to discuss the birthing plan it was put off’ ‘Better staff, as they are not very friendly’ ‘More classes throughout pregnancy, start them at an earlier stage of pregnancy’ ‘It would have been better to stay at North Tyneside as I was taken from hospital to hospital’ ‘More information in early stages and more check ups’ ‘Have more scans when you have complications’

  10. Antenatal care • 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

  11. Antenatal care • 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 *significant variations are circled in the graph

  12. Antenatal care • 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%)

  13. Antenatal care • 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

  14. Labour and delivery care Within 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.

  15. Labour and delivery care • 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’

  16. Labour and delivery care ‘Give me more time to give birth instead of getting a C section’ ‘Nicer midwives, they have bad manners’ ‘I would prefer a private room next time’ ‘I would rather have been closer to home than going to Wansbeck’ ‘More staff to assist you to be more supportive’ ‘Same midwife, I had 3 different ones’ ‘The same midwife throughout labour’ ‘Have more pain relief ’ ‘Not to be sent home when in 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’

  17. Labour and delivery care • 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’)

  18. Labour and delivery care • 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 *significant variations are circled in the graph

  19. Labour and delivery care • 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 *significant variations are circled in the graph

  20. Labour and delivery care • Across 11 of the statements a significantly higher proportion of mothers living in the West ‘strongly agreed’ and gave 10 out of 10 *significant variations are circled in the graph

  21. Labour and delivery care • 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 *significant variations are circled in the graph

  22. 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

  23. Labour and delivery care • 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 *significant variations are circled in the graph

  24. 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

  25. Labour and delivery care • 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

  26. Labour and delivery care • 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 *significant variations are circled in the graph

  27. Labour and delivery care • 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%) *significant variations are circled in the graph

  28. Labour and delivery care • When asked to explain the reason for their choice, the following themes were found Clinical staff on-hand (189 = 28%) Atmosphere (53 = 30%) Comfortable / relaxing (63 = 66%) Level of care / staff(51 = 30%) Facilities (23 = 13%) Just ‘in case’ (185 = 27%) Family to be there (15 = 16%) Homely / relaxed (42 = 25%) Just ‘in case’ (22 = 12%) Facilities (120 = 18%) Facilities (28 = 17%) Previous experience (21 = 12%) Pain relief (97 = 14%) Don’t like hospitals (7 = 7%) Previous experience (20 = 12%) No choice (risk) (46 = 7%) Level of care / staff (18 = 10%) Previous experience (30 = 4%) Convenience (4 = 4%) Closer to home (21 = 12%) Natural (8 = 5%) No intervention (3 = 3%) Recommended (10 = 6%) Convenience (13 = 2%) Partner can stay (7 = 4%) Previous experience (2 = 2%) Recommendation (10 = 1%) Private (4 = 2%) Recommendation (3 = 2%) The ‘norm’ (8 = 1%)

  29. Labour and delivery care • When asked to explain the reason for their choice, the following themes were found Clinical staff on-hand (189 = 28%) Atmosphere (53 = 30%) Comfortable / relaxing (63 = 66%) Level of care / staff(51 = 30%) ‘It has a more relaxed atmosphere and it is more like home’ Just ‘in case’ (185 = 27%) Homely / relaxed (42 = 25%) ‘It will be more comfortable at home’ ‘I would feel safer’ ‘It was comfortable and has brilliant staff, it wasn't like a cattle market’ ‘It is more natural and homely’ ‘There are doctors on duty’ ‘I would feel more comfortable having family with me’ ‘There is more one to one support’ ‘There are doctors there ’ ‘It is a more relaxing place’ ‘They are more caring’ ‘It is more relaxed at home’ ‘In case something goes wrong ’ ‘It has a homely feel and a nicer environment’

  30. 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%) Dislike hospitals (98 = 22%) Unsure (192= 20%) No clinicians (90 = 10%) No clinicians (161 = 17%) No clinicians (92 = 9%) Unsure (90 = 20%) Transfer (51 = 5%) Pain relief (73 = 7%) Transfer (80 = 8%) Too busy (86 = 20%) Pain relief (50 = 5%) Unsure (80 = 8%) Impersonal care (39 = 9%) Dislike hospitals (45 = 5%) Prefer hospital (30 = 3%) Scared (62 = 6%) Facilities / equipment(45 = 5%) Not 1st choice (32 = 7%) Unfamiliar (39 = 4%) Messy (60 = 6%) Unnecessary (21 = 5%) Couldn’t (40 = 4%) Not 1st choice (18 = 2%) Couldn’t (40 = 4%) Too far away (16 = 4%) Just ‘in case’ (38 = 4%) Facilities (27 = 3%) No equipment (36 = 4%) Prefer hospital (27 = 3%) Just ‘in case’ (18 = 2%) Inconvenient (35 = 3%) Not 1st choice (16 = 2%) Dislike hospitals (39 = 4%) Transfer time (32 = 3%) One to one care (11 = 1%) Too far away (17 = 2%) Not sterile (31 = 3%) Couldn’t (22 = 2%) Negative (31 = 3%)

  31. 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%) Dislike hospitals (98 = 22%) Unsure (192= 20%) No clinicians (90 = 10%) No clinicians (161 = 17%) Unsure (90 = 20%) ‘In case things went wrong’ Too busy (86 = 20%) ‘There are no doctors ’ ‘The staff are not experienced enough’ ‘It is too busy’ ‘In case of any complications’ ‘Not enough medical back up staff if needed’ ‘There are no doctors there’ ‘It is a hospital environment’ ‘I would be scared things would go wrong ’ ‘There is no doctor on duty, would not feel as safe’ ‘There is not enough pain relief’ ‘It is too busy it is like a cattle market ’ ‘I don't think it is as safe ’ ‘Limited pain control’ ‘It is too clinical ’ ‘No reason’ ‘No reason’ ‘There are not as many medical staff ’

  32. Labour and delivery care • 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 *significant variations are circled in the graph

  33. Labour and delivery care • 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’ *significant variations are circled in the graph

  34. Labour and delivery care • Comparing response by area of residence and socio-economic group revealed variation *significant variations are circled in the graph

  35. Labour and delivery care • When asked why they had chosen that specific option, the following themes were found Good reputation / better than others (85 = 15%) Facilities (67 = 12%) Close to home (54 = 10%) Quality of care (40 = 7%) Specialists / doctors on-hand (56 = 10%) Big / good hospital (55 = 10%) Previous experience / familiarity (55 = 10%) Safer (26 = 5%) Close to home (137 = 55%) Atmosphere (29 = 12%) Quality of care (41 = 17%) Past experience / familiarity (47 = 19%) Recommendation (12 = 5%) Only birthing centre (11 = 6%) Close to home (9 = 5%) Atmosphere (35 = 20%) Clinicians nearby (16 = 9%) Partners can stay (3 = 2%) Past experience / familiarity (24 = 14%) Good reputation (15 = 9%) Quality of care (10 = 6%) Comfortable / relaxing (68 = 82%) Family can be there (9 = 11%) Clinicians on-hand (6 = 9% Previous experience / familiarity (42 = 63% Close to home (14 = 21% Reputation / better than others (10 = 15% It’s a new unit (10 = 59%) Close to home (9 = 53%

  36. Labour and delivery care • When asked why they had chosen that specific option, the following themes were found Good reputation / better than others (85 = 15%) Facilities (67 = 12%) Close to home (54 = 10%) Quality of care (40 = 7%) Specialists / doctors on-hand (56 = 10%) Big / good hospital (55 = 10%) Previous experience / familiarity (55 = 10%) Safer (26 = 5%) ‘Rake lane has a bad reputation’ ‘It is a better hospital overall’ ‘Family had their babies there, they say it's good and it has a better reputation’ ‘Excellent after care’ ‘It is a bigger hospital’ ‘They have excellent staff’ ‘It has got all the things you need’ ‘It is the best option’ ‘Has everything on hand’ ‘There are doctors on hand if needed’ ‘I would feel safe’ ‘It is the closest maternity care hospital’ ‘I had a good experience the first time’

  37. Labour and delivery care • 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 *significant variations are circled in the graph

  38. Labour and delivery care • 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’ *significant variations are circled in the graph

  39. Labour and delivery care • 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) *significant variations are circled in the graph

  40. Labour and delivery care • When asked why they had chosen that specific option, the following themes were found Atmosphere (6 = 1%) Specialists / doctors on-hand (188 = 27%) Close to home (84 = 12%) Facilities (144 = 21%) Good reputation / better than others (150 = 22%) Previous experience / familiarity (68 = 10%) Quality of care (57 = 8%) Close to home (149 = 60%) Previous experience / familiarity (27 = 11%) Atmosphere (39 = 16%) Quality of care (27 = 11%) Facilities (14 = 6%) Atmosphere (35 = 37%) Only birthing centre (8 = 9%) Quality of care (14 = 15%) Clinicians nearby (26 = 28%) Good reputation (8 = 9%) Specialists / doctors on-hand (12= 14%) Previous experience / familiarity (18 = 22%) Atmosphere (14 = 17%) Close to home (16 = 19%) Quality of care (14 = 17%) Specialists / doctors on-hand (16= 46%) Close to home (7 = 20%) It’s a new unit (4 = 11%)

  41. Labour and delivery care • When asked why they had chosen that specific option, the following themes were found Atmosphere (6 = 1%) Specialists / doctors on-hand (188 = 27%) Close to home (84 = 12%) Facilities (144 = 21%) ‘It has everything you need ’ Good reputation / better than others (150 = 22%) Previous experience / familiarity (68 = 10%) Quality of care (57 = 8%) ‘They have everything there’ ‘There are more specialist staff ‘It has the best reputation ’ ‘There are specialists on hand’ ‘It is a better hospital ’ ‘There are more doctors there ’

  42. Postnatal care Within 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.

  43. Postnatal care • 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

  44. Postnatal care ‘At the RVI I didn't like being on ward, I could not relax’ ‘For the midwives to be more pleasant and to give more hands on help’ ‘To see the midwife for a longer period of time at home’ ‘To see the same midwife each time would be better’ ‘For my partner to be able to stay with me longer after the baby is born’ ‘Midwife to be more caring after I got home’ ‘I was left on my own, there was no space in Rake Lane for me, more help with breastfeeding’ ‘Friendly midwife where you can feel comfortable with them as they are the same one’ ‘To be more aware of where I can get help after the birth’ ‘Just being allowed visitors anytime’ ‘More health visits after you get home’ ‘Help with breast feeding’

  45. Postnatal care • 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

  46. Postnatal care • 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 *significant variations are circled in the graph

  47. Postnatal care • 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 *significant variations are circled in the graph

  48. Postnatal care • 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%)

  49. Postnatal care • 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 *significant variations are circled in the graph

  50. Postnatal care • Comparing results of LEAST important, there were interesting variations found by area of residence and the number of children mothers had, across four statements *significant variations are circled in the graph

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